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Interesting Case

Contributors:
Karen Chau, BS
Cytotechnology Student

Maria Friedlander M.P.A., CT (ASCP)
Education Coordinator
Memorial Sloan-Kettering Cancer Center,
New York, New York

Clinical history:
A 73 year old male, with a history of occupational asbestos exposure 50 years prior, presented with symptoms of right shoulder and right upper rib pain that began approximately one year ago and progressed over time. A CT scan of the chest was performed and revealed circumferential pleural thickening in the right lung and a right pleural effusion. Calcified pleural plaques were also identified along the left diaphragmatic pleura and left lateral hemithorax. An MRI of the right brachial plexus showed encasement of both the right subclavian artery and part of the right brachial plexus. Changes were also noted in the right upper ribs. These features were clinically suspicious for tumor infiltration. A sample of the pleural effusion was submitted for cytologic review. Biopsies of the right pleura were also taken.

Figure 1 (Pap Stain, 100X)	Figure 2 (Pap Stain 400X)
Figure 3 (Pap Stain, 400X)	Figure 4 (Pap Stain, 400X)

Cytologic findings:

The slide was moderately cellular with scattered lymphocytes, polymorphonuclear leukocytes and few scattered single-lying, spindle shaped cells. (Figure 1) These spindly cells had dense cytoplasm and elongated, enlarged nuclei (approximately two times the size of a lymphocyte). (Figure 2)   The nuclei were hyperchromatic with irregular nuclear membranes and finely granular, unevenly distributed chromatin. (Figure 3) Multiple small nucleoli were also present. (Figure 4)

Cytologic diagnosis - Click here!