Metastasis pg activity
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Metastasis pg activity
- 1. Cytopathology of metastatic neoplasia Dr. Akshay Agarwal Moderator: Dr. Hoogar M. B.
- 2. Overview Metastatic neoplasia in lymph node Metastatic neoplasia in lung Diagnosis of primary and secondary lymphomatous effusions
- 3. Lymph node metastasis FNAC Imprint cytology Frozen
- 13. Microacinar pattern Prostate, NEC, Thyroid
- 16. Papillary pattern Thyroid, ovary, breast
- 17. Breast carcinoma Diffuse infiltration involves airways Better differentiated tumors may be recognized by its cohesive clusters of small glandular cells, with relatively uniform nuclei and a smooth border to the cell group
- 19. Nuclei may be moulded but have a more regular chromatin pattern and better defined nuclear membranes than oat cell carcinoma cells Presence of intracytoplasmic mucin vacuoles favours a breast origin
- 20. For poorly differentiated tumors ER/PR S100 CEA
- 21. Colorectal carcinoma Palisaded columnar cells with oval nuclei and apical mucin secretion Cytoplasmic border of the cell group tends to be linear Cavitatory necrosis
- 23. Renal Cell Carcinoma Predeliction for infiltrating mucosal surfaces. Pleomorphic malignant cells with round eccentric nuclei, prominent nucleoli and abundant finely vacuolated cytoplasm Eosinophilic basement membrane material Fibrovascular papillary cores
- 25. Melanoma Free cell pattern Pleomorphic nuclei with prominent nucleoli, presence of duble nuclei and spindle cell forms Melanin may or may not be seen Irregular blue-green on MGG And Brown on PAP
- 29. Lymphoma NHL, most likely high grade follicular lymphoma N:C ratio high, narrow blue rim of cytoplasm with prominent nucleoli HL, lobulated nuclei with macronucleoli, associated with eosinophils, histiocytes and lymphocytes
- 31. Sarcoma Pleomorphic malignant cells with spindle cell forms, giant cells and vascular cell sheets
- 33. Basic First Line IHC Panel for Detection of Primary Site in Metastasis
- 36. mimics Pleomorphic adenoma Submandibular LN Atypia in epithelial cells Warthin’s Tumor Lymphoid cells Necrotic debris and epithelial cells
- 37. Hashimoto’s Thyroiditis Reactive lymphoid cells Bizarre cytology with hurthle cells Benign epithelial inclusions Degenerative atypia in branchial cysts
- 38. Lung Metastasis Some organs such as the lungs and the lymph nodes are more commonly affected by metastases than by primary neoplasia and so knowledge of advances is important.
- 39. Cytology of metastatic neoplasia in the lung Brushings or sputum Wider range is accessible with FNAC Breast and colorectal carcinomas Prostatic, renal, bladder and head and neck carcinoma As well as melanoma, lymphoma, testicular tumours and sarcomas
- 40. The diagnosis of metastasis can usually be established by a combination of the cytological appearance, clinical history and pattern of metastasis IHC may be helpful, but requires cell blocks.
- 42. Cannon-ball / miliary Colorectal Renal Melanoma Sarcoma Ovarian Medullary carcinoma – thyroid
- 44. Lymphangitic Lung and breast carcinoma, lymphoma Intravascular GIT, liver, Choriocarcinoma Lepidic Well differentiated AdenoCa of prostate and pancreas
- 45. Mimics of lung cancer
- 46. Solitary Renal and colorectal carcinoma, melanoma, sarcoma Endobronchial Renal and colorectal carcinoma, sarcoma
- 47. Cytological patterns suggestive metastasis High index of suspicion when malignant cells do not conform to the usual spectrum of appearances in lung cancer. Final diagnosis always requires clinicopathological correlation and ancillary tests.
- 48. Diagnosis of 1o and 2o lymphomatous effusions Majority are secondary Can occur in NHL T/B cell type HL Late manifestation of systemic lymphomas Pleural fluid in the setting of a mediastinal or pulmonary mass
- 49. Primary Lymphomatous Effusions Lymphomas presenting as primary pleural effusions are rare. Most are DLBCL Follicular Lymphoma Small lymphocytic lymphoma Majority are B cell Phenotype Pleural thickening with mediastinal lymphadenopathy
- 50. Body cavity based NHL that occurs exclusively in HIV positive patients Pleural / pericardial / peritoneal in the absence of solid tumor masses. Throughout remain confined to the body cavity.
- 51. Morphologically, Large cell Immunoblastic Anaplastic Abundant amphophilic or basophilic cytoplasm, bizarre cells with irregular nuclei and RS like cells
- 52. EBV and HHV-8 associated Diagnosis based on IHC CD30, CD38, EMA positive Associated with castleman’s syndrome Extremely poor prognosis 2-4 months survival
- 53. PEL can be distinguished from secondary body cavity lymphomas by: 1. Almost exclusive involvement of body cavity 2. Pleomorphic morphology 3. IHC 4. HHV-8
- 54. Pyothorax-associated Lymphoma Rare lymphomas, occur in setting of long- standing inflammation of the pleura Underlying cause of chronic inflammation such as TB, IL-6 associated 20-50 years after initial pleural injury Exclusively in the pleura Not associated with Immunosuppression
- 55. Morphology resemble PEL, Immunoblastic Anaplastic Bizarre cells Do not express pan-B cell markers EBV positive
- 59. Conclusion Identification of metastatic diseases in crucial to upstage the tumor Preliminary diagnosis should follow thorough search of primary site IHC is mandatory for confirmation and typing Detailed history should be available