PART TWO
Diagnostic Cytology
Table 13.13 Large -Cell Undifferentiated Carcinoma
Cytologic feature
Sputum
Bronchial wash
Bronchial brush
BAL
FNA
Mixture of large single
cells and syncytial
groups
+
+
+
+
+
Nuclei round to
lobulated with
irregularly dispersed,
intensely staining
chromatin
+
+
+
+
+
Nucleoli may be large
and vary in number
from cell to cell
+
+
+
+
+
Cytoplasm usually
cyanophilic and varies
from granular to
foamy; cytoplasmic
outline frequently
ill-defined
+
+
+
+
+
Cells may shed in
syncytial groupings
with randomly
oriented overlapping
nuclei
+
+
+
+
+
BAL = bronchoalveolar lavage; FNA=fine-■ needle aspiration.
Fig. 13.98 Large-cell carcinoma. The cells possess high nucleocytoplasmic
ratios, abnormal chromatin distribution, macronucleoli, and marked nuclear
membrane abnormalities. Fine-needle aspirate, lung (Papanicolaou x MP).
or adenocarcinoma).299 The relative frequencies of these histo-
logically confirmed subtypes as encountered in our laboratory
during a 5-year period are shown in Table 13.14. Cytologic char-
acteristics are summarized in Table 13.15. An individual cell of
small-cell carcinoma varies from approximately 1% to 2 times
the size of a lymphocyte. It is round to oval and has a centrally
placed nucleus with a uniform but deeply staining chromatin
pattern and a very high nucleocytoplasmic ratio. Nucleoli are
occasionally visible but are generally inconspicuous.
The exfoliation pattern into sputum for this neoplasm may
vary from large numbers of cells and tissue fragments to several
cells present on only one slide of many examined. In specimens
Fig. 13.99 Giant cell carcinoma. Fine-needle aspirate (Papanicolaou x MP).
of freshly prepared sputum, large numbers of tumor cells may be
found entrapped in strands of mucus. A most characteristic pres-
entation results when clusters of these small tumor cells exhibit
extreme molding and are superimposed on irregular nuclear
outlines (Figs 13.100 to 13.102). Because this tumor is highly
prone to necrosis, the cellular specimen frequently reflects this,
with cells exhibiting karyopyknosis, disintegration of the cyto-
plasm, and formation of cyanophilic masses of necrotic debris
(Figs. 13.103 and 13.104).393 In specimens of sputum prepared
by the Saccomanno technique, nuclear molding may be much
less evident because of greater dispersion of the cells from the
mechanical process. Individual nuclei also tend toward more
344
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