Cytologic changes: Cellular features from lavages, brushes, or fine needle aspirates (FNA) often increase the certainty of a diagnosis based on endobronchial biopsy, which may show marked distortion because of crush artifact. Cytologic preparations are stained with the Papanicolaou stain, which gives especially good nuclear detail. Examine the two photos and decide which one shows small cell carcinoma (SCC). One shows an FNA of tumor and the other shows normal adrenal cells from an FNA of the adrenal gland in a patient with SCC and an enlarged gland on CT. Features of SCC are listed in the table. Answer

Table. Cytologic features of SCC

Crush artifact: Forceps biopsies regularly show marked distortion of cells and streaking of nuclei. Lymphocytes may show the same feature. A few cells at the upper left suggest neoplasia. A positive stain for keratin in these invasive cells along with well-preserved, diagnostic cytologic preparations confirms a diagnosis of small cell carcinoma.

Clinical summary Discussion

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Answer: The photo on the left shows neoplastic cells of SCC. The photo on the right shows benign cells of the adrenal gland.

SCC: Note the scant cytoplasm, granular nuclear chromatin, lack of nucleoli, and angulated nuclei that indent each other, especially at the bottom left. Several homogeneous, dark, round nuclei that are smaller than the tumor cells are probably lymphocyte nuclei.

Benign adrenal cells: Note the presence of pale blue cytoplasm. Cells have round nuclei, distinct small nucleoli, and homogeneous chromatin with an accentuated nuclear membrane.

Clinical summary Discussion

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