Histologic Changes

Figure 1

Some of the tumor showed nests with a different pattern. Here, there is a transition from the small cell pattern in the lower part of the nest to another pattern in the upper part.

Figure 2

A high-power view of the new pattern shows features of other types of differentiation. What are they? The arrow points to one diagnostic structure.

Answer

Clinical summary Image 3

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Answer:

The cells in the upper part of the nest have cytoplasm that increases in amount toward the center of the nest. Three glandular spaces interrupt the pattern.

At higher magnification, bridges, corresponding to desmosomes, are present between cells. Desmosomes are junctions between cells that persist after fixation. The cytoplasm between junctions retracts during fixation to give this ladder-like effect. Intercellular bridges are one feature of squamous carcinoma.

Figure 3

Periodic acid-Schiff stain: The gland-like spaces have secretion that stains red indicating neutral mucin. The glands are lined by cuboid cells. No cytoplasmic PAS staining was noted. These glands represent differentiation to adenocarcinoma. These glands differ from rosettes, which occur in areas of neuroendocrine differentiation and are much smaller.

Clinical summary Image 3

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