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There’s more to Cytology than meets the Eye
Genevieve Warner Learmonth
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When screening a slide, note carefully what you observe, no matter how odd it may seem,
Before you make up your mind,OPEN IT!
There’s a bone in her mouth!
But isn’t a giraffe herbivorous?
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Cervical smear, age 40Screening programme
Primary screener: “carbon laden macrophages”
Or is it melanin?
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Patient referred for Colposcopy & Biopsy
Brown lesion on ectocervix Histopathology: malignant melanoma
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FNA Breast: on - site breast clinic
Screener phoned me and described “smear is black. I think I can see carbon laden macrophages”.
The aspirate looks like liquorice !”
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Slides referred via vacuum tube direct to Cytology Laboratory
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Cytology comment was queried by senior colleagues ,so the mass was excised, Histological findings --- probable lymph node relpaced by diffuse fibrosis and anthracosis. No lypmhoid tissue remaining. No epithelial cells present.Conclusion: Hut Breast
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Further Enquiry
The female patient was admitted to hospital for investigation of dyspnoea ? TB.
Chest Xray showed diffuse fibrosis ? Pneumoconiosis. The mass in the upper outer
quadrant of the breast was an incidental finding !!
Patient was sent to the breast Clinic
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Hut dweller from Transkei, inhalation of smoke in huts, termed “hut Lung” Prof Bateman ( GSH 1992). Mediastinal lymphatics are overwhelmed with carbon. Intramammary nodes involved as well as neck nodes.
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FNA Mass in Right lower lobe of Lung, female 32yrs old.
CytologyReview
Primary screener: “highly atypical cells”.
Plentiful cytoplasm
Round nuclei
?Bronchiolar alveolar carcinoma?
Correlate with Chest Xray in view of age.
Review: Granular cytoplasm, suggestive of hepatic cells.
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Xray Chest --- diaphragmatic hernia
Antero posterior Lateral
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Cystic Mass 5cm in Supraclavicular area ?
nodePrimary screener: ? Talc granules
Too big , have another look
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Have a look at High Power! Rostellum of hooklets, scolices, suckers---- Echinococcus granulosis
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Histology: no laminated membrane, but
cross section of rostellum
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FNA of Parotid Gland male age 35
Clear Fluid aspirated:
Primary screener: “Contaminants,
dust or pollen. Review: Scolices ENT surgeons:
Disbelief ! So “cut it out”
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The specimen in the Bottle
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Histological appearance
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Laminated membrane, Echinococcus
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What’s left in the bottle ?
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Small monomorphic lymphocytes and ? “fibres”
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Larva with constriction in gut Literature search
revealed several publications with similar MRI findings.
Eosinophilia not always a feature
Treat with Albendozole and cortisone
Patient got out of bed four days later
Repeat MRI
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Clear CSF. ? Lymphoma
Primary screener : few lymphocytes Review: Lymphocytes degenerative
changes. No polymorphs. No eosinophils ? Larval worm ? Toxocara I conveyed my findings to the
clinicians, they came rushing to the lab with copies of the MRI.
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Woman 45yr sudden onset transverse myelitis. Lower body paralysis. Arms paralysed. CSF clear fluid for cytology
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? Larva of Toxocara
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Bony lesion: Female sheep farmer from The Karoo, knee joint destroyed. ?Aneurysmal Bone Cyst.
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Dedicated to the late Dr Moira Durcan