Drs. Prolla and Diehl's Case of the month ~ November 2006

Pleural fluid, 66-year old male, with large mediastinal mass:
Small cell carcinoma


200x M-G-G staining, loose groups of small cells, with nuclear molding and tandem pattern

500x M-G-G staining, detail view of the tandem pattern, nuclear molding and very scant blue cytoplasm, tiny clear vacuoles

1000x M-G-G staining, high power view, of tandem pattern,  see the cytoplasmic projections, and the tiny clear vacuoles. Some nucleoli are visible.

500x M-G-G staining, loose group of small cells, with nuclear molding, very high N/C ratio

1000x M-G-G staining, high power view, the blue nucleoli, and cytoplasmic projections are clearly seen

1000x M-G-G staining, high power view, of tandem pattern,  see the cytoplasmic projections, and the tiny clear vacuoles. Some nucleoli are visible.

1000x Papanicolaou staining, three-dimensional loose group of small cells, with very high N/C ratio, small nucleoli are seen, salt and pepper chromatin.

1000x Papanicolaou staining, three-dimensional loose group of small cells, with very high N/C ratio, nuclear molding, small nucleoli are seen, salt and pepper chromatin.

1000x and 500x Papanicolaou staining, three-dimensional loose group of small cells, with very high N/C ratio, small and medium sized nucleoli are seen, salt and pepper chromatin pattern.

500x and 1000x Papanicolaou staining, typical tandem or indian file cell pattern, with nuclear molding, medium sized nucleoli are clearly seen

The smears show the typical features of small cell carcinoma: small cells, with some loose groups showing nuclear molding, many of them with tandem or indian file cell pattern. The cytoplasm is scant or absent. The nuclei are oval or angulated, with "salt and pepper" chromatin, small nucleoli, in the Papanicolaou staining. The M-G-G stained smears show many cellular details: nuclear molding, somewhat large blue nucleoli, very high N/C ratio, cytoplasmic projections, small clear vacuoles (both cytoplasmic and nuclear). Some people would call this an "intermediate type" of small cell carcinoma, to distinguish it from classical "oat cell" pattern, but the treatment and prognosis is the same. The DNA streaking or nuclear smudging ("crush artifacts") are absent in this case, as it is usual to be absent in serous fluids material.

Main features of Small cell carcinoma

Cellular patterns:
Three-dimensional loose groups of small cells, with very high N/C ratio
Cell within cell pattern
Occasional tandem or indian file cell pattern
Cytoplasm:
Small rim of basophilic cytoplasm or naked nuclei
Nucleus
Round or angular hyperchromatic, "oat cell" type
Few small or absent nucleoli
Some cases have a large nucleolus: "intermediate cell" type
"Salt and pepper" chromatin, with nuclear molding
Mitoses, karyorrhexis and apoptotic bodies("blue bodies") are frequent
DNA streaking or nuclear smudging




Case A November 2006 Case B November 2006 References List of cases Atlas
Hosted by www.Geocities.ws

1