August 1st, 2008. 54 year old female. ThinPrep pap A.Trichomonas B.Lactobacillus C.Atrophy D.Bacterial vaginosis E.Artifact 1.

August 1st, 2008

54 year old female. ThinPrep papA. TrichomonasB. LactobacillusC. AtrophyD. Bacterial vaginosisE. Artifact

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34 year old female. ThinPrep papA. Reactive endocervical cellsB. Squamous metaplasiaC. AGUSD. LSILE. HSIL

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31 year old female. ThinPrep papA. Endocervical cellsB. HSILC. Endometrial cellsD. Benign reactive sq. cellsE. LSIL

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59 year old male smoker. Bronchoalveolar lavage.

A. Benign bronchial cells.B. Suspicious for malignancy.C. Sq. cell carcinoma.D. AdenoCa.E. PCP.

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64 year old male. FNA of subcarinal lymph node.

A. LymphomaB. Suspicious for malignancyC. Small cell carcinomaD. AdenoCaE. Squamous cell carcinoma

63 yo male with omental tumor. FNA.

A. Reactive, neg for malignancyB. AmoebaC. Metastatic carcinomaD. Malignant mesotheliomaE. Metastatic melanoma

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89 year old female with thyroid nodule. ThinPrep pap

A. Colloid noduleB. Benign follicular cellsC. Medullary carcinomaD. Papillary thyroid carcinoma E. Hurthle cell carcinoma

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54 yo female. Urine specimen.A. Unsatisfactory specimenB. CandidaC. High grade TCCD. AmoebaE. Filamentous bacteria

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64 year old male. Urine. A. Umbrella cellB. Polyoma virusC. High grade TCCD. Negative for TCCE. Inflammatory changes

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71 yo female. Pancreas FNA.A. AmoebaB. Benign acinar cellsC. Benign ductal cellsD. AdenocarcinomaE. Pseudocyst

Answers1. Atrophy: predominance of parabasal cells. No dysplastic cells seen.2. AGUS: glandular cells with enlarged, hyperchromatic, irregular nuclei. The

eccentric nucleus and vacuolated cytoplasm are clues to glandular origin.3. Benign reactive squamous cells: The nuclei are not enlarged. Binucleation can be

seen in reactive cells and does not automatically mean LSIL. PMN’s in the background.

4. Benign bronchial cells: note the cillia.5. Small cell carcinoma: large nuclei (bigger than lymphocyte nuclei) with high N:C

ratios, nuclear molding, “salt and pepper” chromatin, and mitotic figures.6. Metastatic carcinoma: if you chose melanoma or mesothelioma you are also right

because on this picture it would be impossible to rule those out. This turns out to be metastatic carcinoma, best categorized as hepatoid carcinoma (HepPar1 and CK-7 positive, CK-20 neg).

7. Papillary thyroid carcinoma: notice the enlarged nucleus with a classic intranuclear inclusion. Nuclear grooves and fine chromatin were obvious on the Pap stain.

8. Candida: conidia (yeast) and pseudohyphae.9. High grade TCC: eccentrically located, markedly enlarged nucleus with dark

chromatin. 10. Pancreatic adenocarcinoma: compare the nuclear size of the cells at the top left to

the benign ductal cells arranged in a honeycomb pattern. Notice the high cellularity and the tumor diathesis in the background.