Upper New York State Society of Cytology,Inc.

Interesting Case 2

 

Presented By: Sharon Leo, MS, CT(ASCP),CM IAC

University of Rochester Medical Center, Rochester, New York

History

A 57 year-old male patient had a history of gall bladder cancer with spread to the biliary ducts three years ago. After complaining of fullness in the chest, a X-Ray showed a large pleural effusion. 1000cc of fluid was submitted for evaluation and cell block.

Cytologic Findings

 

Numerous clusters of cells were present in the fluid. There was loss of polarity and cell size and shape varied from group to group( note larger cells in picture on left and smaller cells on right). The basophilic cytoplasm ranged from scant to moderate in amount. The hyperchromatic nuclei varied in size and shape(Strong Fast). The macronucleoli present tended to be in the larger undifferentiated cells. Vacuoles were present in many cells but did not push the nucleus to the periphery of the cell. DeMay(1) notes that the tumor cells within the same group can range bland to malignant. (Note the difference in appearance of the 2 Pap stained groups above).

Diagnosis/Discussion

Malignant tumor cells present derived from adenocarcinoma.

The original tissue was diagnosed as moderately differentiated adenocarcinoma of biliary tract origin involving the liver and gall bladder. The tumor was thought to either represent primary gall bladder carcinoma with invasion into the liver and biliary tree or an intrahepatic cholangiocarcinoma. There also was evidence of primary sclerosing cholangitis of the liver.

Bile duct carcinoma/cholangiocarcinoma accounts for less than 10% of primary liver cancer(1) and develops in the intrahepatic bile ducts, extrahepatic ducts, or hilar area(2). Risk factors for cholangiocarcinoma include liver flukes(Far East), intrahepatic lithiasis, pyogenic cholangitis, and sclerosing cholangitis(1). Ulcerative colitis is another risk factor for intra- and extrahepatic bile duct and gall bladder carcinoma(2). This patient had a history of hepatitis as a child and ulcerative colitis treated with surgery several years ago.

References

1. DeMay RM. The Art and Science of Cytopathology: Volume II. Aspiration Cytology. Chicago: ASCP Press, 1996, pp 1030-1034.

2. MacSween R, Burt A, et al. Pathology of the Liver, Forth Edition. Harcourt Publishers Lmt, 2002, pp 743-745.