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Additionally, the book' s images of the histopathology and gross characteristics of lesions provide morphologic correlations that will be relevant to cytopathologists and surgical pathologists alike. Ali, Ritu Nayar, Jeffrey F. Atlas of Urinary Cytopathology with Histopathologic Correlations. Atlas of Pancreatic Cytopathology with Histopathologic Correlations is a valuable resource for the seasoned cytopathologist, general and surgical pathologists, pathology trainees, and cytotechnologists.

Atlas of Gynecologic. Description : Atlas of Exfoliative Cytopathology with Histopathologic Correlations is a comprehensive reference for interpreting body cavity fluid, respiratory, and gastrointestinal exfoliative cytopathology specimens. Atlas of Gynecologic Cytopathology - This Atlas offers concrete diagnostic guidance for anatomic pathologists who are required to correctly identify cervical disease in cytology.

Clinical and radiologic examinations cannot reliably distinguish benign or inflammatory pancreatic disease from carcinoma. The Atlas features nearly carefully selected high- resolution color images detailing important aspects of gynecologic tract disease. Vandenbussche at Indigo. If you believe in the demise of the Papanicolaou test, VandenBussche et al, the authors of the Atlas of Gynecologic Cytopathology with Histopathologic. Key Features of An Atlas of Gynecologic Cytopathology with Histopathologic Correlations: Provides practical, expert diagnostic guidance for the full range of gynecologic cytopathology Illuminates common diagnostic pitfalls Presents over high- resolution color images Includes colposcopic- pathologic correlations from an expert gynecologist.

I am so glad that at least a part of his extensive archives will be published as an, Atlas of Urinary Cytopathology with Histopathologic Correlations by his successor, Dr. New York, NY: Demos. Pdf pdf popular mechanics usa november Pro tools 11 mac full zip 25 hp johnson outboards. Atlas of gynecologic cytopathology with histopathologic correlations Atlas of Gynecologic Cytopathology: with Histopathologic Correlations. Cart items. Toggle navigation. Stock photo. Search Results Results 1 -8 of 8. Demos Medical, Ali MD. Ships with Tracking Number! May not contain Access Codes or Supplements.

May be ex-library. Buy with confidence, excellent customer service! Atlas of Pancreatic Cytopathology Yener S. Erozan Syed Z. Ali Ralph H. Demos Medical Publishing, Demos Medical Publishing. B Venous phase contrast-enhanced axial CT of the upper abdomen at a higher level shows multiple collateral veins around the stomach arrows , confirming that the splenic vein is occluded by the tumor. A Venous phase contrastenhanced axial CT of the upper abdomen demonstrating a dilated pancreatic duct with atrophy of the pancreatic tail arrowhead.

There is an ill-defined hypodense mass in the neck of the pancreas arrows. The mass is very subtle, and the main clue that a tumor is present is the dilatation of the pancreatic duct. B Coronal reconstruction of contrast-enhanced CT with maximum intensity projection in the venous phase highlights focal narrowing of the portal confluence arrow , indicating the tumor has encased the portal confluence and is not resectable.

Chapter 2: Radiologic Characteristics of Pancreatic Disease 19 Selected Cases Illustrating Salient Radiologic Characteristics Case 4 Adenocarcinoma of the pancreas unresectable due to arterial and venous encasement year-old man with right upper quadrant and back pain. A Arterial phase contrast-enhanced axial CT of the upper abdomen showing a hypodense infiltrating mass arising from the uncinate process of the pancreas arrows. Note the dilated pancreatic duct arrowhead.

B Arterial phase contrast-enhanced axial CT of the upper abdomen demonstrating that the tumor is growing around the superior mesenteric artery arrows. C Arterial phase contrast-enhanced axial CT of the upper abdomen showing that the tumor has encased the celiac axis arrows. A Venous phase contrastenhanced axial CT of the upper abdomen demonstrating a 7-mm lesion in the head of the pancreas arrow. B Venous phase contrast-enhanced axial CT of the upper abdomen highlighting a second 8-mm hypodense lesion in the body of the pancreas arrow.

Chapter 2: Radiologic Characteristics of Pancreatic Disease 21 Selected Cases Illustrating Salient Radiologic Characteristics Case 6 Infiltrating adenocarcinoma arising in an IPMN with markedly dilated pancreatic duct year-old woman with painless jaundice and pancreatic abnormality. A Venous phase contrastenhanced axial CT of the upper abdomen showing a cystic mass with a small enhancing nodule lateral to the common duct in the uncinate process of the pancreas arrows. Note the common bile duct stent arrowhead and the dilated pancreatic duct. B Venous phase contrast-enhanced CT of the upper abdomen with multiplanar reconstruction highlighting the tortuous dilated pancreatic duct arrows.

The intrahepatic biliary tree is also dilated arrowhead. A Arterial phase contrast-enhanced axial CT of the upper abdomen shows a small homogeneous hyperattenuating mass arrow in the neck of the pancreas. The lesion is more conspicuous in the arterial phase. Reproduced with permission from AJR ; — Helical CT of islet cell tumors of the pancreas: typical and atypical manifestations.

B Venous phase contrast-enhanced axial CT of the upper abdomen demonstrates the lesion, but the changes are more subtle because the difference in enhancement between the normal pancreas and the mass is less. Chapter 2: Radiologic Characteristics of Pancreatic Disease 23 Selected Cases Illustrating Salient Radiologic Characteristics Case 8 Small pancreatic endocrine neoplasm year-old man with history of non insulin dependent diabetes.

A Arterial phase contrastenhanced axial CT of the upper abdomen shows a small slightly hypervascular mass in the neck of the pancreas arrows. Note the thin calcified rim. B Venous phase contrast-enhanced axial CT of the upper abdomen shows that the mass is still hypervascular in the venous phase. C Sagittal reconstruction of venous phase contrastenhanced CT confirms the small mass in the anterior portion of the neck of the pancreas.

A Arterial phase contrast-enhanced axial CT of the upper abdomen shows a large hypervascular mass in the body and tail of the pancreas arrows. Note there is cavernous transformation of the portal vein arrowhead and occlusion of the splenic vein. B Delayed phase contrast-enhanced axial CT of the upper abdomen shows the mass to enhance less intensely arrows.

Chapter 2: Radiologic Characteristics of Pancreatic Disease 25 Selected Cases Illustrating Salient Radiologic Characteristics Case 10 Large nonfunctioning pancreatic endocrine neoplasm year-old woman with large pancreatic mass. A Arterial phase contrast-enhanced axial CT of the upper abdomen shows a very large mass in the tail of the pancreas arrows.

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The tumor has an enhancing rim and a necrotic center. It invades into the splenic hilum and has occluded the splenic vein with multiple varices seen arrowheads. B Venous phase contrast-enhanced axial CT of the upper abdomen confirms the mass arrows and shows the collateral veins arrowheads to better advantage. C Coronal reconstruction of venous phase contrastenhanced CT confirms the extent of the tumor arrows. A Venous phase contrast-enhanced axial CT of the upper abdomen shows a large heterogeneous mass in the uncinate process of the pancreas arrows.

B Venous phase contrast-enhanced axial CT of the upper abdomen confirming the mass and showing it extending into the body of the pancreas arrows. C Venous phase contrast-enhanced axial CT of the upper abdomen shows multiple small nodes in the mesentery arrows. Chapter 2: Radiologic Characteristics of Pancreatic Disease 27 Selected Cases Illustrating Salient Radiologic Characteristics Case 12 Solid-pseudopapillary neoplasm of the pancreas year-old woman, pancreatic tail mass found incidentally on CT performed for vague abdominal symptoms.

A Contrast-enhanced axial CT of the upper abdomen shows a cystic mass in the tail of the pancreas arrows. B T2-weighted sequence abdominal MR, confirms the presence of a cystic mass in the tail of the pancreas arrows. C Gadolinium-enhanced MR in venous phase shows subtle nodular enhancement within the mass arrowhead. Axial CT images of the pancreas in the arterial A and venous B phases show a hyperattenuating mass arrows in the body and tail of the pancreas.

The enhancement within the lesion is more pronounced in the arterial phase. A small hypervascular hepatic metastasis is seen in the arterial phase arrowhead in A and this mass in the liver becomes isoattenuating to the liver parenchyma in the venous phase B. There has been a left nephrectomy. Cross section of a pancreas with marked chronic pancreatitis. The normal tan-yellow lobular parenchyma is replaced by firm white bands of fibrosis. A few ducts remain, and most of them, as is often seen in alcoholic chronic pancreatitis, contain large calculi.

Localized chronic pancreatitis can be caused by a focal mass lesion, and when pancreatitis is localized, care should be taken to rule out an underlying neoplasm. The exocrine parenchyma is lost and replaced with dense scar tissue. In contrast to infiltrating ductal adenocarcinoma, the lobular architecture is preserved.

In other examples of chronic pancreatitis the exocrine parenchyma is completely replaced by fatty connective tissue. In these instances, residual islets of Langerhans may be the only clue that the tissue was once pancreas. Hematoxylin and eosin stain, low power Figure 3. This field highlights a number of features of chronic pancreatitis including marked fibrosis, acinar loss, and aggregation of the islets of Langerhans to form large islets. Even though the arrangement of the ducts is slightly distorted by the extensive fibrosis in this case, the glands are separated from the muscular vessels.

In long-standing chronic pancreatitis the aggregated islets can mimic a well-differentiated pancreatic endocrine neoplasm. The latter would be larger and usually monoclonal on immunolabeling for insulin, glucagon, and somatostatin. Hematoxylin and eosin stain, medium power Figure 3. This hypocellular specimen is composed of rare small epithelial tissue fragments in a background showing degenerated adipose tissue and cellular debris. Microcalcifications are often seen in such cases in the cytologic smears. Despite the lack of cellular material, this picture strongly suggests chronic pancreatitis with associated fat necrosis.

Inflammatory cells with predominance of lymphocytes, display nuclear crush artifact. The cytopathologic appearance is non-specific and chronic pancreatitis is often a diagnosis of exclusion. Papanicolaou stain, low power Figure 3. A large disorganized mesenchymal tissue fragment signifies extensive fibrosis that accompanies such cases resulting in a relatively lack or absence of pancreatic epithelium. Diff Quik stain, low power Figure 3. Background is clean, devoid of hemorrhage and blood. Islet cells are often seen as intact or partially intact structures in cases of chronic pancreatitis, where the atrophy of the exocrine portion is accompanied by a prominent endocrine component.

Hypocellular smear with a small partially intact islet of Langerhans in a background of numerous bland fibroblastic nuclei is noted. Aspirates from cases of chronic pancreatitis are often hypocellular and a definite diagnosis requires correlation with clinical and radiographic findings. Diff Quik stain, medium power Figure 3. A fragment of columnar epithelium with reactive changes is observed.

Enlarged nuclei with micronucleoli and scattered neutrophils are a common finding in chronic pancreatitis. The mild cytologic atypia can be ascribed to reactive cellular changes secondary to prolonged inflammation of the pancreas. Note the clean smear background. Papanicolaou stain, high power Figure 3. Cells with significant epithelial atypia are present. They have disorganized and enlarged nuclei, which appear hyperchromatic, forming three-dimensional structures.


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Numerous fragments of glandular epithelium, fibrous tissue, and marked background chronic inflammation give this smear a hypercellular appearance. The polymorphous cellular composition clearly favors a benign reactive process in this case. Note nuclear enlargement and marked disorganization of the architecture with loss of nuclear polarity. Although not diagnostic, an adenocarcinoma cannot be entirely excluded in this case. Follow-up showed extensive chronic pancreatitis. Also note scattered background inflammatory cells.

A mixed inflammatory cell infiltrate composed of lymphocytes, plasma cells, and occasional eosinophils is centered on a pancreatic duct. The inflammatory cell infiltrate in other forms of pancreatitis is typically more diffuse. Intraluminal concretions and calculi are more typical of alcoholic pancreatitis. Venulitis, as shown here, is often best appreciated at the periphery of the inflammatory process. These vascular lesions should be distinguished from other forms of vasculitis.

Polyarteritis nodosa strikes medium-sized muscular arteries, not the veins. Hematoxylin and eosin stain, high power Figure 3. This mass-forming lesion is composed of disorganized mature ductal and stromal elements. Hamartomas can be cystic or solid and are distinguished from chronic pancreatitis because they are localized, form a mass, and lack islets of Langerhans.

This nodule of splenic tissue bottom is present in the normal pancreas top. While these lesions can clinically mimic a well-differentiated endocrine neoplasm, the microscopic diagnosis is usually obvious. Other malformations can mimic a pancreatic neoplasm. For example, duodenal diverticuli can extend into the substance of the head of the pancreas and imitate a cystic neoplasm such as an intraductal papillary mucinous neoplasm.

This poorly demarcated cyst was filled with blood and necrotic debris. The calculus in the adjacent pancreatic duct left suggests that this pseudocyst may have arisen in a patient with chronic alcoholic pancreatitis. Solid-pseudopapillary neoplasms can have a similar gross appearance as they also contain blood and necrotic debris. In contrast to solid-pseudopapillary neoplasms, most pseudocysts are extrapancreatic. The cyst contains necrotic debris and is lined by macrophages and granulation tissue. The epithelium lining cystic neoplasms of the pancreas, such as the mucinous cystic neoplasm, can be focally denuded, mimicking a pseudocyst.

Careful attention to the nature of the stroma ovarian-type in mucinous cystic neoplasms and adequate sampling can avoid this diagnostic pitfall. Hematoxylin and eosin stain, medium power. Figure 3. Polymorphous cellular infiltrate with predominantly lymphocytes and histiocytes is seen. No pancreatic epithelium is noted, and no mucin is present in the smear background. The typical differential diagnosis of pseudocyst involves serous and mucinous cyst forming neoplasms of the pancreas. In occasional cases of pseudocyst, the aspirate may be contaminated by duodenal or normal pancreatic epithelium, creating diagnostic issues on cytologic interpretation.

Predominantly lymphocytes and histiocytes are present in this smear. The several large cells with atypical nuclei and vacuolated cytoplasm are consistent with histiocytes. An unusual case composed predominantly of cellular and crystalline debris. Only rare inflammatory cells and histiocytes were noted in other areas of the smear. Higher magnification of the previous case, illustrating the thick inspissated contents of a pancreatic pseudocyst and a lack of cellular component.

A careful correlation with clinical and radiologic findings is advisable in such cases. Diff Quik stain, high power Figure 3. This polymorphous infiltrate contains inflammatory cells and cyst lining cells with more ovoid stripped nuclei , hemosiderin-laden macrophages, and background degenerated blood. This cyst arose in splenic parenchyma abnormally located within the parenchyma of the pancreas and is lined by mature squamous epithelium without atypia.

The lymphoepithelial cyst lymphoid, not splenic, tissue surrounding the cysts and dermoid cyst other germ cell components represented top the differential diagnosis. Identification of splenic elements will usually lead to the correct diagnosis. This dramatic example contains peculiar small less than1 cm rounded proteinaceous concretions.

The cyst has a thin wall. Lymphoepithelial cysts usually contain pastelike material. Oligocystic serous cystadenoma, mucinous cystic neoplasm, retention cyst, and epidermoid cyst in heterotopic spleen should all be considered in the differential diagnosis of a thin-walled unilocular cyst in the pancreas. The cyst is lined by a mature squamous epithelium that lacks atypia.

A dense lymphoid infiltrate with germinal center formation dominates the stroma. The lining will be similar in epidermoid cysts in intrapancreatic heterotopic spleen, but the stroma in epidermoid cysts in intrapancreatic heterotopic spleen will obviously be splenic. The squamous epithelium matures toward the surface, the nuclei are small and uniform, and the edge of an underlying germinal center is seen. Adenosquamous carcinomas are also composed of squamous cells, but the epithelium of adenosquamous carcinomas has an infiltrative pattern of growth as well as significant dysplasia.

A loose aggregation of lympho-histiocytic cells is present. Numerous isolated background lymphocytes are present as well. This appearance is nonspecific, particularly if no other cellular component is identified. Chronic pancreatitis should be considered in the differential diagnosis, as well as sampling of a peripancreatic lymph node. Radiologic correlation would help to establish the diagnosis.

The characteristic admixture of benign squamous cells in a lymphocytic background is seen. The squamous cells appear mature and normal. Squamous cells in a pancreatic FNA raise a differential diagnosis of squamous cell contamination from the tubular esophagus in EUSguided aspirates , epidermoid cyst, dermoid cyst, primary adenosquamous and metastatic squamous cell carcinoma.

Lack of any cytologic atypia and presence of a significant lymphocytic population will rule out a carcinoma. Papanicolaou stain, medium power Figure 3. A thick aggregation of lymphocytes and histiocytes corresponding possibly to germinal center differentiation in a hyperplastic lymphoid follicle in the cyst wall is noted. Lack of squamous cells in such cases will make the diagnosis of a lymphoepithelial cyst extremely difficult. This thick pasty looking aspirate grossly contains innumerable anucleate squames and keratinaceous debris admixed with scant crushed lymphocytes.

Care should be taken not to confuse the keratinaceous debris with inpissated mucin in such cases. On a transgastric FNA in this case, round globules of amorphouslooking material are seen admixed with benign contaminating gastric epithelium. This case was suspected to be a mucinous cystic neoplasm but on follow-up the lesion turned out to be a lymphoepithelial cyst. The same globules of amorphous material from the above case stained red on Papanicolaou stain consistent with keratinaceous debris from a lymphoepithelial cyst. This amorphous material should not be confused with thick mucin.

An intimate admixture of polymorphous lymphocytes and superficial-type squamous epithelial cells and anucleate squames is seen. A bimodal admixture of these two cell types is highly suggestive of lymphoepilthelial cyst. Cell block section displays an aggregate of lymphoid tissue and juxtaposed benign squamous epithelium, which forms the lining of the cystic structure.

An additional helpful finding, beautifully illustrated here, is an admixture of abundant anucleate squames and blood in the background. Two slightly hemorrhagic cysts sit between the duodenum top and the pancreas bottom. This form of pancreatitis can mimic both cystic and solid neoplasms of the pancreas.

Recognition that this lesion is located in the groove region bordered by the minor papilla, the bile duct, the head of the pancreas, and the duodenum helps establish the correct diagnosis. The cysts are believed to result from the obstruction of small ducts feeding into the minor papillae.

As a result, the cysts are partially lined by reactive, presumably preexisting epithelium top right , while other areas lack an epithelial lining left. This lesion can imitate a pseudocyst, but the characteristic location and the presence of an epithelial lining, even if the lining is focal, help establish the correct diagnosis. An intense reactive spindle cell proliferation, composed of fibroblasts, extravasated red blood cells, and scattered inflammatory cells, is associated with a denuded cyst.

This spindle cell proliferation can be so exuberant as to mimic a spindle cell neoplasm. A nonspecific picture with histiocytes and inflammatory cells in a mucoid background is present. No other cellular component is seen. The diagnosis can be difficult and is dependent on excluding other nonneoplastic entities such as pseudocyst and cystic neoplasms. Histiocytes and rare lymphocytes in a mucoid background are seen. Histiocytes with clear or vacuolated cytoplasm differ from signet ring cell carcinoma by their small round or ovoid nuclei, which lack the prominent nucleoli of a carcinoma.

Cell block section displays histiocytes and inflammatory cells in a thick mucoid background. Differential diagnosis in cases with limited radiologic information may include a pancreatic pseudocyst and less often, a cystic mucinous neoplasm. Note the normal pancreatic parenchyma downstream from the mass left , the relatively small sclerotic, poorly demarcated carcinoma in the center of the field, and the large retention cysts upstream from the carcinoma right. This gross appearance is almost diagnostic of an infiltrating ductal adenocarcinoma, but focal chronic pancreatitis and other neoplasms of the pancreas, such as the well-differentiated pancreatic endocrine neoplasm, should be considered in the differential diagnosis.

As in Figure 4. This carcinoma is large and has an area of central necrosis that forms a cyst. Cystic change in an infiltrating ductal adenocarcinoma can mimic a cystic neoplasm of the pancreas such as a mucinous cystic neoplasm well-defined thick-walled cysts containing mucin or an intraductal papillary mucinous neoplasm the cysts communicate with a large pancreatic duct.

Three features stand out at low magnification. The relatively low neoplastic cellularity and abundant desmoplastic reaction are characteristic of ductal adenocarcinoma. The third feature, the haphazard arrangement of the glands, is an extremely useful diagnostic finding. Chronic pancreatitis, which would have a lobular arrangement of the glands, tops the differential diagnosis. Frozen section stained with hematoxylin and eosin, low power Figure 4. A well-differentiated gland is adjacent to a vessel.

Glands are normally located at the center of pancreatic lobules, while the muscular vessels are found at the periphery. The finding of a gland, even a well-differentiated gland, immediately adjacent to muscular vessel, suggests a violation of the normal lobular architecture of the pancreas and is therefore strongly suggestive of an infiltrating ductal adenocarcinoma. Frozen section stained with hematoxylin and eosin, high power Figure 4.

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Perineural invasion, as demonstrated in this case, is virtually diagnostic of an infiltrating ductal adenocarcinoma. Benign endocrine cells and, extremely rarely, benign glands can abut a nerve in cases of severe chronic pancreatitis. In these cases immunolabeling for endocrine markers and the overall pattern of growth of the glands can help establish the correct diagnosis.

Other diagnostic features of an infiltrating carcinoma include vascular and perineural invasion, a haphazard growth pattern, and a gland immediately adjacent to a muscular vessel. Vascular invasion and a gland immediately adjacent to a muscular vessel, as shown in this field, are both features of an infiltrating ductal adenocarcinoma. Note how the neoplastic cells have replaced the endothelial cells and line the inner surface of the vessel right , mimicking pancreatic intraepithelial neoplasia. When this happens the thick muscular wall can be used to establish that the neoplastic cells are in a vessel see Figure 4.

In this focus of vascular invasion, the neoplastic cells have completely relined the vessel. This pattern of vascular invasion can mimic a pancreatic intraepithelial neoplasia PanIN lesion.

The muscular wall helps establish this as a focus of vascular invasion and not a PanIN. In a patient with a history of pancreatic cancer and an ovarian mass, the loss of DPC4, bilateral involvement of the ovaries, and size of the ovarian neoplasm greater than10 cm all support the diagnosis of a carcinoma of the pancreas metastatic to the ovary over a separate ovarian primary.

Immunolabeling for DPC4, high power Figure 4. A large tissue fragment of ductal-type epithelium, which is composed of cells with enlarged uniform ovoid nuclei, is noted. Such well-differentiated carcinomas can often be exceedingly difficult to diagnose in cases with limited cellularity. Diff Quik stain, low power Figure 4. The normal architecture honeycomb appearance is only slightly disturbed.

The background cellular debris and scattered degenerated cells with atypical nuclei. Reactive atypia such as in some cases of chronic pancreatitis should be carefully excluded in such cases. Note the several large tissue fragments of atypical columnar epithelium. The lower fragment has features similar to reactive columnar epithelium.

The architecture is fairly well preserved, with tall columnar epithelium present at the periphery. There is, however, nuclear enlargement, crowding, and overlapping. The fragment above has features consistent with a well-differentiated adenocarcinoma. Note the markedly enlarged nuclei with prominent nucleoli and irregular nuclear borders. Diff Quik stain, high power Figure 4. Two monolayer tissue fragments of ductal-type epithelium, one superimposed on top of the other, are observed.

The large fragment has a papillary-like configuration. The cells have ovoid nuclei with bland chromatin and small, single nucleoli. There are foci of cellular crowding with variations in the size of the nuclei. Differential diagnosis would include reactive epithelial atypia in chronic pancreatitis. Papanicolaou stain, low power Figure 4.

Two tissue fragments in the center have distinctly different morphology. The upper fragment shows clear features of malignancy. Two tissue fragments of ductal-type epithelium with enlarged nuclei and small nucleoli are present. Cellular atypia and architectural changes are minimal but definitely present and are beyond what typically would be seen in a reactive process such as epithelial atypia in chronic pancreatitis.

Papanicolaou stain, medium power Figure 4. Atypical columnar epithelial cells, some with secretory vacuoles forming an acinus, are seen. Note the enlarged nuclei, some with irregular borders and irregular cell distribution. Cellular debris possibly necrosis is seen in the smear background.

Such findings are highly suspicious for an adenocarinoma. A definitive diagnosis however would require evaluating more cells. There is some resemblance to intestinal epithelium. Irregular acinar formations distinguish them from the latter. Abundant degenerated blood and necrosis is present as well. Abundant gastrointestinal tract contamination, obscuring blood and thick mucin can make such diagnoses extremely difficult to render.

Strips of atypical columnar epithelium with somewhat cleared cytoplasm, which contains mucin, are present. At the upper right there are back-to-back, small glandular formations. There is no significant cellular atypia. Abnormal architecture is the main evidence of cancer. Papanicolaou stain, high power Figure 4.

A tissue fragment composed of several back-to-back glandular formations. This is a typical example of a well-differentiated adenocarcinoma. Tall columnar neoplastic cells contain large, oval, basally located nuclei. They have a vesicular chromatin pattern, slight nuclear border irregularities, and occasional grooves. Focal nuclear crowding and overlapping are also observed. Atypical monolayer tissue fragment showing minimal architectural and individual cellular changes. These changes include focal crowding and disorderly grouping of the cells along with variation in size of the nuclei and nuclear cytoplasmic relation e.

Also note degenerated neoplastic cells and some necrotic debris in the background. Two atypical tissue fragments are present. Normal architecture is lost. Crowded, overlapping nuclei that vary in size and shape are seen. A small shred of fibrous tissue and abundant background mucin are noted as well.

Chronic pancreatitis with associated epithelial atypia should be carefully excluded in such cases. They are especially helpful in the diagnosis of adenocarcinoma without apparent nuclear changes e. A large tissue fragment of atypical ductal epithelium is seen. Nuclear atypia is minimal. Neoplastic cells have enlarged round or ovoid nuclei with uniformly bland chromatin and small nucleoli. A loose group of single neoplastic cells is noted. Most have moderate amounts of cytoplasm and round or ovoid nuclei with markedly irregular nuclear borders.

Although these cells should raise a strong suspicion of a carcinoma, a definitive diagnosis of cancer should not be made without additional evidence. Several atypical epithelial tissue fragments are present in a mucinous background with innumerable necrotic cells. There is a slight variation in nuclear size and chromasia and minimal disturbance of cellular architecture.

A cytopathologic diagnosis of malignancy can be difficult in cases with limited cellularity. An atypical tissue fragment in a mucoid background with extensive necrotic cellular debris is present. Atypical cells have large, moderately hyperchromatic nuclei with irregular borders and indistinct cytoplasmic borders.

Abnormal cellular architecture with irregular distribution of cells, nuclear crowding, and overlapping, along with cellular atypia, is diagnostic for carcinoma. One area of gland-like formation and the suggestion of a luminal border upper margin of the fragment are consistent with an adenocarcinoma. Two small tissue fragments of neoplastic cells with glandular features are seen. Neoplastic cells with large hyperchromatic nuclei and moderate amounts of cytoplasm form back-to-back small, disorganized glands. Hematoxylin and eosin stain, medium power Figure 4.

A large hypercellular tissue fragment of tumor with glandular differentiation is observed. Although glandular differentiation by the neoplastic cells is apparent, the overall organization of the fragment is disturbed. The nuclei are enlarged with moderately hyperchromatic nuclei and conspicuous nucleoli.

Hematoxylin and eosin stain, high power Figure 4. Loose aggregates of neoplastic cells with large nuclei, occasional nuclear grooves, and prominent nucleoli are admixed with cells with small nuclei and back-to-back acinar formations. The former cells are clearly neoplastic; the latter probably represent a better differentiated area of the tumor.

Neoplastic cells in this tissue fragment have markedly enlarged nuclei with significant variation in size and shape. In the upper left area of the fragment, the formation of an acinus and luminal border indicates glandular differentiation. Two hypercellular tissue fragments are composed of neoplastic cells that have large nuclei with small to prominent nucleoli and bland chromatin.

Cellular crowding with nuclear overlapping is apparent. The presence of luminal spaces in the crowded areas and atypical tall columnar epithelium indicate glandular differentiation. This predominantly cystic lesion shows two tissue fragments, several smaller groups of cells, and a single atypical epithelial cell.

The cells have varying morphology, centrally or eccentrically located nuclei with scant or abundant cytoplasm. The larger tissue fragment has a benign appearance, but there are focal atypical changes in the lower border, and several markedly atypical cells are attached to the upper border. Two tissue fragments and single neoplastic cells are noted. Marked pleomorphism and disorganization indicate the malignant nature of the lesion. Glandular differentiation is less apparent. Diff Quik stain, medium power Figure 4.

Several loosely attached tissue fragments and a multinucleated neoplastic cell can be seen. Neoplactic cells have enlarged nuclei with a uniform chromatin pattern. Most have single or double prominent nucleoli. Columnar differentiation is seen in the upper border of the large fragment. Malignant features here are subtle and mostly based on individual cell atypia. Neoplastic cells have uniformly distributed chromatin and small nucleoli. Most nuclei have evenly thickened, smooth nuclear borders. The lower fragment, which is composed of poorly preserved atypical columnar cells, also shows prominent nucleoli.

A large epithelial tissue fragment composed of cells with enlarged ovoid nuclei and bland chromatin pattern. The normal organization of the ductal epithelium is markedly disturbed. One acinus filled with secretion is present. A hypercellular tissue fragment with overcrowded nuclei is seen. Uniformly enlarged round or oval nuclei have one or two micronucleoli and a bland chromatin pattern. In the areas of tightly packed nuclei, cytoplasmic outlines are invisible imparting syncytial appearance. Differential diagnosis includes benign proliferative changes with atypia.

However, in limited material, such as a few small fragments, a definitive cancer diagnosis requires further morphologic evidence of malignancy. As always, clinical and radiologic correlation would help to establish the diagnosis in borderline cases. A large epithelial tissue fragment in an extensively necrotic background is noted. The cells have moderately enlarged, ovoid nuclei with bland chromatin and one or two micronucleoli. Architectural changes include markedly increased cellularity and several gland-like formations in the fragment. The atypical tissue fragment, observed in a necrotic background containing markedly atypical degenerated cells, is diagnostic of a carcinoma.

A large folded tissue fragment of ductal-type neoplastic epithelium is present. Hyperchromatic large nuclei with irregular borders are seen in the lower position of the fragment. The cytomorphologic features are well-developed and an interpretation of adenocarcinoma is quite straight forward in such cases. Note the hypercellularity with marked nuclear enlargement, focal nuclear overlapping, crowding and occasional prominent nucleoli. There is marked anisonucleosis. Several acinar formations, some containing mucin, are also present.

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The cytomorphalogic characteristics seen here are diagnostic of an adenocarcnoma, even in a limited sample. This smear contains tissue fragments, cellular aggregates, and single tumor cells. On the right-hand side, the majority of the neoplastic cells have large round or ovoid nuclei with prominent nucleoli. Cytoplasmic borders are indistinct. Cellular organization varies from rosette-like formations to disorganized crowding of the cells. Some neoplastic cells have columnar configurations. There is also a group of pleomorphic, naked nuclei, which appear to represent degenerated neoplastic cells and which look similar to the nuclei of the malignant cells in the crowded groups.

There is no evidence of glandular differentiation. Diagnosis in such cases is usually not difficult. However, other primary cancers such as variants of ductal carcinoma and acinar cell carcinoma should be considered in the differential diagnosis. In addition to neoplastic cells with bizarre markedly enlarged nuclei and macronucleoli, better differentiated tumor cells form an acinus. The large pleomorphic glandular cells display extreme pleomorphism.

Few intracytoplasmic mucin vacuoles are seen, and there is extensive background necrosis containing karyorrhectic nuclear debris. A neoplastic tissue fragment is associated with large necrotic areas.

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Neoplastic cells have large, pleomorphic nuclei and macronucleoli. Two partial lumen formations are present in the upper portion of the fragment. Another tissue fragment from the same tumor, shown in Figure 4. Malignant cellular features as well as degenerative changes are quite apparent. The presence of intracytoplasmic vacuoles with eccentrically located nuclei suggests glandular differentiation, but similar changes may occur in degeneration.