{"id":2019,"date":"2017-08-01T13:26:05","date_gmt":"2017-08-01T13:26:05","guid":{"rendered":"http:\/\/cytologystuff1.wpengine.com\/non-gyn-atlas\/fine-needle-aspiration-cytology-head-neck-and-lymph-nodes\/"},"modified":"2025-02-10T20:03:14","modified_gmt":"2025-02-10T20:03:14","slug":"fine-needle-aspiration-cytology-head-neck-and-lymph-nodes","status":"publish","type":"page","link":"https:\/\/dev.cytologystuff.com\/zh-hans\/non-gyn-atlas\/fine-needle-aspiration-cytology-head-neck-and-lymph-nodes\/","title":{"rendered":"Fine Needle Aspiration Cytology – Head, Neck and Lymph Nodes"},"content":{"rendered":"

[vc_row 0=””][vc_column 0=”” offset=”vc_hidden-lg vc_hidden-md”][vc_raw_html 0=””]JTNDY2VudGVyJTNFJTNDYSUyMGNsYXNzJTNEJTIyc2hpZnRuYXYtdG9nZ2xlJTIwc2hpZnRuYXYtdG9nZ2xlLWJ1dHRvbiUyMiUyMGRhdGEtc2hpZnRuYXYtdGFyZ2V0JTNEJTIyc2hpZnRuYXYtbWFpbiUyMiUzRSUzQ2klMjBjbGFzcyUzRCUyMmZhJTIwZmEtYmFycyUyMiUzRSUzQyUyRmklM0UlMjBUYWJsZSUyMG9mJTIwQ29udGVudHMlMjAlM0MlMkZhJTNFJTNDJTJGY2VudGVyJTNF[\/vc_raw_html][\/vc_column][\/vc_row][vc_row][vc_column][vc_custom_heading text=”Fine Needle Aspiration Cytology \u2013 Head, Neck and Lymph Nodes” font_container=”tag:h1|text_align:center” use_theme_fonts=”yes”][\/vc_column][\/vc_row][vc_row][vc_column width=”2\/3″][vc_column_text]<\/a><\/p>\n

HEAD, NECK AND LYMPH NODES
\nStan A. Lightfoot, MD<\/em><\/p>\n

Fine Needle Aspiration (FNA) of the head and neck can be organized in many ways but preferentially divided into two groups: lumps and bumps and salivary gland lesions.<\/p>\n

Lumps and Bumps<\/strong>
\nHistory and age are very important. In children the vast majority of these lesions are benign and inflammatory. In adults the majority of lesions are malignant, with the most common cause being metastatic squamous cell carcinoma. History is essential here. Most metastatic squamous cell carcinomas in the neck come from the oropharynx but can uncommonly come from the lung and even less often from a squamous cell carcinoma of the head or face. In the latter case, the diagnosis of the skin cancer has already been made and it is one that has invaded deeply into the dermis or is of longstanding duration.<\/p>\n

Lung cancer does not usually metastasize to neck nodes, so that leaves the oropharynx as the site of the primary lesion. Again history is important as at least 80% of these will already have a prior diagnosis of oropharyngeal cancer thus prompting an FNA for staging purposes or assessment of recurrence. At our institution, 20% of the time the patient’s primary presentation is metastatic squamous cell carcinoma in a neck lymph node. If the squamous cell in the node is in intimate contact with mature lymphocytes, this is strongly suggestive of a nasopharyngeal primary. Otherwise morphologic features are of little help with regard to location of the primary. When this 20% is worked up, a certain number will have no symptoms or signs that help determine the primary lesion. In these cases blind biopsies of the nasopharynx, tonsil and vocal cords are performed. At our institution, if no tumor is found the patient receives irradiation of the entire head and neck region. This results in a 70% 5 year survival.<\/p>\n

Lumps and bumps may also be metastatic malignant melanoma particulary in southern rural populations with high sun exposure. The neck is a favorite site for this lesion and it must be remembered because it can mimic lymphoma, Hodgkin’s disease and carcinoma. We will revisit this when we talk about salivary gland lesions below.<\/p>\n

If the FNA exhibits an atypical lymphoid proliferation the specimen should be taken for flow cytometry examination. Examination of the case is facilitated by preparing at least one Wright stained slide in addition to several Pap-stained ThinPrep slides in all lymphoid lesions. Several things assist with regard to lymphoid lesions and the FNA. Are the lymphocytes of monotonous or heterogeneous morphology? Are there notches and cuts into the nuclear membrane? Are nucleoli present? The utility of these features is discussed in the attached illustrations.<\/p>\n

Lumps and bumps may also be due to benign cysts. In the neck the two most common benign cysts are a branchial cleft cyst or a thyroglossal duct cyst. Both contain many macrophages and a variety of other cells. Cysts may contain atypical squamous cells which may lead to a false positive diagnosis of metastatic disease. If the cyst is tense, and it frequently is, it may feel very firm to the touch. So be wary in the presence of macrophages that you are not dealing with a benign cyst even if there are occasional atypical squamous cells!<\/p>\n

I have left the Salivary Gland FNA’s for the last discussion, because it is the most difficult topic, requiring experience. FNA’s of the salivary gland may be very easy, as in a Warthin tumor or difficult, as in an adenoid cystic carcinoma. However, to be proficient in this area requires abundant experience that cannot be acquired by reading a book. There are several key points regarding the cytology of these glands. The parotid is a favorite site for metastatic disease, notably squamous cell carcinoma. So if the FNA has only well differentiated squamous cell carcinoma, it is almost always metastatic to the parotid. Similar to the neck, lung carcinomas rarely go to the parotid, so a small cell carcinoma in the parotid may indeed be a primary lesion. The lung must be ruled out, but in our experience small cell carcinoma in the parotid is usually primary. And malignant melanoma, true to its name as the great imitator, can complicate the diagnosis of parotid lesions. As an example, recent cases of presumed primary parotid carcinoma and mucoepidermoid carcinoma were in fact metastatic malignant melanomas.<\/p>\n

I would like to thank Susan Townsend, CT(ASCP), and Vala Williams, Preparatory Technician, for their help with this project.<\/p>\n

References<\/strong><\/p>\n

    \n
  1. Al-Khafaji BM, Afify AM: Salivary gland fine needle aspiration using the ThinPrep technique. Acta Cytol 2001; 45:567-74.<\/li>\n
  2. Ford L, Rasgon BM, Hilsinger RL, Cruz RM, Axelsson K, Rumore GJ, Schmidtknecht TM, Puligandla B, Sawicki J, Pshea W: Comparison of ThinPrep versus conventional smear cytopreparatory techniques for fine-needle aspiration specimens of head and neck masses. Otolaryngol Head Neck Surg 2002; 126(5):554-61.<\/li>\n
  3. Leon ME, Deschler D, Wu SS, Galindo LM: Fine needle aspiration diagnosis of lipoblastoma of the parotid region. Acta Cytol 2002; 46(2): 395-404.<\/li>\n
  4. Chen VS M, Qizilbash A , and Young JE : Guides to Clinical Aspiration Biopsy, Head and Neck, 2nd edition. Igaku-shoin Ltd; Tokyo, 1996.<\/li>\n<\/ol>\n

    What role does the ThinPrep\u00ae<\/sup> technology play in the diagnosis of FNA’s from this area? The best way to answer that is to look at the examples:<\/p>\n

    <\/a><\/p>\n

    \n

    Reminder: You may click on any slide image
    \nfor an enlarged view.<\/strong><\/p>\n


    \n\"Image<\/a><\/p>\n
    \n

    Figure 1<\/strong><\/p>\n

    Neck FNA, benign cyst.
    \nAn admixture of cells including benign squamous cells and smaller inflammatory cells are present. Also abundant keratin is seen. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 1<\/strong>
    \nNeck FNA, benign cyst.<\/strong>
    \nAn admixture of cells including benign squamous cells and smaller inflammatory cells are present. Also abundant keratin is seen.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 2<\/strong><\/p>\n

    Neck FNA, benign cyst.
    \nBenign squamous cells, inflammatory cells and keratin are seen in this aspirate. Note the benign metaplastic squamous cells . These are frequently found in the aspiration of cysts. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 2<\/strong>
    \nNeck FNA, benign cyst.<\/strong>
    \nBenign squamous cells, inflammatory cells and keratin are seen in this aspirate. Note the benign metaplastic squamous cells . These are frequently found in the aspiration of cysts.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    Figure 3
    \n<\/strong>
    \nNeck FNA, branchial cleft cyst.
    \nMature squamous cells, keratin debris and anucleated squamous cells indicate a benign cystic process. 10x<\/div>\n<\/div>\n
    Figure 3
    \n<\/strong>
    \nNeck FNA, branchial cleft cyst.<\/strong>
    \nMature squamous cells, keratin debris and anucleated squamous cells indicate a benign cystic process.
    \n10x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 4<\/strong><\/p>\n

    Neck FNA, branchial cleft cyst.
    \nAlso known as lymphoepithelial cysts, these usually occur along the lateral aspects of the neck. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 4<\/strong>
    \nNeck FNA, branchial cleft cyst.<\/strong>
    \nAlso known as lymphoepithelial cysts, these usually occur along the lateral aspects of the neck.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 5<\/strong><\/p>\n

    Neck FNA, thyroglossal duct cyst.
    \nCystic debris, histiocytes and benign squamous cells indicate a benign cystic process. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 5<\/strong>
    \nNeck FNA, thyroglossal duct cyst.<\/strong>
    \nCystic debris, histiocytes and benign squamous cells indicate a benign cystic process.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 6<\/strong><\/p>\n

    Neck FNA, thyroglossal duct cyst.
    \nLocated along the neck’s midline, these cysts are lined with columnar or squamous epithelium which may or may not be seen upon aspiration. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 6<\/strong>
    \nNeck FNA, thyroglossal duct cyst.<\/strong>
    \nLocated along the neck’s midline, these cysts are lined with columnar or squamous epithelium which may or may not be seen upon aspiration.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 7<\/strong><\/p>\n

    Neck FNA, thyroglossal duct cyst.
    \nThis cyst contained mature squamous epithelium. Some FNA’s may not be diagnostic. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 7<\/strong>
    \nNeck FNA, thyroglossal duct cyst.<\/strong>
    \nThis cyst contained mature squamous epithelium. Some FNA’s may not be diagnostic.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 8<\/strong><\/p>\n

    Neck FNA, suspicious for squamous carcinoma.
    \nIn the center of the photo is a squamous cell with a slightly enlarged, atypical nucleus. It is surrounded by inflammatory cells, keratin and necrotic material. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 8<\/strong>
    \nNeck FNA, suspicious for squamous carcinoma.<\/strong>
    \nIn the center of the photo is a squamous cell with a slightly enlarged, atypical nucleus. It is surrounded by inflammatory cells, keratin and necrotic material.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 9<\/strong><\/p>\n

    Neck FNA, suspicious for squamous carcinoma.
    \nThe atypical cell is more clearly seen. The nucleus is enlarged but has an absolutely smooth nuclear membrane and is perfectly oval. It is again surrounded by keratin, inflammatory cells and necrotic debris. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 9<\/strong>
    \nNeck FNA, suspicious for squamous carcinoma.<\/strong>
    \nThe atypical cell is more clearly seen. The nucleus is enlarged but has an absolutely smooth nuclear membrane and is perfectly oval. It is again surrounded by keratin, inflammatory cells and necrotic debris.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 10<\/strong><\/p>\n

    Neck FNA, suspicious for squamous carcinoma.
    \nCells with similar morphology can occur in a benign cyst. Thus, this finding alone does not support an unequivocal diagnosis of malignancy. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 10<\/strong>
    \nNeck FNA, suspicious for squamous carcinoma.<\/strong>
    \nCells with similar morphology can occur in a benign cyst. Thus, this finding alone does not support an unequivocal diagnosis of malignancy.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 11<\/strong><\/p>\n

    Neck FNA, suspicious for squamous carcinoma. A highly atypical squamous metaplastic cell is present. The cell is rounded and the cytoplasm contains keratin The nuclear membrane is irregular and the chromatin is separated into small discrete bundles. This type cell may lead to a strong recommendation that the lesion be excised. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 11<\/strong>
    \nNeck FNA, suspicious for squamous carcinoma.<\/strong>
    \nA highly atypical squamous metaplastic cell is present. The cell is rounded and the cytoplasm contains keratin. The nuclear membrane is irregular and the chromatin is separated into small discrete bundles. This type cell may lead to a strong recommendation that the lesion be excised.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 12<\/strong><\/p>\n

    Neck FNA, suspicious for squamous carcinoma.
    \nThe central cell is a small metaplastic squamous cell with an enlarged oval nucleus with a smooth nuclear membrane. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 12<\/strong>
    \nNeck FNA, suspicious for squamous carcinoma.<\/strong>
    \nThe central cell is a small metaplastic squamous cell with an enlarged oval nucleus with a smooth nuclear membrane.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 13<\/strong><\/p>\n

    Neck FNA, suspicious for squamous carcinoma.<\/strong>
    \nA large squamous cell with a large degenerated nucleus . Keratin filaments are near the periphery of the cell. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 13<\/strong>
    \nNeck FNA, suspicious for squamous carcinoma.<\/strong>
    \nA large squamous cell with a large degenerated nucleus . Keratin filaments are near the periphery of the cell.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 14<\/strong><\/p>\n

    Neck FNA, poorly differentiated carcinoma. Two clusters of cells are noted. The large, irregular cluster has irregular borders and pleomorphic nuclei . The cells of the smaller group exhibit loss of cohesiveness and have an increased N\/C ratio at this magnification. The background contains necrotic debris. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 14<\/strong>
    \nNeck FNA, poorly differentiated carcinoma.<\/strong>
    \nTwo clusters of cells are noted. The large, irregular cluster has irregular borders and pleomorphic nuclei . The cells of the smaller group exhibit loss of cohesiveness and have an increased N\/C ratio at this magnification. The background contains necrotic debris.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 15<\/strong><\/p>\n

    Neck FNA, poorly differentiated carcinoma.
    \nThe pleomorphism and hyperchromasia of the larger group of cells is clearer than at 20x. Neither the cytoplasmic nor the nuclear differentiation give evidence of the primary site. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 15<\/strong>
    \nNeck FNA, poorly differentiated carcinoma.<\/strong>
    \nThe pleomorphism and hyperchromasia of the larger group of cells is clearer than at 20x. Neither the cytoplasmic nor the nuclear differentiation give evidence of the primary site.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 16<\/strong><\/p>\n

    Neck FNA, poorly differentiated carcinoma.
    \nThis carcinoma clearly exhibits loss of cohesiveness. The nuclei are irregular and have clumping of chromatin. There is a large increase in the N\/C ratio. Nucleoli are prominent and differ in number from cell to cell. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 16<\/strong>
    \nNeck FNA, poorly differentiated carcinoma.<\/strong>
    \nThis carcinoma clearly exhibits loss of cohesiveness. The nuclei are irregular and have clumping of chromatin. There is a large increase in the N\/C ratio. Nucleoli are prominent and differ in number from cell to cell.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 17<\/strong><\/p>\n

    Neck FNA, poorly differentiated carcinoma.
    \nThis large cluster has all the primary characteristics of malignancy. Irregular nuclear membranes and notches can be plainly seen as well as clumping of chromatin and parachromatin clearing. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 17<\/strong>
    \nNeck FNA, poorly differentiated carcinoma.<\/strong>
    \nThis large cluster has all the primary characteristics of malignancy. Irregular nuclear membranes and notches can be plainly seen as well as clumping of chromatin and parachromatin clearing.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 18<\/strong><\/p>\n

    Neck FNA, squamous cell carcinoma.
    \nA large malignant cell is surrounded by small benign squamous cells, debris, inflammation and keratin. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 18<\/strong>
    \nNeck FNA, squamous cell carcinoma.<\/strong>
    \nA large malignant cell is surrounded by small benign squamous cells, debris, inflammation and keratin.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 19<\/strong><\/p>\n

    Neck FNA, squamous cell carcinoma.
    \nThis malignant cell with a large, centrally placed nucleus has dense cyanophilic cytoplasm indicative of keratinzation and characteristic of a squamous cell. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 19<\/strong>
    \nNeck FNA, squamous cell carcinoma.<\/strong>
    \nThis malignant cell with a large, centrally placed nucleus has dense cyanophilic cytoplasm indicative of keratinzation and characteristic of a squamous cell.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    Figure 20:<\/strong>
    \nNeck FNA, squamous cell carcinoma. This is a poorly differentiated malignancy and classification is helped by the fact that keratin is present in the background of malignant cells. (It is not uncommon to see both well-differentiated and poorly differentiated squamous cells in a FNA of the neck. The well-differentiated cells establish the identity.) There are two large clusters of cells and a necrotic background. 20x<\/div>\n<\/div>\n
    Figure 20<\/strong>
    \nNeck FNA, squamous cell carcinoma.<\/strong>
    \nThis is a poorly differentiated malignancy and classification is helped by the fact that keratin is present in the background of malignant cells. (It is not uncommon to see both well-differentiated and poorly differentiated squamous cells in a FNA of the neck. The well-differentiated cells establish the identity.) There are two large clusters of cells and a necrotic background.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 21<\/strong><\/p>\n

    Neck FNA, squamous cell carcinoma.
    \nNote the large, irregular nucleolus in the lower central area of the group of malignant cells. The nuclear membranes are outlined by the chromatin clumping. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 21<\/strong>
    \nNeck FNA, squamous cell carcinoma.<\/strong>
    \nNote the large, irregular nucleolus in the lower central area of the group of malignant cells. The nuclear membranes are outlined by the chromatin clumping.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 22<\/strong><\/p>\n

    Neck FNA, squamous cell carcinoma.
    \nNote the excellent preservation of the malignant cells. The nuclear detail is exquisite. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 22<\/strong>
    \nNeck FNA, squamous cell carcinoma.<\/strong>
    \nNote the excellent preservation of the malignant cells. The nuclear detail is exquisite.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 23<\/strong><\/p>\n

    Neck FNA, squamous cell carcinoma. The diagnosis is straightforward with the presence of a tadpole-shaped squamous cell with a cytologically malignant nucleus. Just above and to the right are two malignant squamous metaplastic cells. At the bottom right is another malignant squamous metaplastic cell. Tumor necrosis is present in the background. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 23<\/strong>
    \nNeck FNA, squamous cell carcinoma.<\/strong>
    \nThe diagnosis is straightforward with the presence of a tadpole-shaped squamous cell with a cytologically malignant nucleus. Just above and to the right are two malignant squamous metaplastic cells. At the bottom right is another malignant squamous metaplastic cell. Tumor necrosis is present in the background.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 24<\/strong><\/p>\n

    Neck FNA, squamous cell carcinoma.
    \nThe malignant keratinizing tadpole-shaped squamous cell and the two malignant squamous metaplastic cells are clearly seen. Keratin is present and tumor necrosis surrounds the cells. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 24<\/strong>
    \nNeck FNA, squamous cell carcinoma.<\/strong>
    \nThe malignant keratinizing tadpole-shaped squamous cell and the two malignant squamous metaplastic cells are clearly seen. Keratin is present and tumor necrosis surrounds the cells.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    Figure 25:<\/strong>
    \nNeck FNA, squamous cell carcinoma. In this photo there is an extremely large malignant cell. Note just above this cell are three lymphocytes which give an accurate size comparison of this huge cell. Additionally a scattering of other malignant cells along with some debris can also be seen. Squamous differentiation is evident in the smaller, orangeophilic cells that are in the field, and cling to the surface of this malignant cell. 20x<\/div>\n<\/div>\n
    Figure 25<\/strong>
    \nNeck FNA, squamous cell carcinoma.<\/strong>
    \nIn this photo there is an extremely large malignant cell. Note just above this cell are three lymphocytes which give an accurate size comparison of this huge cell. Additionally a scattering of other malignant cells along with some debris can also be seen. Squamous differentiation is evident in the smaller, orangeophilic cells that are in the field, and cling to the surface of this malignant cell.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 26<\/strong><\/p>\n

    Neck FNA, squamous cell carcinoma. The large cell contrasts with the small lymphocytes in the photo. The small malignant squamous cell can be more clearly discerned. Above and to the right is a well formed malignant squamous cell with an intensely hyperchromatic nucleus and well defined thick cytoplasm. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 26<\/strong>
    \nNeck FNA, squamous cell carcinoma.<\/strong>
    \nThe large cell contrasts with the small lymphocytes in the photo. The small malignant squamous cell can be more clearly discerned. Above and to the right is a well formed malignant squamous cell with an intensely hyperchromatic nucleus and well defined thick cytoplasm.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 27<\/strong><\/p>\n

    Neck FNA, squamous cell carcinoma.
    \nA huge malignant squamous cell is clearly portrayed. Again note the two lymphocytes in the photo. The nuclear chromatin appears raked in this photo. There is almost a three dimensional feel to this cell. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 27<\/strong>
    \nNeck FNA, squamous cell carcinoma.<\/strong>
    \nA huge malignant squamous cell is clearly portrayed. Again note the two lymphocytes in the photo. The nuclear chromatin appears raked in this photo. There is almost a three dimensional feel to this cell.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 28<\/strong><\/p>\n

    Parotid FNA, high grade mucoepidermoid carcinoma.
    \nCytologic criteria lead to a diagnosis of a poorly differentiated carcinoma. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 28<\/strong>
    \nParotid FNA, high grade mucoepidermoid carcinoma.<\/strong>
    \nCytologic criteria lead to a diagnosis of a poorly differentiated carcinoma.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 29<\/strong><\/p>\n

    Parotid FNA, high grade mucoepidermoid carcinoma.
    \nIntracellular mucin was demonstrated by mucicarmine stains. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 29<\/strong>
    \nParotid FNA, high grade mucoepidermoid carcinoma.<\/strong>
    \nIntracellular mucin was demonstrated by mucicarmine stains.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 30<\/strong><\/p>\n

    Parotid FNA, high grade mucoepidermoid carcinoma.
    \nA malignant population of squamous cells was present. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 30<\/strong>
    \nParotid FNA, high grade mucoepidermoid carcinoma.<\/strong>
    \nA malignant population of squamous cells was present.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 31<\/strong><\/p>\n

    Parotid FNA, high grade mucoepidermoid carcinoma.
    \nA malignant cell adjacent to benign salivary tissue pinpoints the tumor location. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 31<\/strong>
    \nParotid FNA, high grade mucoepidermoid carcinoma.<\/strong>
    \nA malignant cell adjacent to benign salivary tissue pinpoints the tumor location.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 32<\/strong><\/p>\n

    Parotid FNA, suspicious for low grade mucoepidermoid carcinoma.
    \nBenign appearing salivary gland tissue, debris and mucin are apparent at low power. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 32<\/strong>
    \nParotid FNA, suspicious for low grade mucoepidermoid carcinoma.<\/strong>
    \nBenign appearing salivary gland tissue, debris and mucin are apparent at low power.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 33<\/strong><\/p>\n

    Parotid FNA, suspicious for low grade mucoepidermoid carcinoma.
    \nSmall nucleoli are present in the otherwise bland nuclei of cell clusters. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 33<\/strong>
    \nParotid FNA, suspicious for low grade mucoepidermoid carcinoma.<\/strong>
    \nSmall nucleoli are present in the otherwise bland nuclei of cell clusters.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 34<\/strong><\/p>\n

    Parotid FNA, suspicious for low grade mucoepidermoid carcinoma.
    \nMany single cells are floating in a mucinous background. The differential diagnosis includes a mucocele. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 34<\/strong>
    \nParotid FNA, suspicious for low grade mucoepidermoid carcinoma.<\/strong>
    \nMany single cells are floating in a mucinous background. The differential diagnosis includes a mucocele.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 35<\/strong><\/p>\n

    Parotid FNA, suspicious for low grade mucoepidermoid carcinoma.
    \nIf the mucin is not noticed a benign diagnosis may be rendered causing a false negative. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 35<\/strong>
    \nParotid FNA, suspicious for low grade mucoepidermoid carcinoma.<\/strong>
    \nIf the mucin is not noticed a benign diagnosis may be rendered causing a false negative.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 36<\/strong><\/p>\n

    Neck FNA, malignant melanoma.
    \nIn this photo there are many single cells, and clusters of cells that contain pigment. In the center is a single plasmacytoid malignant cell, as well as naked nuclei. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 36<\/strong>
    \nNeck FNA, malignant melanoma.<\/strong>
    \nIn this photo there are many single cells, and clusters of cells that contain pigment. In the center is a single plasmacytoid malignant cell, as well as naked nuclei.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 37<\/strong><\/p>\n

    Neck FNA, malignant melanoma.
    \nThe two cell clusters seen at 20x contain brown melanin that distinguishes this as melanoma. The cell below is distinctly plasmacytoid with an oval nucleus and single nucleolus. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 37<\/strong>
    \nNeck FNA, malignant melanoma.<\/strong>
    \nThe two cell clusters seen at 20x contain brown melanin that distinguishes this as melanoma. The cell below is distinctly plasmacytoid with an oval nucleus and single nucleolus.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 38<\/strong><\/p>\n

    Neck FNA, malignant melanoma. Melanoma is a great mimicker of other malignancies. In this photo there is a group of loosely cohesive cells that are malignant, but whose identity would be obscure except that there is abundant cytoplasmic melanin. Note the excellent preservation of the cells and of the melanin granules. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 38<\/strong>
    \nNeck FNA, malignant melanoma.<\/strong>
    \nMelanoma is a great mimicker of other malignancies. In this photo there is a group of loosely cohesive cells that are malignant, but whose identity would be obscure except that there is abundant cytoplasmic melanin. Note the excellent preservation of the cells and of the melanin granules.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    Figure 39:<\/strong> Axillary lymph node FNA, malignant melanoma. There is a pleomorphic aggregate of single cells in this photo. Brownish pigment can be clearly discerned even at this magnification, especially in the center of the photo. Just below the bi-nucleated cell on the right is a plasmacytoid cell with a huge nucleolus. Even at this power the diagnosis of melanoma is easily made. 20x<\/div>\n<\/div>\n
    Figure 39<\/strong>
    \nAxillary lymph node FNA, malignant melanoma.<\/strong>
    \nThere is a pleomorphic aggregate of single cells in this photo. Brownish pigment can be clearly discerned even at this magnification, especially in the center of the photo. Just below the bi-nucleated cell on the right is a plasmacytoid cell with a huge nucleolus. Even at this power the diagnosis of melanoma is easily made.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 40<\/strong><\/p>\n

    Axillary lymph node FNA, malignant melanoma.
    \nThe fine granularity of melanin and its coloration are easily appreciated at this magnification. The nuclei are eccentric with prominent nucleoli. The cells are single. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 40<\/strong>
    \nAxillary lymph node FNA, malignant melanoma.<\/strong>
    \nThe fine granularity of melanin and its coloration are easily appreciated at this magnification. The nuclei are eccentric with prominent nucleoli. The cells are single.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 41<\/strong><\/p>\n

    Axillary lymph node FNA, malignant melanoma.
    \nThe same cluster at higher magnification. Please note the characteristics of melanin. It is ideally represented in these malignant cells. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 41<\/strong>
    \nAxillary lymph node FNA, malignant melanoma.<\/strong>
    \nThe same cluster at higher magnification. Please note the characteristics of melanin. It is ideally represented in these malignant cells.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 42<\/strong><\/p>\n

    Axillary lymph node FNA, malignant melanoma.
    \nA multinucleated giant melanoma cell is present. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 42<\/strong>
    \nAxillary lymph node FNA, malignant melanoma.<\/strong>
    \nA multinucleated giant melanoma cell is present.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 43<\/strong><\/p>\n

    Lymph node FNA, malignant melanoma.
    \nAt this power there are three small groups of cells. Interspersed are numerous single cells with no cytoplasm or minimal cytoplasm. The pleomorphism and hyperchromasia strongly suggest malignancy but the type is not suggested. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 43<\/strong>
    \nLymph node FNA, malignant melanoma.<\/strong>
    \nAt this power there are three small groups of cells. Interspersed are numerous single cells with no cytoplasm or minimal cytoplasm. The pleomorphism and hyperchromasia strongly suggest malignancy but the type is not suggested.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 44<\/strong><\/p>\n

    Lymph node FNA, malignant melanoma. Three cells have well defined cytoplasm. The rest seem to have almost a syncytial cytoplasm. The nuclei give no evidence as to site of origin. The three cells with the well defined cytoplasm could be called plasmacytoid and give a hint as to source of the primary. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 44<\/strong>
    \nLymph node FNA, malignant melanoma.<\/strong>
    \nThree cells have well defined cytoplasm. The rest seem to have almost a syncytial cytoplasm. The nuclei give no evidence as to site of origin. The three cells with the well defined cytoplasm could be called plasmacytoid and give a hint as to source of the primary.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 45<\/strong><\/p>\n

    Lymph node FNA, malignant melanoma.
    \nA higher magnification reflecting the same characteristics as the prior photo. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 45<\/strong>
    \nLymph node FNA, malignant melanoma.<\/strong>
    \nA higher magnification reflecting the same characteristics as the prior photo.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 46<\/strong><\/p>\n

    Lymph node FNA, malignant melanoma.
    \nThe cell lower right corner demonstrates an intranuclear cytoplasmic inclusion a feature that is characteristic of, but not diagnostic for, malignant melanoma. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 46<\/strong>
    \nLymph node FNA, malignant melanoma.<\/strong>
    \nThe cell in the lower right corner demonstrates an intranuclear cytoplasmic inclusion a feature that is characteristic of, but not diagnostic for, malignant melanoma.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 47<\/strong><\/p>\n

    Lymph node FNA, malignant melanoma.
    \nAn intranuclear inclusion is present in the large plasmacytoid malignant cell and a huge nucleolus is present in a second malignant cell. Both are features of melanoma. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 47<\/strong>
    \nLymph node FNA, malignant melanoma.<\/strong>
    \nAn intranuclear inclusion is present in the large plasmacytoid malignant cell and a huge nucleolus is present in a second malignant cell. Both are features of melanoma.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    Figure 48:<\/strong> Neck lymph node FNA, metastatic carcinoma consistent with lung primary. The cell cluster in the middle of the slide is sufficient for the diagnosis of carcinoma, but the identification of the primary depends on additional clinical evaluation. Around the large group are cells with eccentric cytoplasm (plasmacytoid). The cohesive group coupled with these cells is consistent with lung carcinoma. 20x<\/div>\n<\/div>\n
    Figure 48<\/strong>
    \nNeck lymph node FNA, metastatic carcinoma consistent with lung primary.<\/strong>
    \nThe cell cluster in the middle of the slide is sufficient for the diagnosis of carcinoma, but the identification of the primary depends on additional clinical evaluation. Around the large group are cells with eccentric cytoplasm (plasmacytoid). The cohesive group coupled with these cells is consistent with lung carcinoma.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    Figure 49<\/strong>
    \nNeck lymph node FNA, metastatic lung carcinoma.
    \nThe cohesive group is a three dimensional configuration consistent with adenocarcinoma, lung primary.
    \n40x<\/div>\n<\/div>\n
    Figure 49
    \nNeck lymph node FNA, metastatic lung carcinoma.<\/strong>
    \nThe cohesive group is a three dimensional configuration consistent with adenocarcinoma, lung primary.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 50<\/strong><\/p>\n

    Neck lymph node FNA, metastatic lung carcinoma.
    \nNote the cell in the center with a cytoplasmic vacuole and a single spot of mucin in its centrum. These features are consistent with primary lung adenocarcinoma. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 50<\/strong>
    \nNeck lymph node FNA, metastatic lung carcinoma.<\/strong>
    \nNote the cell in the center with a cytoplasmic vacuole and a single spot of mucin in its centrum. These features are consistent with primary lung adenocarcinoma.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 51<\/strong><\/p>\n

    Supraclavicular lymph node FNA, small cell undifferentiated carcinoma. A very cellular specimen is pictured with a few clusters. The cells are slightly larger than a lymphocyte and are hyperchromatic. No cytoplasm can be seen. This pattern is consistent with small cell carcinoma. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 51<\/strong>
    \nSupraclavicular lymph node FNA, small cell undifferentiated carcinoma.<\/strong>
    \nA very cellular specimen is pictured with a few clusters. The cells are slightly larger than a lymphocyte and are hyperchromatic. No cytoplasm can be seen. This pattern is consistent with small cell carcinoma .
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 52<\/strong><\/p>\n

    Supraclavicular lymph node FNA, small cell undifferentiated carcinoma.
    \nThe group in the center exhibits nuclear molding. The mild pleomorphism, the marked increase in N\/C ratio and the lack of nucleoli all point to small cell carcinoma. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 52<\/strong>
    \nSupraclavicular lymph node FNA, small cell undifferentiated carcinoma.<\/strong>
    \nThe group in the center exhibits nuclear molding. The mild pleomorphism, the marked increase in N\/C ratio and the lack of nucleoli all point to small cell carcinoma.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 53<\/strong><\/p>\n

    Supraclavicular lymph node FNA, small cell undifferentiated carcinoma.
    \nNotice the lack of crush artifact. The cells are well preserved and again have all the features of small cell carcinoma. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 53<\/strong>
    \nSupraclavicular lymph node FNA, small cell undifferentiated carcinoma.<\/strong>
    \nNotice the lack of crush artifact. The cells are well preserved and again have all the features of small cell carcinoma.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 54<\/strong><\/p>\n

    Lymph node FNA, metastatic endometrial adenocarcinoma.
    \nThis would be a staging FNA. It would not commonly be for an unsuspected tumor workup. Two large clusters of tightly cohesive cells that do not belong in a lymph node are present, thus establishing metastatic carcinoma. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 54<\/strong>
    \nLymph node FNA, metastatic endometrial adenocarcinoma.<\/strong>
    \nThis would be a staging FNA. It would not commonly be for an unsuspected tumor workup. Two large clusters of tightly cohesive cells that do not belong in a lymph node are present, thus establishing metastatic carcinoma.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 55<\/strong><\/p>\n

    Lymph node FNA, metastatic endometrial adenocarcinoma.
    \nThe cluster in the lower half of the photo has pleomorphic nuclei with prominent nucleoli and nuclear material plastered against the nuclear membrane. The N\/C ratio is high. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 55<\/strong>
    \nLymph node FNA, metastatic endometrial adenocarcinoma.<\/strong>
    \nThe cluster in the lower half of the photo has pleomorphic nuclei with prominent nucleoli and nuclear material plastered against the nuclear membrane. The N\/C ratio is high.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 56<\/strong><\/p>\n

    Lymph node FNA, metastatic endometrial adenocarcinoma.
    \nThe ball like feel to the cluster is present and the clarity of the cells is impressive. Note the clearing of the nuclear material, as it all seems to be located on the nuclear membrane. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 56<\/strong>
    \nLymph node FNA, metastatic endometrial adenocarcinoma.<\/strong>
    \nThe ball like feel to the cluster is present and the clarity of the cells is impressive. Note the clearing of the nuclear material, as it all seems to be located on the nuclear membrane.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 57<\/strong><\/p>\n

    Lymph node FNA, metastatic endometrial adenocarcinoma.
    \nThis sheet of malignant cells again shows the same nuclear features and also displays cytoplasmic vacuolization. Note the irregularity of the nuclear membranes and prominent nucleoli that can be seen in this photo. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 57<\/strong>
    \nLymph node FNA, metastatic endometrial adenocarcinoma.<\/strong>
    \nThis sheet of malignant cells again shows the same nuclear features and also displays cytoplasmic vacuolization. Note the irregularity of the nuclear membranes and prominent nucleoli that can be seen in this photo.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 58<\/strong><\/p>\n

    Neck lymph node FNA, metastatic papillary carcinoma of the thyroid.
    \nAn irregular cohesive cluster of cells within a lymph node establishes the diagnosis of carcinoma. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 58<\/strong>
    \nNeck lymph node FNA, metastatic papillary carcinoma of the thyroid.<\/strong>
    \nAn irregular cohesive cluster of cells within a lymph node establishes the diagnosis of carcinoma.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 59<\/strong><\/p>\n

    Neck lymph node FNA, metastatic papillary carcinoma of the thyroid.
    \nThese malignant cells, while showing hyperchromasia, nucleoli, increased N\/C ratio and clumping of chromatin, give no indication as to the primary site. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 59<\/strong>
    \nNeck lymph node FNA, metastatic papillary carcinoma of the thyroid.<\/strong>
    \nThese malignant cells, while showing hyperchromasia, nucleoli, increased N\/C ratio and clumping of chromatin, give no indication as to the primary site.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 60<\/strong><\/p>\n

    Neck lymph node FNA, metastatic papillary carcinoma of the thyroid. A large cohesive cluster of cells is present. The cells are mildly hyperchromatic and have some cytoplasm. Minimal pleomorphism is present. The diagnosis of carcinoma is established because this is a cohesive cell group is within a lymph node. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 60<\/strong>
    \nNeck lymph node FNA, metastatic papillary carcinoma of the thyroid.<\/strong>
    \nA large cohesive cluster of cells is present. The cells are mildly hyperchromatic and have some cytoplasm. Minimal pleomorphism is present. The diagnosis of carcinoma is established because this is a cohesive cell group is within a lymph node.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 61<\/strong><\/p>\n

    Neck lymph node FNA, metastatic papillary carcinoma of the thyroid. Notice the blandness of the nuclear chromatin which is characteristic of papillary thyroid carcinoma. An intra-cytoplasmic inclusion is present within one nucleus. At this magnification there is more pleomorphism than was seen at the lower power. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 61<\/strong>
    \nNeck lymph node FNA, metastatic papillary carcinoma of the thyroid.<\/strong>
    \nNotice the blandness of the nuclear chromatin which is characteristic of papillary thyroid carcinoma. An intra-cytoplasmic inclusion is present within one nucleus. At this magnification there is more pleomorphism than was seen at the lower power.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 62<\/strong><\/p>\n

    Neck lymph node FNA, metastatic papillary carcinoma of the thyroid.
    \nThe nucleus with one intranuclear inclusion, the blandness of the nuclei and small nucleoli all are consistent with a papillary carcinoma metastasis. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 62<\/strong>
    \nNeck lymph node FNA, metastatic papillary carcinoma of the thyroid.<\/strong>
    \nThe nucleus with one intranuclear inclusion, the blandness of the nuclei and small nucleoli all are consistent with a papillary carcinoma metastasis.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 63<\/strong><\/p>\n

    Neck lymph node FNA, metastatic papillary carcinoma of the thyroid.
    \nA large intranuclear inclusion is present. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 63<\/strong>
    \nNeck lymph node FNA, metastatic papillary carcinoma of the thyroid.<\/strong>
    \nA large intranuclear inclusion is present.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 64<\/strong><\/p>\n

    Lymph node FNA, reactive lymphoid hyperplasia. A FNA of a lymph node may yield small irregular clusters of macrophages and lymphocytes. These should not be misinterpreted as an epithelial neoplasm. There are two such clusters here along with many other small round cells of varying sizes. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 64<\/strong>
    \nLymph node FNA, reactive lymphoid hyperplasia.<\/strong>
    \nA FNA of a lymph node may yield small irregular clusters of macrophages and lymphocytes. These should not be misinterpreted as an epithelial neoplasm. There are two such clusters here along with many other small round cells of varying sizes.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 65<\/strong><\/p>\n

    Lymph node FNA, reactive.
    \nOne cluster contains macrophages with intracytoplasmic pigment, so called tingible body macrophages. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 65<\/strong>
    \nLymph node FNA, reactive.<\/strong>
    \nOne cluster contains macrophages with intracytoplasmic pigment, so called tingible body macrophages.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 66<\/strong><\/p>\n

    Lymph node FNA, reactive.
    \nThe three tingible body macrophages are shown at high magnification. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 66<\/strong>
    \nLymph node FNA, reactive.<\/strong>
    \nThe three tingible body macrophages are shown at high magnification.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 67<\/strong><\/p>\n

    Lymph node FNA, reactive. There is a range of maturation of lymphocytes seen. Small mature lymphocytes, slightly larger and very large lymphocytes are present. A mitotic nucleus can be seen. Tingible body macrophages and a range of maturation make the diagnosis of reactive hyperplasia. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 67<\/strong>
    \nLymph node FNA, reactive.<\/strong>
    \nThere is a range of maturation of lymphocytes seen. Small mature lymphocytes, slightly larger and very large lymphocytes are present. A mitotic nucleus can be seen. Tingible body macrophages and a range of maturation make the diagnosis of reactive hyperplasia.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 68<\/strong><\/p>\n

    Lymph node FNA, atypical lymphoid proliferation.
    \nThe specimen is cellular and when compared to small lymphocyte a the majority of cells are slightly larger than this cell. The monotony of the sample is worrisome. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 68<\/strong>
    \nLymph node FNA, atypical lymphoid proliferation.<\/strong>
    \nThe specimen is cellular and when compared to a small lymphocyte the majority of cells are slightly larger than this cell. The monotony of the sample is worrisome.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 69<\/strong><\/p>\n

    Lymph node FNA, atypical lymphoid proliferation.
    \nOnce again when a small lymphocyte is picked out, the majority of cells are larger. There is no range of maturity in this specimen. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 69<\/strong>
    \nLymph node FNA, atypical lymphoid proliferation.<\/strong>
    \nOnce again when a small lymphocyte is picked out, the majority of cells are larger. There is no range of maturity in this specimen.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 70<\/strong><\/p>\n

    Lymph node FNA, atypical lymphoid proliferation.
    \nA beautiful preparation. The nuclei are all oval with no nicks or cuts. The nucleoli are small and not hyperchromatic. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 70<\/strong>
    \nLymph node FNA, atypical lymphoid proliferation.<\/strong>
    \nA beautiful preparation. The nuclei are all oval with no nicks or cuts. The nucleoli are small and not hyperchromatic.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 71<\/strong><\/p>\n

    Lymph node FNA, atypical lymphoid proliferation.
    \nMonotony, e.g. similar sized lymphocytes and the lack of tingible body macrophages, are the features of this atypical lymphoid proliferation. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 71<\/strong>
    \nLymph node FNA, atypical lymphoid proliferation.<\/strong>
    \nMonotony, e.g. similar sized lymphocytes and the lack of tingible body macrophages, are the features of this atypical lymphoid proliferation.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 72<\/strong><\/p>\n

    Lymph node FNA, malignant lymphoma.
    \nThis specimen is cellular with all cells scattered throughout the photo. Compare a small mature lymphocyte with the vast majority of the rest of the cells that are slightly enlarged. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 72<\/strong>
    \nLymph node FNA, malignant lymphoma.<\/strong>
    \nThis specimen is cellular with all cells scattered throughout the photo. Compare a small mature lymphocyte with the vast majority of the rest of the cells that are slightly enlarged.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 73<\/strong><\/p>\n

    Lymph node FNA, malignant lymphoma.
    \nAt this magnification, irregularities can be seen in the nuclei and large red nucleoli are present in the majority of cells. All these cells are roughly the same size and are larger than the mature lymphocyte in the lower right corner. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 73<\/strong>
    \nLymph node FNA, malignant lymphoma.<\/strong>
    \nAt this magnification, irregularities can be seen in the nuclei and large red nucleoli are present in the majority of cells. All these cells are roughly the same size and are larger than the mature lymphocyte in the lower right corner.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 74<\/strong><\/p>\n

    Lymph node FNA, malignant lymphoma.
    \nHigher magnification exhibits the same features but with more clarity.
    \n60x<\/p>\n<\/div>\n<\/div>\n

    Figure 74<\/strong>
    \nLymph node FNA, malignant lymphoma.<\/strong>
    \nHigher magnification exhibits the same features but with more clarity.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 75<\/strong><\/p>\n

    Lymph node FNA, Hodgkin’s disease.
    \nA cellular specimen is pictured with the vast majority of cells being small round lymphocytes, but with two large bizarre cells that at this magnification are consistent with Reed-Sternberg cells. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 75<\/strong>
    \nLymph node FNA, Hodgkin’s disease.<\/strong>
    \nA cellular specimen is pictured with the vast majority of cells being small round lymphocytes, but with two large bizarre cells that at this magnification are consistent with Reed-Sternberg cells.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 76<\/strong><\/p>\n

    Lymph node FNA, Hodgkin’s disease.
    \nClassic Reed Sternberg cells are diagnostic of Hodgkin’s disease with the associated characteristic background of inflammatory cells. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 76<\/strong>
    \nLymph node FNA, Hodgkin’s disease.<\/strong>
    \nClassic Reed Sternberg cells are diagnostic of Hodgkin’s disease with the associated characteristic background of inflammatory cells.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 77<\/strong><\/p>\n

    Lymph node FNA, Hodgkin’s disease.
    \nThe small lymphocytes present have no atypical features as would be expected. The two large bizarre cells have the “mirror image” features of Reed-Sternberg cells. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 77<\/strong>
    \nLymph node FNA, Hodgkin’s disease.<\/strong>
    \nThe small lymphocytes present have no atypical features as would be expected. The two large bizarre cells have the “mirror image” features of Reed-Sternberg cells.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 78<\/strong><\/p>\n

    Lymph node FNA, Hodgkin’s disease.
    \nA multinucleated, irregular, highly atypical cell is present. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 78<\/strong>
    \nLymph node FNA, Hodgkin’s disease.<\/strong>
    \nA multinucleated, irregular, highly atypical cell is present.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 79<\/strong><\/p>\n

    Lymph node FNA, Hodgkin’s disease.
    \nTwo large highly atypical cells are present. These are not diagnostic of Hodgkin’s disease but strongly suggest that the specimen should be carefully examined for more characteristic Reed-Sternberg cells. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 79<\/strong>
    \nLymph node FNA, Hodgkin’s disease.<\/strong>
    \nTwo large highly atypical cells are present. These are not diagnostic of Hodgkin’s disease but strongly suggest that the specimen should be carefully examined for more characteristic Reed-Sternberg cells.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 80<\/strong><\/p>\n

    Neck FNA, plasmacytoma.
    \nSingle cells with abundant cytoplasm and an eccentric nucleus are present. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 80<\/strong>
    \nNeck FNA, plasmacytoma.<\/strong>
    \nSingle cells with abundant cytoplasm and an eccentric nucleus are present.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 81<\/strong><\/p>\n

    Neck FNA, plasmacytoma.
    \nThe nuclei are relatively small with smooth nuclear membranes and chromatin that is evenly dispersed. Small nucleoli are present in several of the cells. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 81<\/strong>
    \nNeck FNA, plasmacytoma.<\/strong>
    \nThe nuclei are relatively small with smooth nuclear membranes and chromatin that is evenly dispersed. Small nucleoli are present in several of the cells.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 82<\/strong><\/p>\n

    Neck FNA, plasmacytoma.
    \nA higher magnification is shown here and it reflects the diagnosis of malignant plasma cells. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 82<\/strong>
    \nNeck FNA, plasmacytoma.<\/strong>
    \nA higher magnification is shown here and it reflects the diagnosis of malignant plasma cells.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 83<\/strong><\/p>\n

    Parotid FNA, Warthin tumor (adenolymphoma).
    \nEpithelial and lymphoid components of this benign neoplasm are seen at screening magnification. 10x<\/p>\n<\/div>\n<\/div>\n

    Figure 83<\/strong>
    \nParotid FNA, Warthin tumor (adenolymphoma).<\/strong>
    \nEpithelial and lymphoid components of this benign neoplasm are seen at screening magnification.
    \n10x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 84<\/strong><\/p>\n

    Parotid FNA, Warthin tumor (adenolymphoma).
    \nSheets of oxyphilic cells with abundant granular cytoplasm were present. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 84<\/strong>
    \nParotid FNA, Warthin tumor (adenolymphoma).<\/strong>
    \nSheets of oxyphilic cells with abundant granular cytoplasm were present.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 85<\/strong><\/p>\n

    Parotid FNA, Warthin tumor (adenolymphoma).
    \nLymphocytes are admixed with oxyphilic cells in a background of amorphous debris. 95% of Warthin tumors occur in the parotid gland. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 85<\/strong>
    \nParotid FNA, Warthin tumor (adenolymphoma).<\/strong>
    \nLymphocytes are admixed with oxyphilic cells in a background of amorphous debris. 95% of Warthin tumors occur in the parotid gland.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 86<\/strong><\/p>\n

    Salivary gland FNA, pleomorphic adenoma. At the central upper portion of the photo is an irregular grouping of epithelial cells with oval bland nuclei. Some have very tiny nucleoli. Immediately beneath this is stroma and a few single stromal cells. Pleomorphic adenoma is the most common salivary gland tumor. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 86<\/strong>
    \nSalivary gland FNA, pleomorphic adenoma.<\/strong>
    \nAt the central upper portion of the photo is an irregular grouping of epithelial cells with oval bland nuclei. Some have very tiny nucleoli. Immediately beneath this is stroma and a few single stromal cells. Pleomorphic adenoma is the most common salivary gland tumor.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 87<\/strong><\/p>\n

    Salivary gland FNA, pleomorphic adenoma.
    \nThe fibrillar nature of the stroma is clearly seen. There is a mixture of epithelium with stromal cells at the bottom of the stroma. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 87<\/strong>
    \nSalivary gland FNA, pleomorphic adenoma.<\/strong>
    \nThe fibrillar nature of the stroma is clearly seen. There is a mixture of epithelium with stromal cells at the bottom of the stroma.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 88<\/strong><\/p>\n

    Salivary gland FNA, pleomorphic adenoma.
    \nStroma can be seen both outside the cells (right side of the photo) and in intimate association with the cells. The epithelial nuclei appear organized and bland. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 88<\/strong>
    \nSalivary gland FNA, pleomorphic adenoma.<\/strong>
    \nStroma can be seen both outside the cells (right side of the photo) and in intimate association with the cells. The epithelial nuclei appear organized and bland.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 89<\/strong><\/p>\n

    Parotid FNA, pleomorphic adenoma.
    \nIn the center is a large cluster of crowded, difficult to see, epithelial cells. Those seen are bland. Around the epithelial cells is stroma in with embedded single stromal cells. The fibrillar nature of the stroma is appreciated. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 89<\/strong>
    \nParotid FNA, pleomorphic adenoma.<\/strong>
    \nIn the center is a large cluster of crowded, difficult to see, epithelial cells. Those seen are bland. Around the epithelial cells is stroma in with embedded single stromal cells. The fibrillar nature of the stroma is appreciated.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 90<\/strong><\/p>\n

    Parotid FNA, pleomorphic adenoma.
    \nFibrillar stroma with epithelial cells is characteristic of pleomorphic adenoma. The association of epithelial cells and the fibrillar stroma is seen here. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 90<\/strong>
    \nParotid FNA, pleomorphic adenoma.<\/strong>
    \nFibrillar stroma with epithelial cells is characteristic of pleomorphic adenoma. The association of epithelial cells and the fibrillar stroma is seen here.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 91<\/strong><\/p>\n

    Parotid FNA, pleomorphic adenoma.
    \nBeautiful photo of the intimate association of epithelial cells, stromal cells and fibrillar stroma. Pleomorphic adenomas are slow growing tumors which may reoccur if not completely excised. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 91<\/strong>
    \nParotid FNA, pleomorphic adenoma.<\/strong>
    \nBeautiful photo of the intimate association of epithelial cells, stromal cells and fibrillar stroma. Pleomorphic adenomas are slow growing tumors which may reoccur if not completely excised.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 92<\/strong><\/p>\n

    Parotid FNA, small cell carcinoma. When a small lymphocyte is picked out, the cluster of cells in the center and the smaller group just to the right of it both contain cells that are larger than the lymphocyte. Distinct hyperchromasia is present in both clusters. The background is necrotic. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 92<\/strong>
    \nParotid FNA, small cell carcinoma.<\/strong>
    \nWhen a small lymphocyte is picked out, the cluster of cells in the center and the smaller group just to the right of it both contain cells that are larger than the lymphocyte. Distinct hyperchromasia is present in both clusters. The background is necrotic.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 93<\/strong><\/p>\n

    Parotid FNA, small cell carcinoma.
    \nThe large cluster is a tightly bound, disordered group of cells. The nuclei are smudged and hyperchromatic. No cytoplasm is seen. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 93<\/strong>
    \nParotid FNA, small cell carcinoma.<\/strong>
    \nThe large cluster is a tightly bound, disordered group of cells. The nuclei are smudged and hyperchromatic. No cytoplasm is seen.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 94<\/strong><\/p>\n

    Parotid FNA, small cell carcinoma.
    \nThe pleomorphism of small cell carcinoma is present here. Characteristic salt and pepper chromatin is present. No nucleoli are present. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 94<\/strong>
    \nParotid FNA, small cell carcinoma.<\/strong>
    \nThe pleomorphism of small cell carcinoma is present here. Characteristic salt and pepper chromatin is present. No nucleoli are present.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 95<\/strong><\/p>\n

    Parotid FNA, lymphoma.
    \nThe specimen is cellular with a dirty background. Standing out are large single cells scattered within the photo. The cells are oval with minimal or no cytoplasm and have prominent nucleoli. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 95<\/strong>
    \nParotid FNA, lymphoma.<\/strong>
    \nThe specimen is cellular with a dirty background. Standing out are large single cells scattered within the photo. The cells are oval with minimal or no cytoplasm and have prominent nucleoli.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 96<\/strong><\/p>\n

    Parotid FNA, lymphoma.
    \nThese large cells have minimal cytoplasm. One nucleus has a “bite” out of it. The nucleoli are large and not oval. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 96<\/strong>
    \nParotid FNA, lymphoma.<\/strong>
    \nThese large cells have minimal cytoplasm. One nucleus has a “bite” out of it. The nucleoli are large and not oval.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 97<\/strong><\/p>\n

    Parotid FNA, lymphoma.
    \nSingle cells with large nuclei and large irregular nucleoli are present. The nuclear membranes are irregular. Minimal cytoplasm is present. A mitotic figure is shown. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 97<\/strong>
    \nParotid FNA, lymphoma.<\/strong>
    \nSingle cells with large nuclei and large irregular nucleoli are present. The nuclear membranes are irregular. Minimal cytoplasm is present. A mitotic figure is shown.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 98<\/strong><\/p>\n

    Parotid FNA, lymphoma.
    \nLarge pleomorphic cells are arranged singly. Nuclei have nipples or noses. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 98<\/strong>
    \nParotid FNA, lymphoma.<\/strong>
    \nLarge pleomorphic cells are arranged singly. Nuclei have nipples or noses.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 99<\/strong><\/p>\n

    Parotid FNA, lymphoma.
    \nSingle malignant cells are seen here. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 99<\/strong>
    \nParotid FNA, lymphoma.<\/strong>
    \nSingle malignant cells are seen here.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 100<\/strong><\/p>\n

    Axillary lymph node FNA, metastatic breast carcinoma. A tight cluster of epithelial cells in the lymph node establishes that metastatic disease is present. The cells are large with irregular hyperchromatic nuclei and prominent nucleoli. Pleomorphism is marked. Nuclear membrane irregularity is present. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 100<\/strong>
    \nAxillary lymph node FNA, metastatic breast carcinoma.<\/strong>
    \nA tight cluster of epithelial cells in the lymph node establishes that metastatic disease is present. The cells are large with irregular hyperchromatic nuclei and prominent nucleoli. Pleomorphism is marked. Nuclear membrane irregularity is present.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 101<\/strong><\/p>\n

    Axillary lymph node FNA, metastatic breast carcinoma.
    \nNote the dense cytoplasm with a columnar look at the upper right corner. 60x<\/p>\n<\/div>\n<\/div>\n

    \n

    Figure 101<\/strong>
    \nAxillary lymph node FNA, metastatic breast carcinoma.<\/strong><\/p>\n

    Note the dense cytoplasm with a columnar look at the upper right corner.
    \n60x<\/p>\n<\/div>\n

    <\/div>\n

    \n\"Image<\/a><\/p>\n
    Figure 102 <\/strong>Axillary lymph node FNA, metastatic breast carcinoma. Many cells that are not normal for a lymph node are present. Note the lymphocyte for size comparison. The largest cell is huge and clearly malignant. It appears to be a tumor giant cell at this power. A single cluster of cells is present in the upper portion that suggests the epithelial nature of this lesion. Several single cells with large nuclei and minimal cytoplasm are present in the lower portion. 20x<\/div>\n<\/div>\n
    Figure 102<\/strong>
    \nAxillary lymph node FNA, metastatic breast carcinoma.<\/strong>
    \nMany cells that are not normal for a lymph node are present. Note the lymphocyte for size comparison. The largest cell is huge and clearly malignant. It appears to be a tumor giant cell at this power. A single cluster of cells is present in the upper portion that suggests the epithelial nature of this lesion. Several single cells with large nuclei and minimal cytoplasm are present in the lower portion of the photo.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 103<\/strong><\/p>\n

    Axillary lymph node FNA, metastatic breast carcinoma.
    \nThe tumor giant cell and the single malignant cells are more clearly visualized. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 103<\/strong>
    \nAxillary lymph node FNA, metastatic breast carcinoma.<\/strong>
    \nThe tumor giant cell and the single malignant cells are more clearly visualized.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 104<\/strong><\/p>\n

    Axillary lymph node FNA, metastatic breast carcinoma.
    \nThe epithelial nature of the malignancy is revealed by the clustering of the malignant cells. Notice the pleomorphism, marked irregularity of the nuclei and prominent nucleoli. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 104<\/strong>
    \nAxillary lymph node FNA, metastatic breast carcinoma.<\/strong>
    \nThe epithelial nature of the malignancy is revealed by the clustering of the malignant cells. Notice the pleomorphism, marked irregularity of the nuclei and prominent nucleoli.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 105<\/strong><\/p>\n

    Axillary lymph node FNA, metastatic breast carcinoma.
    \nAt the left is a cluster of epithelial cells that establishes the diagnosis of metastatic carcinoma. A tumor giant cell is present in the center. A scattering of other single malignant cells is present and the background is necrotic. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 105<\/strong>
    \nAxillary lymph node FNA, metastatic breast carcinoma.<\/strong>
    \nAt the left is a cluster of epithelial cells that establishes the diagnosis of metastatic carcinoma. A tumor giant cell is present in the center. A scattering of other single malignant cells is present and the background is necrotic.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 106<\/strong><\/p>\n

    Axillary lymph node FNA, metastatic breast carcinoma.
    \nA closer look at the giant cell and the single malignant cell. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 106<\/strong>
    \nAxillary lymph node FNA, metastatic breast carcinoma.<\/strong>
    \nA closer look at the giant cell and the single malignant cell.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 107<\/strong><\/p>\n

    Axillary lymph node FNA, metastatic breast carcinoma.
    \nThe tumor giant cell has large irregular nuclei. A slight plasmacytoid suggestion is present in some of the single cells. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 107<\/strong>
    \nAxillary lymph node FNA, metastatic breast carcinoma.<\/strong>
    \nThe tumor giant cell has large irregular nuclei. A slight plasmacytoid suggestion is present in some of the single cells.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 108<\/strong><\/p>\n

    Axillary lymph node FNA, metastatic breast carcinoma.
    \nA cluster of malignant cells with the features of pleomorphism, nuclear membrane irregularity and mild hyperchromasia is present. Note the prominent nucleoli. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 108<\/strong>
    \nAxillary lymph node FNA, metastatic breast carcinoma.<\/strong>
    \nA cluster of malignant cells with the features of pleomorphism, nuclear membrane irregularity and mild hyperchromasia is present. Note the prominent nucleoli.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 109<\/strong><\/p>\n

    Axillary lymph node FNA, metastatic breast carcinoma. Apart from the single cluster at the lower left, all the cells seen are arranged singly. By far the most impressive is the huge malignant giant cell in the center of the picture. However, note at its right, a nice plasmacytoid cell is also present. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 109<\/strong>
    \nAxillary lymph node FNA, metastatic breast carcinoma.<\/strong>
    \nApart from the single cluster at the lower left, all the cells seen are arranged singly. By far the most impressive is the huge malignant giant cell in the center of the picture. However, note at its right, a nice plasmacytoid cell is also present.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 110<\/strong><\/p>\n

    Axillary lymph node FNA, metastatic breast carcinoma.
    \nA giant cell and the plasmacytoid cells are seen more clearly. 40x<\/p>\n<\/div>\n<\/div>\n

    Figure 110<\/strong>
    \nAxillary lymph node FNA, metastatic breast carcinoma.<\/strong>
    \nA giant cell and the plasmacytoid cells are seen more clearly.
    \n40x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 111<\/strong><\/p>\n

    Axillary lymph node FNA, metastatic breast carcinoma.
    \nThe most important cell is the one in the center. A mucin drop in a vacuole is present in that malignant cell. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 111<\/strong>
    \nAxillary lymph node FNA, metastatic breast carcinoma.<\/strong>
    \nThe most important cell is the one in the center. A mucin drop in a vacuole is present in that malignant cell.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 112<\/strong><\/p>\n

    Thymus fine needle aspiration, atypical carcinoid.
    \nAt screening power the aspirate appears abundantly cellular. 20x<\/p>\n<\/div>\n<\/div>\n

    Figure 112<\/strong>
    \nThymus fine needle aspiration, atypical carcinoid.<\/strong>
    \nAt screening power the aspirate appears abundantly cellular.
    \n20x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 113<\/strong><\/p>\n

    Thymus fine needle aspiration, atypical carcinoid.
    \nNuclei often display small nucleoli and stippled chromatin. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 113<\/strong>
    \nThymus fine needle aspiration, atypical carcinoid.<\/strong>
    \nNuclei often display small nucleoli and stippled chromatin.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 114<\/strong><\/p>\n

    Thymus fine needle aspiration, atypical carcinoid.
    \nCells are arranged in small clusters or appear singly. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 114<\/strong>
    \nThymus fine needle aspiration, atypical carcinoid.<\/strong>
    \nCells are arranged in small clusters or appear singly.
    \n60x<\/div>\n
    <\/div>\n

    \n\"Image<\/a><\/p>\n
    \n

    Figure 115<\/strong><\/p>\n

    Thymus fine needle aspiration, atypical carcinoid.
    \nCytoplasm is scant to moderately abundant. 60x<\/p>\n<\/div>\n<\/div>\n

    Figure 115<\/strong>
    \nThymus fine needle aspiration, atypical carcinoid.<\/strong>
    \nCytoplasm is scant to moderately abundant.
    \n60x<\/div>\n<\/div>\n
    <\/div>\n

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