What is the most likely diagnosis given the following cytology specimen from the lung?
Cytology specimen from the lung.
Acute bacterial pneumonia
Squamous cell carcinoma
Adenocarcinoma
Small cell carcinoma
Reactive changes
Show Answer and Explanations
Acute bacterial pneumonia — Correct answer
Correct. The specimen consists primarily of neutrophils and macrophages. A careful hunt for malignant cells and cellular debris is warranted, since this could be part of a tumor diathesis.
Squamous cell carcinoma
Incorrect. SCC shows cells with hyperchromasia, irregular nuclear contours, dense cytoplasm, and an irregular arrangement of cells with abnormal forms such as "tadpole cells" or abnormal mitoses.
Adenocarcinoma
Incorrect. Adenocarcinoma tends to have prominent nucleoli, a low N/C ratio, irregular nuclear borders, glandular structures, and cells are typically no multinucleated.
Small cell carcinoma
Incorrect. Small cell carcinoma shows malignant cells (pleomorphic, hyperchromatic nuclei) with "salt and pepper" chromatin, a very high N/C ratio, nuclear molding and crush artifact.
Reactive changes
Incorrect. Reactive atypia shows mildly atypical features, and a major clue is the streaming appearance of the nuclei, like a school of fish.
