Non Gyne Cytopathology: Practice Question

Which of the following cytologic features in malignant pleural effusion is most consistent with metastatic breast ductal adenocarcinoma?
  1. Papillary fragment with psammomatous calcifications.
  2. Small cell clusters in mucinous effusion
  3. Picket fence arrangement of columnar cells
  4. Large hollow spherical cell aggregates
  5. Large, elongated cells with pyknotic hyperchromatic nuclei
Show Answer and Explanations

Papillary fragment with psammomatous calcifications.

Incorrect. This feature can be seen in papillary carcinoma of the thyroid, breast, and ovary.

Small cell clusters in mucinous effusion

Incorrect. Metastatic mucinous carcinoma of the breast may cause this feature.

Picket fence arrangement of columnar cells

Incorrect. This is a feature of endocervical adenocarcinoma in situ in PAP smear.

Large hollow spherical cell aggregates — Correct answer

Correct. Metastatic ductal carcinoma causes a two-cell population look, with cell balls showing smooth community border, three dimensional tight clusters with nuclear overlapping and nuclear molding.

Large, elongated cells with pyknotic hyperchromatic nuclei

Incorrect. These are features of squamous cell carcinoma usually seen in pap smears.

Summary

Summary: Metastatic breast ductal adenocarcinoma in pleural effusions characteristically shows large hollow spherical cell aggregates (cell balls) with smooth community borders, three-dimensional tight clusters with nuclear overlapping and nuclear molding, and a two-cell population appearance. These features help distinguish it from other malignancies that may present in pleural effusions.
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