"Cannonballs" and psammoma bodies: unusual cytologic features of metastatic pulmonary small-cell carcinoma in a pleural effusion Journal Article

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Authors: Conway, A. B.; Hart, M. K.; Jessurun, J.; Pambuccian, S. E.
Article Title: "Cannonballs" and psammoma bodies: unusual cytologic features of metastatic pulmonary small-cell carcinoma in a pleural effusion
Abstract: Large three-dimensional cell aggregates and psammoma bodies are usually encountered in benign serous effusions (mesothelial hyperplasia and endosalpingiosis), mesotheliomas, and metastatic papillary carcinomas. We report a case of pulmonary small-cell carcinoma occurring in an 88-year-old woman that initially presented with a malignant pleural effusion characterized cytologically by a predominance of large three-dimensional neoplastic cell aggregates ("cannonballs"), associated with rare psammoma bodies. Although the crowded three-dimensional tumor-cell aggregates did not allow detailed cytologic examination, the diagnosis of metastatic small-cell carcinoma could be established noting the characteristic chromatin features of the occasional single neoplastic cells and the characteristic "cell-in-cell" and "stack-of-coins" arrangements of rare small clusters of neoplastic cells. Immunoperoxidase stains showing positivity of the tumor cells for CD56, synaptophysin, and TTF1 further supported this diagnosis. Endobronchial ultrasound-guided fine-needle aspiration of a mediastinal lymph node subsequently confirmed the diagnosis of pulmonary small-cell carcinoma. Metastatic pulmonary small-cell carcinoma should be considered in the differential diagnosis of serous effusions showing large three-dimensional neoplastic cell aggregates and psammoma bodies to prevent a potential diagnostic pitfall.
Journal Title: Diagnostic cytopathology
Volume: 41
Issue: 3
ISSN: 1097-0339; 1097-0339
Publisher: Unknown  
Journal Place: United States
Date Published: 2013
Start Page: 247
End Page: 252
Language: eng
DOI/URL:

10.1002/dc.21770

10.1002/dc.21770
Notes: CI: Copyright (c) 2011; JID: 8506895; 2011/04/11 [received]; 2011/05/31 [accepted]; 2011/10/11 [aheadofprint]; ppublish