We do not have any affiliations or financial interests in any of the corporate organizations involved with the products to which our case study will refer.Disclosure for Education Planners

Continuing Medical Education (CME): The American Society of Cytopathology is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.The American Society of Cytopathology designates this enduring educational activity for a maximum of 1 AMA PRA Category 1 credit(s).TM Physicians should only claim credit commensurate with the extent of their participation in the activity. American Board of Pathology Continuing Certification (CC): This product can help fulfill the CME requirements and Self-Assessment Modules (SAMs) mandated by the American Board of Pathology CC process.Continuing Medical Laboratory Education (CMLE): The ASC designates this activity for the indicated number of CMLE credit hours and also fulfills requirements of the ABMS to participate in the Maintenance of Certification program.This program is approved for continuing education credits in the State of Florida for 1 credit and the State of California for ½ credit.

Disclosure for Education Planners

Review the Case Study and visit the ASC Web site (https://education.cytopathology.org/) to take the test for Continuing Education Credit.

Clinical History

A 29-year old female with incidentally discovered left retroperitoneal mass during workup for nausea and vomiting. A non-contrast CT scan shows a 5.1 cm left retroperitoneal mass at the level of the mid and lower pole of the left kidney. A CT-guided fine needle aspiration and core biopsy of the mass were performed and sent for cytopathological evaluation.

Cytopathology Features

Fine needle aspiration biopsy of ganglioneuroma usually will reveal scant fragments of tissue consisting of loose fibrillary matrix embedded with spindle-shaped Schwann cells demonstrating wavy, uniform, elongated nuclei with fine chromatin and delicate ill-defined cytoplasm. Scattered mature ganglion cells with abundant granular, well-defined, eosinophilic cytoplasm, large nuclei with vesicular chromatin; and prominent nucleoli are also identified. Mitotic figures, necrosis, and atypia are not usually observed.

Figure 2: Diff-Quik stain, 40X
Figure 1: Diff-Quik, 40X
Figure 3: Cell Block, 40X

Saeed Asiry, MBBS
Vira Wolf, MD, MS, SCT(ASCP),
Lenox Hill Hospital, New York, NY