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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.

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Clinical History

A 70 year old female had a history of well-differentiated neuroendocrine tumor (WDNET) of the stomach arising from autoimmune metaplastic atrophic gastritis (AMAG). The follow-up positron emission tomography (PET) showed a 2.3 cm right paratracheal lesion, level 4R (superior mediastinum).  A EUS-FNA was performed.  The images of conventional FNA smears are shown in Figure 1.

Cytopathology Features

Overall, the conventional smears were hypercellular. The cells were arranged in cohesive or loosely cohesive clusters as well as flat sheets. The cells were small, uniform in size, round or oval in shape, and had smooth nuclear couture. Papanicolaou stain demonstrated fine chromatin with “salt and pepper” appearance. The background was clean with no necrosis or cellular fragments/ debris. Immunohistochemical (IHC) stains demonstrated positivity for cytokeratin AE1/3, synaptophysin, chromogranin, and GATA3.

Zarine Kamaluddin, MD and Allan Espinoza, MD
The Ohio State University Wexner Medical Center
Columbus, Ohio

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