Good afternoon Curofians on this breezy sunday. Hope y'all enjoying your holiday. Case details : 13 year old female, diffuse mass over right paravertebral region on the back. Swelling soft and ill defined. Swelling roughly measured 6x4 cms. FNAC done, aspirated blood mixed granular white material, easy to spread. USG not affordable by the patient. Attached 12 slides. What is your cytodiagnosis? Give precise description, differential diagnosis, further workup and your suggestions. Thank you, Best regards. [Credit : Dr.Kazi Wajid Husain.,MD]

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Respected sir, thank you for sharing this case Smears from a paravertebral mass is highly cellular and show branching sheets, clusters and singly scattered oval to round cells with hyperchromatic nuclei, regular uniformly dispersed chromatin exhibiting mild anisonucleosis and moderate to scant cytoplasm. Few rosettes or acini formation are noted. Occasional mitotic fig are seen. No necrosis is noted. No multinucleate cells or myxoid background or neurophil background or lymphoglandular bodies are seen. Impression : FNA from paravertebral mass showing a SMALL ROUND CELL TUMOUR. D/D: 1. Ewing/PNET 2. Alveolar RMS 3. Synovial sarcoma 4. Rare : DSRCT, Small cell Osteosarcoma, lymphoma/leukaemia, Rhabdoid tumour. Suggestions : 1. Core biopsy with IHC for Subtyping. Panel: CK, VIMENTIN, LCA, MYOGENIN, CD99, BCL2, TLE 1 2. Sir, requires radiological correlation (MRI scan to look for plane of the swelling, nature and necrosis, etc) Thank you sir. Regards...
Revered Dr. Sivaganesh sir, We are almost done.. Excellent description and interpretation, we couldn't have asked for more. Given a single option to select a diagnosis among your differentials, what would you choose based on the age, clinical site and crisp cytological details as described by you. And what is your opinion regarding the tumor cell orientation towards vessels. Thank you sir.
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Excellent description by Dr Porko and I am totally agree with him.. Smears are cellular and showing malignant cells arranged diffusely and in sheets. The cells have minimal pleomorphism with round to oval nuclei, moderate to scanty cytoplasm, dispersed chromatin. Rosetting present (fig 10). Vascular proliferation noted. No necrosis. Few mirotic figure seen. Opinion: Small round blue cell tumor. Among the differential diagnosis, depending upon age of patient, location and microscopy- I will go for EWING'S SARCOMA/ PNET.
cellular smears. Most of the cells are arranged in papillary , branching pattern. occasional acini are noted. cells are uniform. Hyperchromatic nuclei. mild anisonucleosis and scanty cytoplasm.. possibility of 1. synovial sarcoma 2. Alveolar RMS 3. Rule out RCC papillary form. Though it is rare in this age 4. secondary deposit from papillary carcinoma thyroid require radiological correlation
Very well explained by Dr. Porko.
sir might be round cell tumor
Adding few more points to be considered, comment on : calcification, background matrix, associated inflammatory infiltrate. No nuclear features of PTC noted. Monotony of cells : other DDs : Ependymoma, Neuroendocrine tumours. Radiology findings are essential. * Excellent job done by Dr.Porko.
Sir, my differentials for this case are ewing's sarcoma/pnet and based on site, monomorphic cells with minimal pleomorphism and no mitosis (not identified in these pics) I'll keep carcinoid also as differential...
Small round cell tumour ok Remarkable findings on morphology are splayin of tumour cells around capillaries eccentrically placed nuclei,with nucleoli.tapering cytoplasmic end. ?Neural PNET ?? ewings
Revered Sir, features are suggestive of small round cell tumour..... possibly Emings based on age clinical findings and features. thanks
Very good description by Dr Sivaganesh. Very informative. I am not good in pathology. So I can't comment
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