PMC7568226_01
(a) Contrast-enhanced computed tomography showing a large mildly enhancing anterior mediastinal mass (depicted by arrow) with the right-sided pleural effusion, (b) two distinct population of cells appreciated consisting of small- and medium-sized cells (Papanicolaou x10), (c) higher power shows tumor cells with high N: C ratio, convoluted and lobulated nuclei with scant cytoplasm resembling blasts (Papanicolaou x40), (d) Giemsa stained smear showing the presence of tumor cells with convoluted, lobulated nuclei with scant cytoplasm (Giemsa x40).
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F1
His contrast-enhanced computed tomography suggested a large mildly enhancing anterior mediastinal mass with the right-sided PE [Figure 1a]. One liter of hemorrhagic fluid was received and pleural fluid smears were prepared from centrifuged deposits and examined [Figure 1b-d].
(a) Cell block consisting of monomorphic population of tumor cells with high N: C ratio and scant cytoplasm (hematoxylin and eosin x40), (b) tumor cells showing membranous positivity for leukocyte common antigen (immunohistochemistry [IHC] x10), (c) tumor cells showing membranous positivity for CD3 (IHC x20), (d) tumor cells showing membranous positivity for CD5 (IHC x20), (e) tumor cells showing nuclear positivity for terminal deoxynucleotidyl transferase (IHC x10), (f) tumor cells showing nuclear positivity for KI 67 (IHC x10).
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F2
A cell block was made [Figure 2a], followed by immunohistochemical evaluation utilizing a panel consisting of leukocyte common antigen (LCA), CK, terminal deoxynucleotidyl transferase (TdT), CD3, CD5, CD10, CD19, CD20, CD 30, Bcl2, Bcl6, kappa, lambda, CD117, PLAP, and KI 67. The cells were positive for LCA, Tdt, CD3, CD5, and KI 67 [Figure 2b-f] while the rest of the markers were negative, thus confirming our cytomorphological diagnosis of lymphoblastic lymphoma, T-cell type, which was later confirmed on histopathology.