PMC5576978_01
CT of the thorax with an enlarged station 4R.
gr3.jpg
PMC5576978_01_gr3.jpg
fig3
Fig. 3, Fig. 4.
Subcarinal lymph node aspiration and cell block preparation. a) Haematoxylin/Eosin (H/E) stain in cell block of lymph node material contained numerous lymphoid aggregates (magnification x 40). b) in high power view (magnification x 400) the lymphoid cells were small in size with convoluted or "gyroid" nucleus and abundant clear cytoplasm. c,d) after conventional cytological preparation (Papanikolaou stain) the lymphoid cells were uniform with basophilic dark nucleus (magnification x 200, x 400).
gr5.jpg
PMC5576978_01_gr5.jpg
fig5
The features of the lymphoid cells were like lymphoplsmatoid or monocytoid cells (Fig. 5).
Immunostain for CD20. The neoplastic lymphoid cells were almost totally positive for CD20 (magnification x 400).
gr6.jpg
PMC5576978_01_gr6.jpg
fig6
The majority of neoplastic cells were positive for CD20 (Fig. 6), a B-cell lymphoid marker, supporting the diagnosis of a low grade, non-Hodgkin lymphoma of B-cell origin.
PMC5576978_02
Enlarged 11Linferior lymph node.
gr7.jpg
PMC5576978_02_gr7.jpg
fig7
EBUS was performed and lung cancer (adenocarcinoma) was diagnosed (Fig. 7).
Lung adenocarcinoma. a)Haematoxylin/Eosin (H/E) stain in cell block preparation of the lung tumor, revealed aggregations of large neoplastic cells (magnification x 100). b) Their cytoplasm varied in size and enclosed polymorphous nucleus. The cytoplasm was amphophilic (magnification x 100). c) Papanikolaou stain in lymph node aspiration with neoplastic cells similar of those in lung tumor. The nucleus was enlarged with conspicuous nucleoli (magnification x 400).
gr8.jpg
PMC5576978_02_gr8.jpg
fig8
In cell block (H/E stain), the neoplastic cells performed unequal size with polymorphic nucleus and formed large aggregates with fibrous stroma between them and small sized vessels (Fig. 8a and b). The nucleus was large with eosinophilic nucleoli (Fig. 8c).
Immunostains in lung adenocarcinoma. a) Strong cytoplasmic positivity for CK7 immunostain of neoplastic cells in cell block preparation (magnification x 100). b) atypical adenoid structures were positive for CK 7 (magnification x 100). c, d) the majority of neoplastic cells performed nuclear positivity for TTF-1 (magnification x 200).
gr9.jpg
PMC5576978_02_gr9.jpg
fig9
The immunohistochemical examination confirmed the neoplastic features of an adenocarcinoma with the positivity of CK 7 (Fig. 9a and b) and the lung origin with the positivity of TTF-1 (Fig. 9c and d).
PMC5576978_03
Subcarinal lymph node 22mm.
gr10.jpg
PMC5576978_03_gr10.jpg
fig10
EBUS was performed (Fig. 10). EBUS guided aspiration of the subcarina lymph node and the paraesophagial lump provided cell block material.
Subcarina lymph node aspiration and cell block preparation. a) Haematoxylin/Eosin (H/E) stain in cell block of lymph node material contained numerous lymphoid aggregates (magnification x 40). b) in high power view (magnification x 400) the lymphoid cells were small in size with convoluted or "gyroid" nucleus and abundant clear cytoplasm. c,d) after conventional cytological preparation (Papanikolaou stain) the lymphoid cells were uniform with basophilic dark nucleus (magnification x 200, x 400).
gr11.jpg
PMC5576978_03_gr11.jpg
fig11
Some of them were convoluted (Fig. 11a and b). PAP stain in cytological preparation showed lymphoid cells with uniform, basophilic dark nucleus and scattered inflammatory cells (Fig. 11c and d).
Immunohistochemistry for CD3, CD20 in cell block material. a)The majority of lymphoid cells were of T-cell origin and strongly positive for CD3, b) while CD20 positive lymphocytes (B cells) were practically absent (magnification x 200).
gr12.jpg
PMC5576978_03_gr12.jpg
fig12
The lymphoid aggregates was almost totally positive in CD3, while rare cells were positive for CD20, indicating that the lymphoid population was of T-cell origin (Fig. 12a and b).
Immunohistochemistry for CD56, synaptophysin and CK7 in cell block material a)Immunostain for CD56, b) synaptophysin and c) CK7 were negative (magnification x 200). Upper right sided inserts are external positive controls for the above markers.
gr13.jpg
PMC5576978_03_gr13.jpg
fig13
All the immunostains were performed with external positive controls for each marker, in all slides (Fig. 13a,b,c).
PMC5576978_04
Large mass surrounding the trachea.
gr14.jpg
PMC5576978_04_gr14.jpg
fig14
EBUS was performed and the diagnosis was ectopus thyroid (Fig. 14).
Paratranchea tumor. a, b) Cell block contained abundant stroma, haemorages areas, inflammatory cells and follicular structures in variable size and configuration (magnification x 100). c) the epithelial cells were uniform in size, cuboidal with amphophilic cytoplasm and lumens contained an eosinophilic amorfous material resembling colloid (magnification x 400) which was also exaggerated in the surrounding matrix (d) (magnification x 100).
gr15.jpg
PMC5576978_04_gr15.jpg
fig15
In the lumens was found an amorfous eosinophilic material, resembling colloid without peripheral vacuolization (Fig. 15a,b,c). This material was acellular and was expanded within the matrix (Fig. 15d).
PMC5576978_05
PMC5576978_06