PMC4564623_01
The excised supraclavicular lymph node showed the characteristic morphology of DSRCT. Cohesive nests of undifferentiated small blue cells with some degree of nuclear atypia were seen embedded within moderately cellular fibrous stroma (histopathology, hematoxylin and eosin stain, 100x).
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Excisional biopsy of a left supraclavicular lymph node showed replacement of the node by small round cells with intervening dense fibrous stroma (Figure 1).
CT examination confirmed a unilateral right pleural effusion and small lung nodules (transverse computed tomographic image of patient's chest demonstrating posterior right chest effusion).
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In addition, enlarged supradiaphragmatic lymph nodes, multiple small bilateral lungs nodules, and a right pleural effusion were noted (Figure 2).
Liquid-based cytology slides contained rare crowded groups of lesional cells with nuclear overlapping, high nuclear/cytoplasmic ratios, open chromatin, and small but discernible nucleoli. These cells were difficult to differentiate from reactive mesothelial cells by microscopy (ThinPrep, Papanicolaou stain, 600x).
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Rare groups of lesional cells were also noted (Figure 3).
A cohesive and crowded group of metastatic DSRCT cells in pleural fluid with central epithelioid forms having minimal to moderate eosinophilic cytoplasm and open chromatin. Some cells at the tumor group margin have elongated/spindled morphologies with more dense chromatin (cell block, hematoxylin and eosin stain, 400x).
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Hematoxylin and eosin stained sections prepared from the cell block showed cohesive groupings of metastatic tumor cells with a "floating island" morphology (Figures 4 and 5).
A higher magnification view of DSRCT involving fluid. The image shows a cohesive and crowded group of lesional cells from the pleural fluid with central epithelioid forms. Small arrows mark peripheral elongated/spindled forms. Some of these cells have more dense chromatin, while others have chromatin that is similar to that seen in the epithelioid cells within the body of the island (cell block, hematoxylin and eosin stain, 600x).
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Hematoxylin and eosin stained sections prepared from the cell block showed cohesive groupings of metastatic tumor cells with a "floating island" morphology (Figures 4 and 5).