Low power: DQ stain
Cellular smear with loosely cohesive groups and singly dispersed malignant cells
Medium power: DQ stain
Malignant cells with enlarged irregular nuclei and lymphocytes in the background
High power: DQ stain
Malignant cells with high N:C ratios, enlarged irregular nuclei and moderate amount of delicate cytoplasm
Medium power: Pap stain
Malignant cells with enlarged irregular nuclei, coarse chromatin, prominent nucleoli, in a lymphocytic background
Medium power: Pap stain
Malignant cells in small clusters and singly, with enlarged irregular nuclei, coarse chromatin, prominent nucleoli, in a lymphocytic background
High power: Pap stain
Malignant cells with enlarged irregular nuclei, coarse chromatin, and prominent nucleoli.
Note lymphocytes in the background
High power: Pap stain
Malignant cells with high grade features in a lymphocytic background
Cell block: H&E stain
Malignant cells in a background of lymphocytes
Cell block: H&E stain
Few malignant cells in a background of abundant lymphocytes
Cell block: H&E stain
Malignant cells with obvious malignant features (high N:C ratio, enlarged irregular nuclei, coarse chromatin)
Features
• Loosely cohesive, syncitial aggregates or singly dispersed
• Lymphocytic background
• Highly malignant appearing cells
• High N:C ratios
• Moderate delicate cytoplasm
• Distinct cell borders
• May have cytoplasmic vacuoles
• Enlarged, irregular, often pleomorphic nuclei
• Coarse chromatin
• Prominent nucleoli
• Lymphocytes
• May see sickled RBCs in sickle cell trait patients
• Rare tumors usually occur in young (10 - 40 yrs) black males and frequently associated with sickle cell trait. Typically presents with flank pain, hematuria and rapidly enlarging renal mass. Metastasis is common.
• Express cytokeratin, CK7, vimentin focal
Qi J et al. Acta Cytol. 2001 Sep-Oct;45(5):735-9.