• DOI:10.1002/dc.22849
• Corpus ID: 2971848

Intracellular and extracellular hyaline globules in endobronchial ultrasound‐guided transbronchial needle aspiration of mediastinal lymph node: A clue for the diagnosis of metastatic hepatocellular carcinoma

@article{Samad2013IntracellularAE,
  title={Intracellular and extracellular hyaline globules in endobronchial ultrasound‐guided transbronchial needle aspiration of mediastinal lymph node: A clue for the diagnosis of metastatic hepatocellular carcinoma},
  author={Arbaz Samad and Stefan E. Pambuccian},
  journal={Diagnostic Cytopathology},
  year={2013},
  volume={41}
}

• Arbaz Samad, S. Pambuccian
• Published 1 September 2013
• Medicine
• Diagnostic Cytopathology

A 59-year-old male presented to our institution with progressive shortness of breath of a few weeks duration. Two years previously, he had undergone liver transplantation for end stage liver disease secondary to cirrhosis caused by hepatitis C and alcohol abuse, complicated by a 4.9 3 4.4 cm hepatocellular carcinoma. Imaging studies, performed as part of the evaluation for re-transplantation due to progressive worsening of his liver function, revealed bilateral pleural-based nodules and enlarged mediastinal lymph nodes ranging in size from 1.2 to 1.6 cm. The patient underwent endobronchial ultrasound-guided transbronchial needle aspiration of a mediastinal station 2L lymph node. Diff-Quik and Papanicolaou-stained smears and H&E-stained cellblock preparations were made. Diff-Quik stained smears showed scant polymorphous lymphoid cells and scattered single cells and loosely cohesive groups of large polygonal cells with abundant granular cytoplasm, low nuclear-cytoplasmic ratios, and pleomorphic hyperchromatic nuclei with prominent macronucleoli. Numerous naked nuclei were present. Bland spindle-shaped endothelial cells and capillaries were also identified transgressing some of the epithelial cell groups. The neoplastic cells ranged in size from 32 to 40 lm with nuclei measuring 12–20 lm and nucleoli measuring 6–8 lm. A prominent feature of the smears was the presence of numerous large, sharply outlined, homogenous glassy intracytoplasmic and extracellular metachromatic pink, magenta or purple globules (Fig. C-1). These hyaline globules (HGs) were round to oval or elongated, irregularly-shaped and varied in size from 4 to 30 lm in largest dimension. One to ten of these HGs were present in the cytoplasm of the majority of the tumor cells and were located adjacent to the nuclei, occasionally displacing them or even masking them. The differentiation between the globules and the nuclei was frequently difficult due to their similar staining characteristics, occasionally giving the false impression of binucleation or multinucleation; extracellular HGs mimicked naked nuclei. However, at closer inspection, HGs could be differentiated from tumor cell nuclei, as they stained homogenously, lacking the granularity of the nuclear chromatin and the nucleoli. Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN *Correspondence to: Stefan E. Pambuccian, M.D., Professor, Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, Fairview, C422 Mayo MMC 76, 420 Delaware Street SE, Minneapolis MN 55455, USA. Tel.: +[phone], (612) 2735920. Fax: +[phone]. E-mail: [e-mail] Received 8 September 2011; Revision 1 November 2011; Accepted 23 January 2012 DOI 10.1002/dc.22849 Published online 23 February 2012 in Wiley Online Library (wileyonlinelibrary. com).