Australian Society of CytologyCase of the Month
October 2003 - Answer and Discussion
Spindle cell carcinoid tumour.
Answer
The brushings show small numbers of ciliated columnar cells intermixed with numerous well differentiated spindle cells. Some of these spindle cells form interlacing whorls.
The chromatin pattern of these spindle cells is fairly granular in appearance.
Subsequent biopsy and immunohistochemistry confirmed this diagnosis (see histology images). Strong positivity in the synaptopysin stain gives further support to the tumour being a spindle cell carcinoid.
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| H&E Stain | Synaptophysin |
Discussion
Spindle cell carcinoid tumours have a peripheral or sub-pleural location and are mainly seen in FNA material. Spindle-type tumours are found more often in older women than other carcinoid lesions. The tumour grows in sheets of intersecting bundles of spindle cells. Nuclei are elongated with thin nuclear membranes, fine stippled chromatin and small inconspicuous nucleoli. Nuclear/cytoplasmic ratio is normal. There is uniformity of nuclear size.
These tumours may be distinguished by their strong staining for chromogranin a and synaptophysin or by demonstrating large numbers of neurosecretory granules by electron microscopy.
References
- Fekete P, Cohen C, Derose P. Pulmonary spindle cell carcinoid. Needle aspiration biopsy, histologic and immunohistochemical findings. Acta Cytol 1990; 34:50-56.
- Ranchod M, Levine G. Spindle-cell carcinoid tumours of the lung. A clinicopathologic study of 35 cases. Am J Surg Pathol 1980; 4:315-331.
- Gray W. Diagnostic Cytopathology, Churchill Livingstone 1995.
- Orell SR, Sterrett GF, Walters M, Whitaker D. Manual and atlas of fine needle aspiration cytology 2nd edition, Churchill Livingstone 1992.
