A 60-year-old man presents with a 4-month history of increasing weight loss and shortness of breath. He has smoked two packs of cigarettes a day for 20 years. His past medical history is significant for emphysema and chronic bronchitis. A chestX-ray shows a mass in the left main stem bronchus. Cytologic examination of a bronchial brushing shows pleomorphic keratinized cells with large irregular and pyknotic nuclei. These cells would most likely show which of the following patterns of arrangement on cytologic examination?
Answer : D Rosettes
The clinical features of this case are most consistent with neuroblastoma. This malignant neural crest tumor is composed of neuroblasts and originates in the adrenal medulla or sympathetic ganglia.
Microscopically, the tumor iscomposed of dense sheets of small, round to fusiform cells with hyperchromatic nuclei and scanty cytoplasm. Characteristic rosettes are defined by a rim of dark tumor cells in a circumferential arrangement around a central pale fibrillar core.