| CASE REPORT
|CytoJournal 2005, 2:9
FNAB cytology of extra-cranial metastasis of glioblastoma multiforme may resemble a lung primary: A diagnostic pitfall
Mamatha Chivukula1, HE Dincer2, Julie A Biller2, Hendrikus G Krouwer3, Grant Simon1, Vinod Shidham1
1 Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
2 Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
3 Neurology and Neurosurgery; Medical College of Wisconsin, Milwaukee, WI, USA
Background :As extra-cranial metastasis of glioblastoma multiforme (GBM) is rare, it may create a diagnostic dilemma especially during interpretation of fine needle aspiration biopsy (FNAB) cytology.
Case presentation :We present transbronchial FNAB findings in a 62-year-old smoker with lung mass clinically suspicious for a lung primary. The smears of transbronchial FNAB showed groups of cells with ill-defined cell margins and cytological features overlapping with poorly differentiated non-small cell carcinoma. The tumor cells demonstrated lack of immunoreactivity for cytokeratin, thyroid transcription factor-1, and usual neuroendocrine markers, synaptophysin and chromogranin in formalin-fixed cellblock sections. However, they were immunoreactive for the other neuroendocrine immunomarker, CD56, suggesting neural nature of the cells. Further scrutiny of clinical details revealed a history of GBM, 13 months status-post surgical excision with radiation therapy and systemic chemotherapy. The tumor recurred 7 months earlier and was debulked surgically and with intra-cranial chemotherapy. Additional evaluation of tumor cells for glial fibrillary acidic protein (GFAP) immunoreactivity with clinical details resulted in final interpretation of metastatic GBM.
Conclusion :Lack of clinical history and immunophenotyping may lead to a diagnostic pitfall with possible misinterpretation of metastatic GBM as poorly differentiated non-small cell carcinoma of lung in a smoker.
Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
Source of Support: None, Conflict of Interest: None
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