case_images: PMC8731288_01
case_images: (a) High cellularity EUS FNA direct smear with loosely cohesive neoplastic cells with open chromatin and discernable nucleoli in backgrounds of blood (Papanicolaou stain, 400X). (b) Higher magnification EUS FNA direct smear with cohesive groups of high nuclear/cytoplasmic ratio malignant cells with vague acinar architecture compatible with adenocarcinoma (modified Giemsa stain, 600X). (c) Cell block preparation with background eosinophilic granular debris (necrosis) and scattered overtly cytologically malignant individual cells with hyperchromasia and anisonucleosis (hematoxylin and eosin stain, 600X).
case_images: CRIPA2021-4933279.001.jpg
case_images: PMC8731288_01_CRIPA2021-4933279.001.jpg
case_images: fig1
case_images: Endosonographic ultrasound-guided fine needle aspiration biopsies of an abnormal perigastric lymph node confirmed metastatic adenocarcinoma (Figure 1).
case_images: (a) As the diagnosis of malignancy was confirmed, scattered groups of microorganisms (arrows) were also identified in close proximity to some of the neoplastic cells (modified Giemsa stain, 1000X). (b) These clustered microorganisms were large and noted in tetrad arrangements with amphophilic tinctorial appearances (Papanicolaou stain, 1000X).
case_images: CRIPA2021-4933279.002.jpg
case_images: PMC8731288_01_CRIPA2021-4933279.002.jpg
case_images: fig2
case_images: In addition to malignant cells and necrosis, the fine needle aspiration cytology preparations also demonstrated admixed large coccoid bacteria with amphophilic to basophilic staining arranged in tetrad fashions, compatible with Sarcina ventriculi (Figures 2-3).
case_images: (a) In focal areas of the direct smears, numerous collections of large bacteria arranged in tetrads (Sarcina ventriculi) were noted. In addition, scattered smaller cocci and a few bacilli (mixed bacteria) were also identified in backgrounds with necrosis and poorly preserved nucleated cells (Papanicolaou stain, original magnification 1000X). (b) Highest power magnification depicting clustered Sarcina organisms with adjacent macrophages, noting comparatively clear background without accompanying acute inflammation, suggesting carry-through microorganisms from lumen of GI tract (Papanicolaou stain, original magnification 1000X).
case_images: CRIPA2021-4933279.003.jpg
case_images: PMC8731288_01_CRIPA2021-4933279.003.jpg
case_images: fig3
case_images: In addition to malignant cells and necrosis, the fine needle aspiration cytology preparations also demonstrated admixed large coccoid bacteria with amphophilic to basophilic staining arranged in tetrad fashions, compatible with Sarcina ventriculi (Figures 2-3).