case_images: PMC4785778_01
case_images: Low power image of aspirate smear (left, Diff-Quik, x40; right, Papanicolaou x100) showing high cellularity with abundant extracellular myxoid material imparting a streaming appearance to the slide, admixed with single cells and occasional larger clusters
case_images: CJ-13-4-g001.jpg
case_images: PMC4785778_01_CJ-13-4-g001.jpg
case_images: F1
case_images: The Diff-Quik stained aspirate smears were hypercellular with cells arranged in loose clusters and singly dispersed in a background of metachromatic myxoid/granular material [Figure 1]. The Papanicolaou-stained aspirate smears were similar, composed predominantly of single cells and loose clusters in a background of myxoid material [Figure 1].
case_images: High power image of the aspirate smear slides (left Diff-Quik, x400; right Papanicolaou, x400) showing cells with abundant, dense cytoplasm, well-defined cytoplasmic borders, cytoplasmic windows, occasional vacuoles, and round to oval nuclei, pale chromatin, and moderate variation in nuclear size
case_images: CJ-13-4-g002.jpg
case_images: PMC4785778_01_CJ-13-4-g002.jpg
case_images: F2
case_images: Some cell clusters showed intercellular windows [Figure 2]. The nuclei had evenly distributed finely granular chromatin and smooth nuclear contours with small, centrally located nucleoli [Figure 2].
case_images: Various vacuoles appreciated in the aspirate smears, varying from large, solitary vacuoles displacing the nucleus into an eccentric position (upper left, Papanicolaou, x400), large solitary perinuclear vacuoles with grey-light blue material suggestive of mucin (upper right, Papanicolaou, x400), or multiple small vacuoles, often overlying the nucleus (lower left and lower right, Diff-Quik, x400)
case_images: CJ-13-4-g003.jpg
case_images: PMC4785778_01_CJ-13-4-g003.jpg
case_images: F3
case_images: Cytoplasmic vacuoles were readily appreciated, most commonly as multiple small vacuoles located near the nucleus [Figure 3]. Cytoplasmic vacuoles were less obvious on the Papanicolaou-stained slides, but occasional signet ring-like cells were seen [Figure 3].
case_images: Some tumor cells had intracytoplasmic vacuoles filled with material which stained magenta on Diff-Quik stain (x400, right and left)
case_images: CJ-13-4-g004.jpg
case_images: PMC4785778_01_CJ-13-4-g004.jpg
case_images: F4
case_images: Occasional cells had single large vacuoles filled with granular metachromatic material similar to that seen in the background, imparting a signet ring appearance [Figure 4].
case_images: The pleural decortication specimen demonstrated infiltrative sheets of cells with abundant eosinophilic cytoplasm and a discohesive arrangement within a myxoid stroma (upper left, H and E, x400), which were positive for WT1 (upper right, x400), calretinin (lower left, x400) and negative for TTF-1 (lower right, x400), consistent with a malignant mesothelioma
case_images: CJ-13-4-g005.jpg
case_images: PMC4785778_01_CJ-13-4-g005.jpg
case_images: F5
case_images: Immunohistochemical studies revealed that the cells were diffusely, strongly positive for calretinin, WT-1, and D2-40 and were negative for TTF-1 and Napsin A [Figure 5].