case_images: PMC9063506_01
case_images: a through e: Aspirates revealed dispersed cells with finely granular cytoplasm showing some pink granules in MGG stained smears and with eccentric nuclei, inconspicuous nucleoli, and few binucleate and multinucleated cells (arrow) with loose aggregates showing nuclear pleomorphism. (a: MGGx200, b: PAPx400, c: MGGx400, d: MGGx400, e: PAPx400), with intranuclear cytoplasmic pseudoinclusions (arrow in 'c'). f and g: The H and E stained smear (x100) showed homogenous, eosinophilic material which demonstrated yellowish to apple green birefringence under polarizing microscopy. h and i: The cells were immunoreactive for calcitonin (h) and chromogranin (i).
case_images: Cytojournal-19-8-g001.jpg
case_images: PMC9063506_01_Cytojournal-19-8-g001.jpg
case_images: F1
case_images: Fine-needle aspiration (FNA) showed findings seen in Figure 1. Cytology smears were cellular, comprising predominantly of dispersed cells and few loose cellular aggregates [Figure 1a]. Cells were oval to polygonal in shape and showed pleomorphism, with presence of anisokaryosis and some binucleate to rare multinucleate cells [Figures 1d and e]. Nuclei were round and placed eccentrically and the simultaneous presence of moderately abundant, and fairly dense cytoplasm with well-defined borders imparted a distinct plasmacytoid aspect [Figures 1b-e]. Intranuclear cytoplasmic inclusions were also noted [Figure 1c]. Few of the cells showed pink cytoplasmic granules [Figure 1d]. Additional confirmation was forthcoming by way of few dense amorphous clumps of eosinophilic material evident on hematoxylin and eosin staining [Figure 1f], which was verified to be amyloid by virtue of yellow birefringence under the polarizing microscope subsequent to Congo red staining [Figure 1g]. Finally, intense cytoplasmic positivity for calcitonin [Figure 1h] and chromogranin [Figure 1i] was demonstrable on immunocytochemistry.