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An adult with lung nodules and renal mass: diagnosis on cytology Part 1.

CASE REPORT A 64-year-old Chinese man presented with cough and haemoptysis over 2 months. Chest X-ray revealed multiple nodules in both lungs associated with a right pleural effusion, a finding confirmed on thorax computed tomography (CT) scan. In addition, mediastinal lymphadenopathy and multiple pleural nodules were noted on CT scan. CT scan of the abdomen revealed a right renal mass measuring 8.4 cm in the upper pole. Following a negative diagnosis for malignancy on a series of investigations, a CT guided fine needle aspiration (FNA) biopsy of the lung was performed. Due to relative ease in obtaining a tissue sample, aspiration of a right pleural based mass was performed using a 22 gauge needle which was followed by a core tissue biopsy. Four alcohol-fixed smears stained with Papanicolaou (Pap) and four air-dried smears stained with Diff Quik (DQ) showed low to moderate cellularity. There were clusters of polygonal cells with abundant pale vacuolated cytoplasm (Fig. 1), discernible nucleoli and generally low nuclear to cytoplasmic ratios (Fig. 2). There were some clusters associated with a branching vascular network (Fig. 3). The background revealed fibrinous material. The tissue biopsy consisted of five cores of tissue measuring from 0.2 to 0.7 cm in length. These were fixed in buffered formalin and processed for routine histology.