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Case of the Month



Metastatic Adenocarcinoma of Lung Origins

The patient is a 56-year-old woman with a history of COPD. She has a long history of tobacco use and a remote history of breast carcinoma. She presents with nausea, chest pressure, and shortness of breath. She is discovered to have a pericardial effusion which is tapped and sent for cytologic evaluation. Pap stained smears demonstrate numerous clusters of epithelial cells with abundant cytoplasm and irregular nuclei with prominent, central nucleoli. Many of the clusters are arranged in well-formed glands. Immunoperoxidase stains performed on the cell block are positive for both TTF-1 and Napsin A and negative for ER and Her2neu. Histochemical stains (PAS and mucicarmine) are positive. A diagnosis of metastatic adenocarcinoma of lung origin is assigned.