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Small cell mesothelioma (SCM) is an extremely rare variant of epithelioid mesothelioma that can be mistaken for other forms of small round blue cell tumors, particularly small cell lung carcinoma (SCLC). Here, we describe a fine-needle aspiration (FNA) from a pleural lesion in a 75-year-old man with a history of known asbestos exposure. The FNA revealed cohesive clusters of uniform small round blue cells with high nuclear-to-cytoplasmic ratio, finely powdery chromatin, small inconspicuous nucleoli, and scant amount of cytoplasm. Mitoses were infrequent and nuclear molding was absent. Immunochemical profile supported a mesothelial origin, which was later confirmed by pleurectomy with a diagnosis of SCM. This report demonstrates the difficulties in cytologic evaluation of lung FNAs in differentiating SCM from SCLC or other small round blue cell tumors. As therapy differs for SCM, early recognition of the cytologic features is essential in making the correct diagnosis needed for appropriate clinical management. Diagn. Cytopathol. 2016;44:526-529. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Diffuse pulmonary meningotheliomatosis (DPM) is an exceedingly rare entity consisting of multiple minute pulmonary meningothelial-like nodules profusely involving the lungs. To the best of our knowledge, we present the first cytologic description of this uncommon lesion from a 57-year-old nonsmoking woman. Computerized tomographic-guided fine-needle aspiration cytology from a left upper lobe nodule showed whorled/nested clusters of elongated cells with oval nuclei, clear pseudonuclear inclusions, nuclear grooves/indentations, smooth nuclear contours, fine granular chromatin, inconspicuous nucleoli, and abundant fibrillary cytoplasm with indistinct cell borders. The subsequent pulmonary wedge resections confirmed the diagnosis of DPM. As this condition is exceptionally rare, familiarity with these cytologic features is of the essence to accurately establish this challenging diagnosis., (© 2015 Wiley Periodicals, Inc.)

Introduction: Due to the large numbers of negative results of sputum examinations in the face of malignant disease, we used a decision analytic model to determine whether, and under what conditions, sputum cytology (Spt) might have a cost-effective role to play in the approach to lung lesions., Methods: We constructed a decision analytic model to compare the utility of Spt, image-directed fine-needle aspiration (FNA), bronchoscopic examination (Bronch), and open biopsy (OBx) in the evaluation of lung lesions. Prevalence and cost data were derived from local databases and diagnosis-related groups. Diagnostic sensitivity (sens) and specificity (spec) of the tests were derived from the literature and local data. Output of the model was lowest cost per correct malignant diagnosis and included surgical treatment costs. We did not attempt to model survival data or morbidity. Sensitivity analyses were performed using cost, test sensitivity, and lesion size variables., Results: In the baseline case, a patient who is a surgical candidate with lesion size 2.8 cm, prevalence of malignancy=0.67, FNA sens=0.95, Bronch sens=0.80, Spt sens=0.51, OBx is the best initial procedure with a cost per correct diagnosis of $12,888. Sputum examination has the highest cost per correct diagnosis of $63,424. FNA and bronchoscopy have cost per correct diagnosis of $21,543 and $16,615, respectively. Sens analysis shows that OBx is the preferred strategy in the workup of lung lesions in patients who are surgical candidates older than 30 years of age. Spt is the preferred strategy only when the patient is not a surgical candidate, the lesion size is large (>4.7 cm), and only if sputum sens is >0.45., Conclusions: Spt is not cost-effective in clinical practice, except when the patient has a large clinically unresectable lesion and the laboratory can demonstrate sufficient test sens.