{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T09:47:53Z","timestamp":1753868873480,"version":"3.41.2"},"reference-count":20,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2012,2,1]],"date-time":"2012-02-01T00:00:00Z","timestamp":1328054400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostic Cytopathology"],"published-print":{"date-parts":[[2013,10]]},"abstract":"<jats:p>Endobronchial Ultrasound\u2010Guided Transbronchial Needle Aspiration (EBUS\u2010TBNA) is a reliable and accurate method for the diagnosis of mediastinal metastases in patients with pulmonary and extrathoracic neoplasms. We report the cytopathologic findings of a case of metastatic signet\u2010ring cell carcinoma with abundant extracellular mucin production in the mediastinal lymph nodes of a 41\u2010year\u2010old woman, who presented with nausea, abdominal pain, and weight loss. Imaging studies showed a renal mass, numerous lung nodules, and mediastinal and retroperitoneal lymphadenopathy. EBUS\u2010TBNA of level 4R and 7 lymph nodes showed abundant, thick, \u201cclean\u201d mucus with entrapped ciliated bronchial cells, rare histiocytes, and fragments of cartilage. No neoplastic cells could be identified in Diff\u2010Quik\u00ae\u2010stained smears during the rapid on\u2010site evaluation, but rare signet\u2010ring cells were identified in the Papanicolaou\u2010stained smears and cellblock sections. A distinctive feature of the aspirates was the presence of large branching (arborizing), \u201cspidery\u201d stromal fiber meshwork fragments. These stained metachromatically (magenta) with Romanowsky\u2010type stains and cyanophilic to orangeophilic with Papanicolaou stains and showed occasional attached bland spindle cells, but had no capillary lumina or CD31\u2010staining endothelial cells. The tumor cells were strongly and diffusely positive for CEA, CDX2, CK7, CK20, and MUC2, supporting the diagnosis of a metastatic signet\u2010ring cell adenocarcinoma, most likely of gastrointestinal origin. We believe that the presence of the large spidery stromal fiber fragments is a useful clue to the presence of a mucinous neoplasm in EBUS\u2010TBNA and allows the differentiation of the neoplastic mucus from contaminating endobronchial mucus. Diagn. Cytopathol. 2013;41:896\u2013900. \u00a9 2012 Wiley Periodicals, Inc.<\/jats:p>","DOI":"10.1002\/dc.22816","type":"journal-article","created":{"date-parts":[[2012,2,1]],"date-time":"2012-02-01T15:38:08Z","timestamp":1328110688000},"source":"Crossref","is-referenced-by-count":0,"title":["Endobronchial ultrasound\u2010guided transbronchial needle aspiration diagnosis of mediastinal lymph node metastasis of mucinous adenocarcinoma: Arborizing stromal meshwork fragments as a diagnostic clue"],"prefix":"10.1002","volume":"41","author":[{"given":"Arbaz","family":"Samad","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine and Pathology University of Minnesota Medical School Minneapolis Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin C.","family":"Peltola","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology University of Minnesota Medical School Minneapolis Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohi O.","family":"Mitiek","sequence":"additional","affiliation":[{"name":"Division of Thoracic and Foregut Surgery Department of Surgery University of Minnesota Medical School Minneapolis Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose","family":"Jessurun","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology University of Minnesota Medical School Minneapolis Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. 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