Circulating tumor cells from well-differentiated lung adenocarcinoma retain cytomorphologic features of primary tumor type.

The detailed cytomorphologic appearance of circulating tumor cells (CTCs) in cancer patients is not well described, despite publication of multiple methods for enumerating these cells. In this case study, we present the cytomorphology of CTCs obtained from the blood of a woman with stage IIIB well-differentiated lung adenocarcinoma. Four years after she was diagnosed with her disease, 67 CTCs were identified in a blood sample using an immunofluorescent staining protocol and then subsequently stained with Wright-Giemsa. The cytomorphology of the CTCs was compared with the original tissue biopsy from 4 years prior. We found that CTCs and cells from the original biopsy had strikingly similar morphologic features, including large size in comparison to white blood cells and low nuclear to cytoplasmic ratios with voluminous cytoplasm. Careful cytomorphologic evaluation of CTCs will provide insights about the metastatic significance of these cells, which could yield widespread implications for the diagnosis, treatment, and management of cancer.