Prominent repair-like changes that mimic atypical squamous cells after radiation treatment in the lung: A report of two cases

Radiation changes in lung cytology specimens can lead to diagnostic challenges, especially during on-site evaluation. We present a case of two patients, both with a prior history of lung malignancy and subsequent radiation treatment, one with a metastatic high-grade undifferentiated pleomorphic sarcoma and the other with a small cell carcinoma. One was thought to be malignant, and one was thought to be atypical on-site. Common to both cases was a hypocellularity and a prominent repair-like/reactive change with polygonal cells or elongated fiber-like cells and dense cytoplasm mimicking atypical squamous cells in shape and cytoplasm. Knowledge of these prominent findings may help cytopathologists quickly recognize radiation changes at on-site evaluation and avoid overcalls.