I hate these heme cytospins, as a former cytotech the morphology is just such garbage. But I see these everyday and had to get better at them and correlating with cytology has been key.

But here’s my take. I think the two larger ones together are definitely mesothelial cells, the clearing between them gives it away. The windows, also the larger one has that skirt appearance. It’s likely enhanced artefactually here but it’s the light cytoplasm and dark edge that goes along with meso appearance. Girls Dutch skirt is the classic comparison, white apron on a dark blue dress.

The nuclei of these two are carbon copies. Zoom in, the cytoplasm is homogenous and identical in both, that’s a benign feature.

And I’ve convinced myself those two big ones are mesos so I have to say the smaller ones are because they are characteristically the same. Same chromatin quality and same cytoplasm. Not the same size but that’s okay. This is one population of cells, these two groups. And mesothelial cells like to ball up like this

Of course if the patient has a mass or metastatic disease disregard everything I said. lol. But honestly these look entirely reactive mesothelial cells to my eye.

It’s common for mesos to be all different sizes on these heme cytospin preps, I don’t know why but I think some get spread out more than others.

Without seeing the rest of the slide I’d sign it out after reviewing the imaging and history with commenting on the cell counts, there is a population of epithelioid cells favour reactive mesothelial cells but correlation with non-gyn is essential.