Introduction: Driver mutations are common in lung adenocarcinomas (ADCAs). Patients with EML-ALK rearrangement (ALK+) may benefit from crizotinib. With more minimally-invasive procedures and smaller samples, allocating sufficient specimen for identifying the underlying mutation is essential. Our aim was to determine if ALK(+) surgical pathology (SP) and cytopathology (CP) cases have salient morphological features that can aid in appropriate upfront triage. Materials and Methods: A retrospective search for FISH confirmed ALK(+) SP and CP cases was performed. The control group included ALK(-) cases harboring other driver mutations (EGFR or KRAS). Slides were reviewed by two pathologists for architectural arrangement, cytological features, including signet ring cells (SRCs) and psammoma bodies (PBs), and TTF-1 staining. Results: Sixteen ALK(+) were identified. Of these, 9 had corresponding SP and CP, and the remaining had either SP (5) or CP (2). Eleven ALK(-) patients served as controls (6 KRAS(+) and 5 EGFR(+)). Of these, 8 had corresponding SP and CP, and 3 only CP. No architectural pattern(s) specific to ALK(+/-) was observed. PBs were seen more commonly in ALK(+) patients: 5/14 SP (36%), and 1/11 CP (9%); equivocal PB forms were seen in 2/11 CP (18%). Conversely, PB forms were not identified in ALK(-) cases. SRCs were present in ALK(+) patients (SPZ7/14(50%); CPZ6/11(55%)), but not ALK(-) cases (Table 1). TTF-1 staining was present in 5/7 (71%) available ALK(-), and in 11/13 (85%) available ALK(+) cases, including 6/8 (75%) cases with SRCs. Conclusions: Our study demonstrates that PBs are associated with ALK(+) and seen readily on SP rather than CP. SRCs are also present in ALK(+) and identified on both SP and CP. Unlike many mucinous lung ADCAs, SRCs associated with ALK(+) cases are TTF-1(+). In cases with scant cellularity, samples with PBs or SRCs can be appropriated for ALK FISH testing prior to evaluation of other mutations.