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Mubeen A, Mito JK. The diagnostic utility of Merkel cell polyoma virus immunohistochemistry in cytology specimens. Cytopathology 2024; 35:390-397. [PMID: 38353321 DOI: 10.1111/cyt.13366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine neoplasm that predominantly affects elderly and immunocompromised patients. Merkel cell polyoma virus (MCPyV) is clonally integrated into the majority of MCCs and has been linked to patient outcomes, playing a central role in the pathogenesis of the disease. We aimed to assess the utility of MCPyV immunohistochemistry (IHC) in the diagnosis of MCC in cytology cell block specimens and correlating with clinicopathologic features. METHODS Fifty-three cytology samples of MCC with sufficient cell block material were stained for MCPyV by IHC and scored semi-quantitatively in extent and intensity. Morphologic mimics of MCC including small cell lung carcinoma (n = 10), non-Hodgkin lymphoma (n = 10), basaloid squamous cell carcinoma (n = 6) and other neuroendocrine carcinomas (n = 8) were stained in parallel. Positive staining was defined as >1% of the tumour cells showing at least moderate staining intensity. RESULTS The cytologic features of MCC were characterized by high nuclear-cytoplasmic ratios, hyperchromatic nuclei with 'salt and pepper' chromatin, and nuclear moulding. MCPyV was detected in 24 of 53 cases (45%). Staining was strong and diffuse in roughly half of the positive samples. Of the morphologic mimics, one follicular lymphoma showed strong and diffuse staining. In contrast to prior studies, we saw no association between MCPyV status and patient outcomes. CONCLUSION Merkel cell polyoma virus IHC is highly specific (97%) for the diagnosis of MCC in our cohort, and can serve as a useful diagnostic tool for distinguishing MCC for morphologic mimics.
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Affiliation(s)
- Aysha Mubeen
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Pathology, The University of New Mexico, Albuquerque, New Mexico, USA
| | - Jeffrey K Mito
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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2
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Wagner WD, Lahm DW, Dave A, Chundury RV. Metastatic Merkel cell carcinoma presenting as an orbital mass. Orbit 2024; 43:244-247. [PMID: 35920584 DOI: 10.1080/01676830.2022.2104324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/16/2022] [Indexed: 10/16/2022]
Abstract
A 67-year-old female presented with 2 weeks of right eye pain, redness, and diplopia. An orbital mass was found on magnetic resonance imaging (MRI), and biopsy revealed Merkel cell carcinoma (MCC). She had no primary head or neck lesion and no previous history of MCC. Positron emission tomography (PET) scan showed hypermetabolic subcutaneous lesions of the lower extremity andmultiple osseous lesions of the axial and appendicular skeleton. She received palliative external radiation of 20 Gy in 5 fractions to the orbit. After discussing immunotherapy, she opted for comfort care and expired 1 month later. To the best of our knowledge, this is only the third case of MCC with distant metastasis to the orbit and the first case in which the patient had no previous diagnosis of MCC and no known primary tumor.
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Affiliation(s)
- William D Wagner
- Stanley Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Derek W Lahm
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Atman Dave
- Department of Radiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Rao V Chundury
- Stanley Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
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3
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Rekhi B, Qian X, Domanski HA, Klijanienko J, Field A. Pitfalls in soft tissue cytopathology. Cytopathology 2024; 35:30-47. [PMID: 37548096 DOI: 10.1111/cyt.13282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/28/2023] [Accepted: 07/16/2023] [Indexed: 08/08/2023]
Abstract
Fine needle aspiration biopsy (FNAB) is a diagnostic modality for the evaluation of suspicious soft tissue masses. Despite its reasonable sensitivity, specificity and positive predictive value in differentiating benign from malignant neoplasms, the exact subtyping of the primary soft tissue tumours can be challenging. Certain tumours constitute "pitfalls" and add to the diagnostic challenge. This review provides a detailed account of the diagnostic challenges in soft tissue cytopathology, including pitfalls and, more importantly, the ways to overcome these challenges by integrating clinical details, key cytomorphological features and judicious application of ancillary techniques.
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Affiliation(s)
- Bharat Rekhi
- Department of Pathology, Bone and Soft Tissues, Disease Management Group (DMG) Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Xiaohua Qian
- Department of Pathology, Cytopathology Service and Bone and Soft Tissue Service, Stanford University School of Medicine, Stanford, California, USA
| | | | | | - Andrew Field
- Department of Anatomical Pathology, St. Vincent's Hospital, University of New South Wales Sydney and Notre Dame University Sydney Clinical Medical Schools, Sydney, New South Wales, Australia
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4
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Kundu R, Singh B, Dey P. Cytology coupled with immunocytochemistry nails Merkel cell carcinoma: a rare intruder in the cerebrospinal fluid. Cytopathology 2022; 33:530-533. [PMID: 35416339 DOI: 10.1111/cyt.13127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/31/2022] [Accepted: 04/08/2022] [Indexed: 11/28/2022]
Abstract
Merkel cell carcinoma is an uncommon aggressive skin tumor which is well known for its recurrence and metastasis. Leptomeningeal metastasis involving the cerebrospinal fluid is extremely rare. The diagnosis may easily be missed as it simulates other much common small round blue cell tumors. A history of primary diagnosis may not always be available. Awareness and cytomorphological vigilance with judicious employment of appropriate immunomarkers on limited cerebrospinal fluid samples is indispensable for nailing the diagnosis. The tumor cells are usually monotonous small round cells, singly scattered or as loosely cohesive clusters. Cells have round to elongated nuclei with coarsely granular chromatin, nuclear molding at places and scanty basophilic cytoplasm. A limited immunocytochemistry panel employing CK20 and CD56 for which the tumor is positive is confirmatory. We herein present a case of infiltration of cerebrospinal fluid by Merkel cell carcinoma.
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Affiliation(s)
- Reetu Kundu
- Department of Cytology & Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh-160012, India
| | - Brijdeep Singh
- Department of Cytology & Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh-160012, India
| | - Pranab Dey
- Department of Cytology & Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh-160012, India
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5
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Liu CY, Lai FJ, Chang ST, Chuang SS. Diagnostic clues for differentiating Merkel cell carcinoma from lymphoma in fine-needle aspiration cytology. Diagn Cytopathol 2021; 50:E23-E27. [PMID: 34491618 DOI: 10.1002/dc.24872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/23/2021] [Accepted: 08/30/2021] [Indexed: 11/09/2022]
Abstract
Nodal fine needle aspiration (FNA) is usually the first procedure in the work-up of malignancy of unknown primary. Merkel cell carcinoma (MCC) is an aggressive cutaneous cancer more common in Caucasians but rare among Asians. It is a diagnostic challenge in evaluating FNA from a metastatic MCC without the knowledge of a current or prior history of skin cancer. We report the case of a Taiwanese male with cervical and axillary masses. The diagnosis of the FNA from the axillary lymph node was lymphoproliferative lesion suspicious for lymphoma. The histopathological evaluation of nodal biopsy revealed a metastatic neuroendocrine carcinoma and the subsequent excision of the right palm tumor confirmed MCC. Retrospective review of the FNA and imprint cytology smears of the nodal biopsy showed nuclear molding, Indian filing and rare cytoplasmic pale bodies, but no lymphoglandular bodies. Cytologically metastatic MCC may mimic small round cell tumor including lymphoma, we consider these three cytological features as additional diagnostic clues for metastatic MCC. In this report, we present the cytologic and pathological features of this metastatic MCC and discuss the differential diagnosis of the cytologic mimickers.
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Affiliation(s)
- Chih-Yi Liu
- Division of Pathology, Sijhih Cathay General Hospital, New Taipei City, Taiwan.,College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Feng-Jie Lai
- Department of Dermatology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Sheng-Tsung Chang
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Nursing, National Tainan Institute of Nursing, Tainan, Taiwan
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6
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Cells to Surgery Quiz: August 2019. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.06.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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7
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Kapatia G, Peddinti RS, Radotra BD, Dey P. Fine needle aspiration cytology of a recurrent hand swelling. Cytopathology 2019; 30:558-559. [PMID: 30953596 DOI: 10.1111/cyt.12699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/04/2019] [Accepted: 03/29/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Gargi Kapatia
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raja S Peddinti
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bishan D Radotra
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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8
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Bizzarro T, Buda R, Ricci M, Bernardi L. Cytological diagnosis of a rare case of primary Merkel cell carcinoma of the parotid gland. Cytopathology 2017; 28:552-554. [PMID: 29052284 DOI: 10.1111/cyt.12485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2017] [Indexed: 11/28/2022]
Affiliation(s)
- T Bizzarro
- Division of Anatomic Pathology and Histology, Infermi Hospital of Rimini AUSL Romagna, Rimini, Italy
| | - R Buda
- Division of Anatomic Pathology and Histology, Infermi Hospital of Rimini AUSL Romagna, Rimini, Italy
| | - M Ricci
- Division of Anatomic Pathology and Histology, Infermi Hospital of Rimini AUSL Romagna, Rimini, Italy
| | - L Bernardi
- Division of Anatomic Pathology and Histology, Infermi Hospital of Rimini AUSL Romagna, Rimini, Italy
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Stoos-Veic T, Tadic M, Aralica G, Milicic V, Tomasovic-Loncaric C. EUS-FNA of the Merkel cell carcinoma metastasis to the pancreas: Cytomorphology and immunocytochemistry on direct cytological smears. Cytopathology 2017; 28:307-311. [PMID: 28685876 DOI: 10.1111/cyt.12425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To report two cases of Merkel cell carcinoma (MCC) metastatic to the pancreas diagnosed with endoscopic ultrasound-guided-fine needle aspiration (EUS-FNA) and to add the case of concomitant chronic lymphocytic leukaemia/small lymphocytic lymphoma (CLL/SLL) and MCC to the literature. The aim is to alert the cytopathologists once more to the problems of differential diagnosis of pancreatic metastasis of MCC and to describe the possibilities of ancillary methods performed on direct cytological smears. METHODS EUS-FNA procedures were performed according to standard institution protocol, using 22-G needles with cytopathologist on-site. Based on rapid on-site evaluation (ROSE), additional passes were made for immunocytochemistry (ICC). A mini panel of antibodies was used to aid the differential diagnosis. RESULTS Smears revealed a dispersed pattern of small round cells with scant cytoplasm, round nuclei with inconspicuous nucleoli and occasional nuclear moulding, suspicious of small cell carcinoma. Results of ICC applied to the direct cytological smears were as follows: LCA negative, Cytokeratin (clone MNF116) positive, TTF-1 negative, CD 56 positive, NSE weakly positive, Chromogranin A weakly positive and CK20 positive, in one case in a dot-like perinuclear pattern. The diagnosis of MCC was made. CONCLUSION Increasing incidence of MCC warrants the inclusion of MCC in the differential diagnosis of tumours of small round blue cell morphology even in unusual sites. The cytomorphological features coupled with an ICC panel are usually enough to make a confident diagnosis of MCC. EUS-FNA is a minimally invasive technique which enables sampling adequate tissue for all the ancillary methods eventually needed to support the diagnosis.
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Affiliation(s)
- T Stoos-Veic
- Department of Pathology and Cytology, University Hospital Dubrava, Zagreb, Croatia.,Faculty of Medicine, University of Osijek, Osijek, Croatia
| | - M Tadic
- Department of Gastroenterology, University Hospital Dubrava, Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - G Aralica
- Department of Pathology and Cytology, University Hospital Dubrava, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - V Milicic
- Department of Cytology, University Hospital Center Osijek, Osijek, Croatia.,Faculty of Medicine, University of Osijek, Osijek, Croatia
| | - C Tomasovic-Loncaric
- Department of Pathology and Cytology, University Hospital Dubrava, Zagreb, Croatia
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Barton L, Zhao L, Doty JN, Stasko T, Conrad R. An elderly man with a solitary liver lesion. Cytojournal 2017; 14:11. [PMID: 28603540 PMCID: PMC5458409 DOI: 10.4103/1742-6413.207138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/03/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- Lisa Barton
- Address: Department of Pathology and Laboratory Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
| | - Lichao Zhao
- Address: Department of Pathology and Laboratory Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
| | - Jessica N Doty
- Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
| | - Thomas Stasko
- Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
| | - Rachel Conrad
- Address: Department of Pathology and Laboratory Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
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11
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Lucci R, D' Anna M, Marano A, Vigliar E, Avellino M, Napolitano V, Troncone G, Bellevicine C. Morphological and immunocytochemical features of Merkel cell carcinoma metastatic to the pancreas diagnosed by endoscopic ultrasound-guided fine-needle aspiration. Diagn Cytopathol 2017; 45:629-630. [PMID: 28387053 DOI: 10.1002/dc.23718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/16/2017] [Accepted: 03/21/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Raffaella Lucci
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Melania D' Anna
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Antonio Marano
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Elena Vigliar
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Manuela Avellino
- Endoscopic Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Vincenzo Napolitano
- Endoscopic Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Claudio Bellevicine
- Department of Public Health, University of Naples "Federico II", Naples, Italy
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Ferreira J, Gasparinho MG, Fonseca R. Cytomorphological features of blastic plasmacytoid dendritic cell neoplasm on FNA and cerebrospinal fluid cytology: A review of 6 cases. Cancer Cytopathol 2015; 124:196-202. [DOI: 10.1002/cncy.21645] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/16/2015] [Accepted: 10/16/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Joana Ferreira
- Pathology Department, Instituto Portugues de Oncologia de Lisboa Francisco Gentil; Lisbon Portugal
| | | | - Ricardo Fonseca
- Pathology Department, Instituto Portugues de Oncologia de Lisboa Francisco Gentil; Lisbon Portugal
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Cipolletta Campanile A, Malzone MG, Sanna V, Barizzi J, Manna A, Gioioso A, De Chiara A, Fulciniti F. Cytological and Immunocytochemical Features of Merkel Cell Carcinoma on Fine Needle Cytology Samples: A Study of 22 Cases. Endocr Pathol 2015; 26:243-9. [PMID: 25982258 DOI: 10.1007/s12022-015-9375-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Merkel cell carcinoma (MCC) is an uncommon neuroendocrine small cell tumor derived from the transformation of the homonymous cells in the basal layer of the epidermis. MCC has a generally aggressive course, with a high tendency for local recurrence, lymph node involvement, and distant metastasis. Fine needle cytology (FNC) and immunocytochemistry were used as diagnostic procedures for 22 cases of MCC presented at our institute. All cases of MCC were successfully diagnosed on FNC. Among all of the monoclonal antisera used (CD56, CK20, CK MNF116, neuron-specific enolase (NSE), synaptophysin, and chromogranin), NSE and CD56 showed the highest frequency of positivity. The accuracy of the cytological diagnosis was 100% compared to the corresponding previous or subsequent pathological diagnoses. FNC and immunocytochemistry represent excellent and accurate diagnostic methods to distinguish MCC from other small-cell malignant entities.
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Affiliation(s)
- Anna Cipolletta Campanile
- S.S.D. di Citopatologia e S.C. di Anatomia Patologica, Istituto Nazionale Tumori "Fondazione G. Pascale", via Mariano Semmola, 80131, Napoli, Italy
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