Premium
EUS‐FNA of the Merkel cell carcinoma metastasis to the pancreas: Cytomorphology and immunocytochemistry on direct cytological smears
Author(s) -
StoosVeic T.,
Tadic M.,
Aralica G.,
Milicic V.,
TomasovicLoncaric C.
Publication year - 2017
Publication title -
cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.512
H-Index - 48
eISSN - 1365-2303
pISSN - 0956-5507
DOI - 10.1111/cyt.12425
Subject(s) - merkel cell carcinoma , medicine , pathology , differential diagnosis , fine needle aspiration , metastasis , chromogranin a , immunocytochemistry , cytokeratin , pancreas , cytopathology , carcinoma , biopsy , radiology , cytology , immunohistochemistry , cancer
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 MNF 116) positive, TTF ‐1 negative, CD 56 positive, NSE weakly positive, Chromogranin A weakly positive and CK 20 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.