Journal of Cytology
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Year : 2014  |  Volume : 31  |  Issue : 3  |  Page : 179-180
Fine-needle aspiration cytology of recurrent Merkel cell carcinoma of eye-brow


1 Department of Cytopathology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

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Date of Web Publication29-Nov-2014
 

How to cite this article:
Khairwa A, Dey P, Bal A. Fine-needle aspiration cytology of recurrent Merkel cell carcinoma of eye-brow. J Cytol 2014;31:179-80

How to cite this URL:
Khairwa A, Dey P, Bal A. Fine-needle aspiration cytology of recurrent Merkel cell carcinoma of eye-brow. J Cytol [serial online] 2014 [cited 2020 Jun 6];31:179-80. Available from: http://www.jcytol.org/text.asp?2014/31/3/179/145666


Sir,

Merkel cell carcinoma (MCC) is a rare and highly aggressive tumor of the skin. It is commonly seen in the head-neck region and is rarely encountered in lower limbs and upper extremities, within the oral cavity and the vulva. [1],[2],[3],[4],[5] MCC is an aggressive neuroendocrine tumor of the skin that develops rapidly within weeks to months on chronic sun exposed skin. MCC presents as skin-colored, red or violaceous, firm and nontender nodule with a smooth and shiny surface. [1] Ulceration of the tumor is occasionally seen in advanced cases. [1] MCC has a high propensity for regional and distant metastases, and it often spreads to the draining nodes, with frequent metastatic dissemination to the different organs of the body. [4] In this present paper, we are describing the fine needle aspiration cytology (FNAC) of a case of recurrent MCC of the eyebrow.

The 60-year-old man presented to us with 2 month history of a painless, nontender swelling on the right temporal region near the outer canthus of right eye. Physical examination showed a tumor measuring 3.0 cm × 2.0 cm × 1.6 cm swelling in the right temporal region near the right lateral part of eye. The patient was operated for similar swelling 2 months back, which was reported as MCC on histopathology. FNAC smears showed discrete small round cells. The individual cells were small-to-medium in size with uniform, round-to-oval nuclei and scanty cytoplasm [Figure 1]a. Nuclei showed fine chromatin and small inconspicuous nucleoli [Figure 1]b. Occasional nuclear molding was also seen. The cytological diagnosis of recurrent MCC was suggested. Previous histopathology of the tumor was also reviewed along with cytology smear and both showed similar morphology [Figure 1]c. The tumor cells were positive for chromogranin [Figure 1]d and cytokeratin.
Figure 1: (a) Discrete small round cells (MGG, ×220). (b) Cells with fine chromatin and deep blue cytoplasm (MGG ×440). (c) Histology section showing discrete small cell population (H and E, ×440). (d) Strong chromogranin positivity in Merkel cell carcinoma (Immunocytochemitry, ×440)

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Merkel cell carcinoma is a rare form of neuroendocrine carcinoma that originates from the neural crest cells and is found in the skin and parts of the mucosa that are derived from the ectoderm. There are only a few studies that demonstrated recurrence of MCC diagnosed by FNAC. [6],[7] Discrete round cell population with monomorphic nuclei in a subcutaneous nodule should raise the suspicion of MCC. Metastatic small cell carcinoma is a close differential diagnosis in such cases and immunocytochemistry is needed to differentiate these two entities. MCC is positive for chromogranin and CK20, [8] whereas, small cell carcinoma is negative for CK20. On FNAC smear, MCC also simulates non Hodgkin lymphoma. However, the absence of lymphoglandular body excludes the possibility of lymphoma.

In this brief report we presented an uncommon case of MCC. Discrete small round cells with absence of lymphoglandular bodies in subcutaneous swelling should always raise suspicion of MCC.

 
   References Top

1.
Schrama D, Becker JC. Merkel cell carcinoma - pathogenesis, clinical aspects and treatment. J Eur Acad Dermatol Venereol 2011;25:1121-9.  Back to cited text no. 1
    
2.
Cymerman JA, Kulkarni R, Gouldesbrough D, McCaul J. Small cell neuroendocrine tumour of the anterior tongue: A case report. Int J Surg Case Rep 2013;4:753-5.  Back to cited text no. 2
    
3.
Sheikh ZA, Nair I, Vijaykumar DK, Jojo A, Nandeesh M. Neuroendocrine tumor of vulva: A case report and review of literature. J Cancer Res Ther 2010;6:365-6.  Back to cited text no. 3
    
4.
Vasileiadis I, Sofopoulos M, Arnogiannaki N, Georgopoulos S. A Merkel-cell carcinoma metastatic to the tonsil: A case report and review of the literature. J Oral Maxillofac Surg 2013;71:1812.e1-6.  Back to cited text no. 4
    
5.
Medhi S, Purandare NC, Dua SG, Gujral S. Bilateral renal metastases in a case of Merkel cell carcinoma. J Cancer Res Ther 2010;6:353-5.  Back to cited text no. 5
    
6.
Szeder V, Grim M, Halata Z, Sieber-Blum M. Neural crest origin of mammalian Merkel cells. Dev Biol 2003;253:258-63.  Back to cited text no. 6
    
7.
Ostovic KT, Haris V, Miletic Z, Lambasa S, Lajtman Z, Stoos-Veic T. Fine needle aspiration cytology of metastatic Merkel cell carcinoma. Coll Antropol 2010;34:691-6.  Back to cited text no. 7
    
8.
Moll R, Löwe A, Laufer J, Franke WW. Cytokeratin 20 in human carcinomas. A new histodiagnostic marker detected by monoclonal antibodies. Am J Pathol 1992;140:427-47.  Back to cited text no. 8
    

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Correspondence Address:
Pranab Dey
Department of Cytopathology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9371.145666

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