Journal of Cytology
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 Table of Contents    
IMAGES IN CYTOPATHOLOGY  
Year : 2018  |  Volume : 35  |  Issue : 1  |  Page : 53-54
Martian Popping Thing


Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India

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Date of Web Publication18-Jan-2018
 

   Abstract 


How to cite this article:
Madakshira MG, Ahmed I. Martian Popping Thing. J Cytol 2018;35:53-4

How to cite this URL:
Madakshira MG, Ahmed I. Martian Popping Thing. J Cytol [serial online] 2018 [cited 2021 Jun 15];35:53-4. Available from: https://www.jcytol.org/text.asp?2018/35/1/53/223602




“Martian Popping Thing” is a stress buster doll which resembles an obese bowling pin with eyes and ears.[1] Fine needle aspirate smears from well-differentiated pancreatic ductal adenocarcinoma show similar singly scattered bizarre tumor giant cells, the nuclei of which resembles the shape of “Martian Popping Thing.”[2] These cells offer a subtle clue in the cytopathological diagnosis of well-differentiated pancreatic ductal adenocarcinoma. The other cytological features which are seen on the aspirate smears of a case of pancreatic ductal adenocarcinoma include cellular smears with paucity or absence of acinar cells, cell clusters which are too crowded (tight wads) or too loose (drunken honey combs), nucleomegaly (>2 times normal), irregular nuclear contour, and mitotic figures.[3]

A 67-year-old man presented with complains of anorexia and effort intolerance of 1 month duration and abdominal pain of 7 days duration. Evaluation revealed a lump occupying the left hypochondrium and extending into epigastrium. Contrast-enhanced computed tomography (CT) showed a hyodense hyperenhancing irregular focal lesion in the pancreatic tail which is exophytic reaching up to the splenic hilum and encasing a short segment of the distal splenic artery [Figure 1]. Liver showed mild enlargement with multiple round focal hypoenhanced lesions diffusely scattered in both lobes of the liver [Figure 1]. Also seen were multiple enlarged, heterogeneously enhancing lymph nodes in the periportal, pancreatic, and upper retroperitoneum. Tumor marker profile showed a raised CA 19-9. CT-guided fine needle aspiration (FNA) was done from the lesion in the tail of the pancreas. Romanowsky stained aspirate smears were cellular with absence of acinar cells. Few normal ductal epithelial cells were seen in a characteristic honeycomb pattern. However, the predominant cell population was composed of crowded cells clusters [Figure 2] with nuclear overlapping or “drunken honey comb” [Figure 3] cell clusters. These cell clusters show marked anisonucleosis with coarse chromatin and irregular nuclear borders. Also seen to pop-out of the background were singly scattered bizarre tumor giant cells having a large nuclei shaped in the form of obese bowling pins (Martian Popping Thing) [Figure 4]. Based on the clinical, radiological, and cytomorphological features, a diagnosis of ductal adenocarcinoma of pancreas was offered. In view of the advanced stage of malignancy, the patient was counseled and put on palliative chemotherapy with gemcitabine.
Figure 1: CT scan showing an exophytic lesion in the tail of the pancreas (white arrow) reaching up to the spleen. Also seen are multiple lesions in the liver

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Figure 2: May–Grumwald–Giemsa (×400 magnification) stained smear shows a tight cluster (tight wads) of malignant ductal epithelial cells

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Figure 3: May–Grumwald–Giemsa (×400 magnification) stained smear shows a loose cluster (drunken honey comb pattern) of atypical ductal cells

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Figure 4: May–Grumwald–Giemsa (×1000 magnification) stained smear shows a bizarre cell akin to “Martian Popping Thing”

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Cytopathology of the pancreas has been accepted as a norm for establishing diagnosis in a setting of unresectable tumor at the time of initial presentation due to advanced locoregional spread, metastasis, or due to other medical comorbidities.[4] Confirmation of diagnosis is mandatory before institution of chemotherapy or radiation therapy.[4] This has been possible as the sensitivity and specificity of diagnosing well-differentiated pancreatic adenocarcinoma is 98% and 100%, respectively.[3] During this process, the synchrony between cytology and radiology has provided an opportunity for minimally invasive, accurate, relatively safe, and cost-effective diagnosis, which was earlier possible following a laparotomy.[4]

For the cytologist, the characteristic features enumerated in the introductory paragraph provide subtle clues to make a confident diagnosis of pancreatic duct adenocarcinoma. Of significance is the detection of peculiar tumor giant cells having bizarre nuclei likened to the “Martian Popping Thing.” Such cells are seldom seen in other carcinomas making their presence a beacon for labeling the lesion as well-differentiated pancreatic ductal adenocarcinoma.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Schaefer CE, Cangelosi D. Essential Play Therapy Techniques: Time-tested Approaches. Guilford Publications; 2016.  Back to cited text no. 1
    
2.
DeMay RM. Pancreas. In: DeMay RM, editor. The Art and Science of Cytopathology. 2nd ed. Chicago: American Society for Clinical Pathology Press; 2012. p. 1313-6.  Back to cited text no. 2
    
3.
Lin F, Staerkel G. Cytologic criteria for well differentiated adenocarcinoma of the pancreas in fine-needle aspiration biopsy specimens. Cancer 2003;99:44-50.  Back to cited text no. 3
[PUBMED]    
4.
Bellizzi AM, Stelow EB. Pancreatic cytopathology: A practical approach and review. Arch Pathol Lab Med 2009;133:388-404.  Back to cited text no. 4
[PUBMED]    

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Correspondence Address:
Dr. Manoj G Madakshira
Department of Pathology, Armed Forces Medical College, Pune - 411 040, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JOC.JOC_238_16

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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