Merkel cell carcinoma is an uncommon aggressive skin tumour 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 more common small round blue cell tumours. A patient history with a 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 reaching the correct diagnosis. The tumour cells are usually monotonous small round cells, singly scattered or arranged in loosely cohesive clusters. Cells have round to elongated nuclei with coarsely granular chromatin, nuclear moulding in places and scanty basophilic cytoplasm. A limited immunocytochemistry panel employing CK20 and CD56, for which the tumour is positive, is confirmatory. We herein present a case of infiltration of cerebrospinal fluid by Merkel cell carcinoma.
Primary hepatic angiosarcoma (PHA) is a rare, rapidly growing, highly aggressive hepatic malignancy, primarily seen in elderly males. Establishing an accurate clinical diagnosis is challenging owing to its rarity and nonspecific presentation. Rendering a cytologic diagnosis of PHA is extremely difficult, and immunocytochemistry(ICC) on cell block(CB) sections is essential to confirm the diagnosis. The characteristic cytomorphologic features of PHA have rarely been documented, further augmenting the diagnostic challenge. A 32‐year‐old male presented with abdominal pain, abdominal distension, and significant weight loss over the past 9 months. On examination, the abdomen was distended, with multiple spider angiomas and a large mass in the right hypochondrium. His renal function tests, liver function tests, and serum tumor markers were within normal limits. An abdominal triphasic computerized tomography revealed a large lobulated mass in the right lobe with central necrosis. An ultrasound‐guided FNA was performed from the liver lesion. The cytologic smears showed singly scattered large, markedly pleomorphic, epithelioid‐elongated tumor cells having oval‐elongated nuclei, irregular nuclear contours, coarse chromatin, prominent macronucleoli, and abundant finely vacuolated cytoplasm in a background of blood. ICC on the CB demonstrated diffuse positivity for vimentin, CD31, and nuclear positivity for FLI‐1, confirming a vascular origin. Hence, a final cytologic diagnosis of primary hepatic angiosarcoma was rendered. The index report describes the characteristic cytomorphologic and immunocytochemical features of a rare hepatic malignancy in a young male and reiterates the usefulness of FNAC coupled with CB‐ICC in the quick and precise diagnosis of such challenging cases.
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