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2021, Volume 37, Number 1, Page(s) 084-088
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DOI: 10.5146/tjpath.2020.01501 |
Metastatic Epithelial-Myoepithelial Carcinoma in a Female Presenting with Neck Mass and Lytic Lesion in Acetabulum: A Diagnostic Challenge on Cytology |
Parikshaa GUPTA1, Arvind RAJWANSHI1, Nandita KAKKAR2 |
1Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, CHANDIGARH, INDIA 2Department of Histopathology, Postgraduate Institute of Medical Education and Research, CHANDIGARH, INDIA |
Keywords:
Epithelial-myoepithelial carcinoma, Salivary gland neoplasms, Fine needle aspiration cytology, Cytodiagnosis, GATA3 |
Epithelial-myoepithelial carcinoma (EMC) is a rare, low-grade, malignant salivary neoplasm. Establishing an accurate cytological diagnosis is
often challenging owing to its rarity, bland cytologic appearance and variable representation of cell populations in the smears. The diagnostic
struggle is more so when the aspiration is from a metastatic site with an unknown primary, as in such cases the list of differential diagnoses
expands further. A 58-year-old female presented with a low-back pain from last one month. On examination, she also had a level III, right
cervical swelling for the last 20 years. Radiology revealed a lytic lesion in the left acetabulum. She had undergone surgery 35 years ago for a
right-sided upper neck swelling, the medical records of which were not available. Fine needle aspiration (FNA) from the cervical swelling was
performed. The smears were cellular and showed predominantly dispersed, round to polygonal tumor cells with mild pleomorphism, eccentric
nuclei, coarse chromatin, occasional nucleoli and moderate cytoplasm with some showing vacuolations. The cell-block section revealed tumor
cells arranged in the form of tubules lined by dual layer of tumor cells without any chondromyxoid stroma. On immunocytochemistry, the
luminal cells showed positivity for CK7 (epithelial marker) and the abluminal cells showed positivity for p63 (myoepithelial marker). Based on
these features, a final diagnosis of metastatic epithelial-myoepithelial carcinoma was rendered. The present report highlights the characteristic
cytomorphological and immunocytochemical features of EMC and reiterates the diagnostic accuracy of FNAC for diagnosis of such challenging
cases.
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