ORIGINAL ARTICLE

Year : 2021  |  Volume : 16  |  Issue : 2  |  Page : 371-372

Metastatic melanocarcinoma – Cytomorphological patterns

Reetika Garg, Arvind Bhake, Anil Agrawal
Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India

Correspondence Address:
Dr. Reetika Garg
Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed University), Sawangi (M), Wardha - 442 001, Maharashtra
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jdmimsu.jdmimsu_159_19

Introduction: The cytodiagnosis of melanocarcinoma achieved on Fine Needle Aspiration Cytology is cytomorphologically dicey at metastatic site. This is due to various morphologies achieved by melanocarcinoma as observed in histopathological examination. Therefore, it becomes imperative for cytopathologist to know about cytomorphological patterns observed at the diagnosis of melanocarcinoma. More so when melanocarcinoma is amelanotic and the clinical evidence of primary melanocarcinoma in the skin and other places is absent. Aim and Objectives: The present poster describes the experience with the cytomorphological patterns and diagnosis of melanocarcinoma, where the clinical evidence of presence of growth of melanocarcinoma in skin at any body site was absent. Materials and Methods: Fine needle aspiration done in 15 cases from metastatic sites, slides prepared were processed conventionaly. Result and Conclusion: It was observed that the certain cytomorphological features and typified cytomorphological arrangements in the presence of melanin containing cells or even amelanotic cells is enough characterizing melanocarcinoma which is described in the poster.

Keywords: Melanocarcinoma, diagnostic cytology, cytomorphological patterns

Introduction

• Melanocarcinoma (MC) may secondarily involve virtually any tissue and visceral structures in the body^[1]
• The metastatic promiscuity of MC is thought of vertical phase of local growth of cutaneous MC^[2]
• The MC when presented as a cutaneous lesion on many occasions is surgically removed as a matter of small growths on the soul of feet or at any other cutaneous sites by the surgeons inadvertently thinking it to be differential benign growth unsuspected of MC^[3]
• Over a period of time, patients report their surgeons with the nodular growth at the same site or lymphadenopathies or distant cutaneous nodules without evidence of primary site tumor^[4]
• These patients are often subjected to fine-needle aspiration cytology (FNAC) of enlarged lymph nodes or the nodules without any suspected clinical diagnosis of MC
• The cytomorphological characterization of the cells and their patterns can help the cytopathologist at the diagnosis of MC with pigments or without pigments
• The present study describes the experience with 15 such cases from archives of cytopathology at Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, over 4 years.

Materials and Methods

• A total of 15 cases were included in the study with its clinical details recorded
• The inclusion criteria were the cytodiagnosis of MC on FNAC of enlarged lymph nodes or subcutaneous nodules without evidence of cutaneous MC at the time of hospital consultation but with the history of local excision of the lesion in the past
• FNAC was carried out by conventional methods, and aspirates were processed for May–Grünwald–Giemsa (MGG) and Papanicolaou stain
• The cytodiagnosis of metastatic MC was made by standard references over the topic
• The evaluation of cytomorphological patterns of the cell placement, cellular type, and cell characters was assessed.

Results

• Fifteen cases (11 males and 4 females)
• Age: Youngest – 23 years and eldest – 67 years (mean age = 43 years)
• Distribution of lymph nodes and nodules.



• Ten cases of inguinal lymph node
• One case of internal iliac lymph node (ultrasound guided)
• One case of axillary lymph node
• Three cases of popliteal nodules.
• Cytomorphological characterization



• The most common pattern of cell placement was dissociated or loosely followed by microtissue fragments, pseudospindle cell sheaths, and pseudoglandular arrangements (rare)
• Cells are chiefly round polygonal in shape followed by spindle-shaped cells followed by pleomorphic population of cells and small cells
• Nulcear character-enlarged nuclei mostly centrally placed without significant pleomorphism but with prominent nucleoli. Nuclear pseudoinclusion was rarest
• Cytoplasmic melanin was present but not in plenty; however, occasional cell in the cell sheath contains plenty of melanin or background melanin-containing macrophages
• Binucleate cells were observed as banal cytomorphological features
• Pap stain was more depictive of MC characters of that of MGG stain.

Discussion

• Not many studies in literature deal with the cytodiagnosis of metastatic MC in the absence of known primary of MC are reported in literature
• The present study shares some similar observations with that of Lindsey et al.'s study^[1]

Conclusion

• The cytodiagnosis of metastatic MC on FNAC in the absence of known primary is a unique cytopathologic challenge which a cytopathologist should apprehend
• The presence of typified and previously described characters can unravel the diagnosis of metastatic MC impacted by previous history of excision of primary site tumor whose histopathology is unknown.

References

1.	Lindsey KG, Ingram C, Bergeron J, Yang J. Cytological diagnosis of metastatic malignant melanoma by fine-needle aspiration biopsy. Semin Diagn Pathol 2016;33:198-203.
2.	Yin J, Lloydd R. Metastatic melanoma-a case report of rare cyto-morphologic variant in fine needle aspiration specimen. N Z J Med Lab Sci 2014;68:28.
3.	Saqi A, McGrath CM, Skovronsky D, Yu GH. Cytomorphologic features of fine-needle aspiration of metastatic and recurrent melanoma. Diagn Cytopathol 2002;27:286-90.
4.	Wick MR, Gru AA. Metastatic melanoma: Pathologic characterization, current treatment, and complications of therapy. Semin Diagn Pathol 2016;33:204-18.