J Pathol Transl Med.  2018 Mar;52(2):136-139. 10.4132/jptm.2017.07.27.

Fine-Needle Aspiration Cytology of Carcinosarcoma in the Salivary Gland: An Extremely Rare Case Report

• An HJ
• Baek HJ
• Kim JP
• Kim MH
• Song DH

• KMID: 2408517
• DOI: http://doi.org/10.4132/jptm.2017.07.27

Abstract

Carcinosarcoma of the salivary gland is an extremely rare tumor that is composed of both malignant epithelial and mesenchymal components. Diagnosing carcinosarcoma with fine-needle aspiration cytology is challenging because of its overlapping cytomorphologic characteristics with other high-grade malignant salivary gland tumors. Among the many features, including pleomorphic oncocytoid epithelial components, necrotic background, and mitoses, recognizing the singly scattered atypical spindle cells is most essential in carcinosarcoma. We present a case of a 66-year-old male patient with characteristic features of carcinosarcoma, who was successfully treated by wide local excision and subsequent radiation therapy.

Keyword

Carcinosarcoma; Salivary glands; Biopsy, fine-needle

MeSH Terms

Aged
Biopsy, Fine-Needle*
Carcinosarcoma*
Humans
Male
Mitosis
Salivary Glands*

Figure

• 

  Fig. 1. Computed tomography image of the patient and gross examination, fine-needle aspiration specimen, and microscopic and immunohistochemical findings of carcinosarcoma. (A) Computed tomography scan shows a movable mass with sialolithiasis in the right submandibular area. (B) A well-circumscribed, ivory, heterogeneous mass is extended to the extra-parenchymal area. (C) A single malignant epithelial cell with marked nuclear pleomorphism, increased nuclear-cytoplasmic ratio, coarse chromatin pattern, and prominent nucleoli. (D) Abundant necrotic debris and a mixture of inflammatory cells are scattered in the background of dispersed atypical spindle cells. (E) Sheet-like fragments show squamous differentiation with a few mitosis. (F) Tumor is mainly composed of two components-undifferentiated carcinoma and undifferentiated pleomorphic sarcoma. (G) Under higher magnification, the carcinomatous component is haphazardly arranged with numerous mitoses and the sarcomatous components are permeating to the undifferentiated carcinoma. (H) Carcinoma cells are positive for cytokeratin. (I) Sarcoma cells are positive for vimentin. (J) Focal area mimicking epithelial-myoepithelial carcinoma.

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