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Presented by Ralph Hruban, M.D. and prepared by Greg Seidel, M.D.
Case 6: This 80 year old female presented with a nodule in her neck.
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1. Question
Week 116: Case 6
This 80 year old female presented with a nodule in her neck./images/1216026a.jpg
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/images/1216026e.jpgCorrect
Answer: Metastatic Merkel cell carcinoma
Histology: In this case, a lymph node superior to the parotid gland was replaced by small round blue cells. The neoplastic nuclei have a “ground glass” appearance with “dusty” chromatin.
Discussion: Merkel cell carcinomas tend to arise on the face or extremities in elderly patients. They are cellular, have a high mitotic count, and, as seen in this case, the nuclei have a characteristic “ground glass” or “dusty chromatin” appearance. The major differential diagnosis would include a metastatic small cell carcinoma from the lung. Immunolabeling can help make this distinction. Merkel cell carcinomas express neurofilament, cytokeratin (dot-like pattern) and neuron specific enolase. Therefore the stains to use to distinguish between a small cell carcinoma of the lung and Merkel cell carcinoma are TTF-1, NF and CK20.
Incorrect
Answer: Metastatic Merkel cell carcinoma
Histology: In this case, a lymph node superior to the parotid gland was replaced by small round blue cells. The neoplastic nuclei have a “ground glass” appearance with “dusty” chromatin.
Discussion: Merkel cell carcinomas tend to arise on the face or extremities in elderly patients. They are cellular, have a high mitotic count, and, as seen in this case, the nuclei have a characteristic “ground glass” or “dusty chromatin” appearance. The major differential diagnosis would include a metastatic small cell carcinoma from the lung. Immunolabeling can help make this distinction. Merkel cell carcinomas express neurofilament, cytokeratin (dot-like pattern) and neuron specific enolase. Therefore the stains to use to distinguish between a small cell carcinoma of the lung and Merkel cell carcinoma are TTF-1, NF and CK20.
