PART TWO
Diagnostic Cytology
Fig. 22.45 Neuroendocrine carcinoma (Merkel cell tumor) of the skin. Immunocytochemical detection of neuron-specific enolase (A) and cytokeratin
(B) (alkaline phosphatase; x HP).
Key features of neuroendocrine carcinoma of the skin
Few small clusters of monotonous fragile cells;
Dispersed tumor cells often without cytoplasm; and
Frequent mitoses.
Concluding Remarks
FNA cytology is today accepted as an indispensable diagnostic
tool in the clinical management of patients with salivary gland
and head and neck lesions. Several studies have shown that most
cases of reactive lesions and benign and malignant tumors can
be accurately diagnosed. Thus patients with reactive lesions can
be spared surgery while those with tumors can be given a more
individualized treatment.
The accuracy of salivary gland FNA is high but the correct sub-
classification of some tumors such as variants of pleomorphic
adenoma,
basaloid
adenoma/carcinoma,
well-differentiated
mucoepidermoid carcinoma, and polymorphous low-grade car-
cinoma is notoriously difficult even for experienced cytopathol-
ogists.
An optimal cytology service depends on proficiency both in
FNA biopsy technique and interpretation of the FNA smears. In
the "Swedish model" the cytopathologist performs the biopsy and
reads the slides. This has several advantages and will allow the use
of quick stain to reduce the number of non-diagnostic biopsies
as well as to procure material for ancillary techniques such as
immunocytochemistry and molecular biology. The importance of
a close collaboration between surgeons, radiologists, oncologists,
and cytopathologists can, however, never be overemphasized.
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