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Objective: To report atypical cytomorphologic features in fine needle aspiration biopsies (FNABs) from two cases of Merkel cell carcinoma (MCC), a primary neuroendocrine neoplasm of skin., Study Design: Retrospective review of FNABs with histologic correlation from six patients with MCC and a report of findings from two whose smears showed atypical features., Results: Typically the aspirates produce highly cellular smears of loosely clustered and individual, relatively monomorphic, small tumor cells with round to oval, regularly contoured nuclei. In two of our cases, the tumor cell nuclei exhibited a spectrum of pleomorphism ranging from moderately complex nuclear membranes with cleaves, indentations and protrusions in one case to large, markedly bizarre, convoluted nuclei and multinucleate tumor cells in the extreme case. Both cases were primary neoplasms, and the diagnosis was based on clinical, histologic and immunohistochemical data. Additionally, electron microscopy was performed on the tumor with bizarre nuclei and demonstrated rare, dense core neurosecretory granules and paranuclear bundles of intermediate filaments.

Objective: A phase I/II clinical trial of surgical cytoreduction combined with intraperitoneal hyperthermic chemotherapy (IPHC) for patients with disseminated peritoneal carcinoma was begun in December 1991. The use of peritoneal cytology to assess this treatment modality was the objective of this study., Study Design: Adult patients with primary intraabdominal cancer with peritoneal dissemination underwent surgical debulking and intraoperative, two-hour, heated abdominopelvic perfusion with mitomycin C (MMC). Peritoneal washings were sent before and after IPHC, and the use of peritoneal cytology in this setting was reviewed retrospectively., Results: Twenty patients (9 female, 11 male) with adenocarcinoma (19) and one with epithelial mesothelioma, all with bulky peritoneal disease, were treated. Pre- and post-IPHC cytologic specimens were available for 18 cases. Cytology was tumor negative in three cases before and after IPHC. Conversion to negative post-IPHC cytology was seen in 6 of 15 cases and correlated with total or near-total tumor debulking (Fisher's exact test, P = .002). For 13 patients with follow-up > or = 6 months, 6 patients with both negative post-IPHC cytology and tumor < or = 1 g were alive at 6 months; of 7 patients with residual gross tumor or positive post-IPHC cytology, 5 had died within 6 months (P = .02)., Conclusion: Some patients undergoing IPHC with tumor-positive peritoneal cytology will convert to negative cytology following IPHC. This correlates with total or near-total tumor debulking and is associated with improved survival.

Combined hepatocellular-cholangiocarcinoma (HCC-CC) is rare, constituting much less than 5% of all primary liver cancers. Its dual histologic and cytologic differentiation may be a major problem in the differential diagnosis of fine needle aspiration biopsies (FNABs) of the liver. We describe two cases of combined HCC-CC, both examined initially by FNAB. Cytologic smears were markedly cellular, with a population of slightly to moderately pleomorphic neoplastic cells, often arranged in cohesive cords and columns resembling anastomosing hepatic plates. Many of these cells had centrally placed nuclei and a moderate amount of granular, eosinophilic cytoplasm. Other cellular groups were arranged in acinar formations, with eccentric nuclei and intraluminal and cytoplasmic mucin production. Both types of cells were positive for cytokeratin and carcinoembryonic antigen; in one case the carcinoma cells were also focally positive for alpha-fetoprotein. Although these neoplasms may pose diagnostic challenges, our experience suggests that HCC-CC may be suspected or even diagnosed by FNAB.