Jayaram Gita, Elsayed Elnazir Mohamed
Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Acta Cytol. 2005 Sep-Oct;49(5):520-4. doi: 10.1159/000326198.
Carcinosarcoma (sarcomatoid carcinoma) is a rare tumor with a high predilection for the aerodigestive tract. Cytologic diagnosis of metastatic carcinosarcoma has been reported in very few cases.
An 84-year-old woman presented with a 2-cm-diameter, right cervical lymph node that was referred for fine needle aspiration cytology (FNAC). She had received radiotherapy for a palatal squamous cell carcinoma 2 years earlier. The FNAC smears had a sarcomatoid appearance. Repeat fine needle aspiration was performed, with cytologic and immunocytochemical staining. Careful consideration of the cytologic and immunophenotypic features led to an impression of carcinosarcoma. Histologic sections of the palatal biopsy that had been previously diagnosed as squamous cell carcinoma were reviewed, and a final diagnosis of carcinosarcoma was established.
Metastasis of rare lesions, such as carcinosarcoma may be confusing and difficult to diagnose on FNAC, especially when the cytologic sample shows a predominantly sarcomatoid component. The difficulty is compounded when the sarcomatoid component happens to have been overlooked on the initial histologic assessment. With representative cytologic sampling, immunocytochemical staining and review of the histologic material, the correct diagnosis was achieved in this case.
癌肉瘤（肉瘤样癌）是一种罕见肿瘤，高度好发于气消化道。转移性癌肉瘤的细胞学诊断仅有极少病例报道。
一名84岁女性因右颈部一个直径2厘米的淋巴结前来接受细针穿刺细胞学检查（FNAC）。她两年前曾因腭部鳞状细胞癌接受过放疗。FNAC涂片呈肉瘤样外观。进行了重复细针穿刺，并进行了细胞学和免疫细胞化学染色。仔细考虑细胞学和免疫表型特征后得出癌肉瘤的印象。对先前诊断为鳞状细胞癌的腭部活检组织切片进行复查，最终确诊为癌肉瘤。
罕见病变如癌肉瘤的转移可能令人困惑，在FNAC上难以诊断，尤其是当细胞学样本主要显示肉瘤样成分时。当肉瘤样成分在最初的组织学评估中被忽视时，困难会更加复杂。通过具有代表性的细胞学采样、免疫细胞化学染色以及对组织学材料的复查，本病例得以做出正确诊断。
