Turcan Didem, Yilmaz Evrim, Acu Berat, Acikalin Mustafa Fuat
Department of Pathology, Gaziantep 25 Aralık State Hospital, Gaziantep, Turkey.
Department of Pathology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
Cytopathology. 2025 Jan;36(1):50-55. doi: 10.1111/cyt.13440. Epub 2024 Sep 4.
One of the most common malignancies that metastasize to the parotid glands and associated lymph nodes is cutaneous melanoma. Although fine-needle aspiration (FNA) is well established for diagnosing primary salivary gland tumours, there is limited literature on its role in diagnosing metastatic lesions.
This study aims to investigate the cytomorphological features of malignant melanoma diagnosed by FNA in cases presenting with a parotid mass.
We present the clinical and cytomorphological findings of four cases. Conventional FNA biopsy smears and cell blocks were performed using standard techniques and for the differential diagnosis, a panel of immunohistochemical markers was used.
The patients included three females and one male, aged 54 to 77. FNA biopsies revealed atypical cells with large, hyperchromatic, pleomorphic nuclei, some of which exhibited prominent nucleoli. Plasmacytoid and oncocytic morphologies were also observed. Numerous mitotic figures were noted. Immunohistochemical staining showed HMB-45, S100 positivity in all cases. SOX10, MART-1 and MITF positivity were also observed. Three of the four patients had no history or suspected lesions of melanoma at the time of FNA diagnosis. The absence of melanin pigment complicated the diagnosis, but immunostains confirmed malignant melanoma.
Diagnosing malignant melanoma by FNA can be challenging, especially when the melanoma is in an unusual site, cytological findings are ambiguous, and there is no history of cutaneous melanoma. Accurate diagnosis requires a high level of suspicion and the use of appropriate immunohistochemistry.
皮肤黑色素瘤是转移至腮腺及相关淋巴结的最常见恶性肿瘤之一。尽管细针穿刺抽吸活检（FNA）在诊断原发性涎腺肿瘤方面已得到广泛应用，但关于其在诊断转移性病变中的作用的文献有限。
本研究旨在探讨细针穿刺抽吸活检诊断腮腺肿块病例中恶性黑色素瘤的细胞形态学特征。
我们报告了4例患者的临床及细胞形态学检查结果。采用标准技术进行常规细针穿刺抽吸活检涂片和细胞块制作，并使用一组免疫组化标志物进行鉴别诊断。
患者包括3名女性和1名男性，年龄在54至77岁之间。细针穿刺抽吸活检显示非典型细胞，细胞核大、染色质增多、形态多样，部分细胞核仁明显。还观察到浆细胞样和嗜酸性细胞形态。可见大量有丝分裂象。免疫组化染色显示所有病例HMB - 45、S100均呈阳性。还观察到SOX10、MART - 1和MITF呈阳性。4例患者中有3例在细针穿刺抽吸活检诊断时无黑色素瘤病史或可疑病变。黑色素的缺失使诊断复杂化，但免疫染色证实为恶性黑色素瘤。
通过细针穿刺抽吸活检诊断恶性黑色素瘤可能具有挑战性，尤其是当黑色素瘤位于不寻常部位、细胞学表现不明确且无皮肤黑色素瘤病史时。准确诊断需要高度的怀疑及使用适当的免疫组化方法。
