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Cytopathology of Cutaneous Tumors

  • Kenneth B. Calder
  • Rahel Mathew
  • Michael B. Morgan
Chapter

Abstract

Cytopathology is the study of morphologic cellular features based upon microscopic anatomy. In addition, the cytologic findings of cells reflect functional differentiation (cytoplasm) and cellular activity (nuclear findings). Understanding the cellular details of neoplasms has significant diagnostic utility. The cytologic features of the most common skin tumors are presented in this chapter.

Cytopathology is the study of morphologic cellular features based upon microscopic anatomy. In addition, the cytologic findings of cells reflect functional differentiation (cytoplasm) and cellular activity (nuclear findings). Understanding the cellular details of neoplasms has significant diagnostic utility. The cytologic features of the most common skin tumors are presented in this chapter.

Squamous Cell Carcinoma

The features most characteristic of squamous cell carcinoma (SCC) include a substantial increase in the nuclear cytoplasm ratio, an eosinophilic cytoplasm and the presence of intercellular bridges. Other features that assist in the diagnosis of SCC include pleomorphic cells, which may have a mosaic tile arrangement, and the presence of hyperchromatic nuclei with an irregular chromatin pattern.

Basal Cell Carcinoma

The malignant cells of a basal cell carcinoma (BCC) are cohesive, monotonous and overcrowded. The cells have very high nuclear to cytoplasmic ratios. The cells are small to intermediate with oval, elongated and hyperchromatic nuclei with occasional inconspicuous nucleoli. Peripheral palisading of the nuclei can be seen.

Basosquamous Carcinoma

Basosquamous carcinoma is a distinct entity with overlapping cytohistologic features of both BCC and SCC. The cells of basosquamous carcinoma are spindle shaped with an eosinophilic cytoplasm (keratinization), similar to SCC. On the other hand, there are also cytologic features of BCC as well: peripheral palisading and stromal fibroplasia.

Melanoma

The epithelioid cells of melanoma tend to be medium to large sized, round to polyhedral, with prominent cellular polymorphism. An abundant granular cytoplasm with intracytoplasmic melanin granules is also present. Nuclear features include: relatively large nuclei, with or without intranuclear inclusions, and prominent “cherry red” macronucleoli. Nuclear pleomorphism, a high mitotic rate with atypical mitoses, as well as bi- or multinucleation is also usually present.

Merkel Cell Carcinoma

The cells of merkel cell carcinoma are monomorphic, loosely cohesive with nuclear molding. Tumor cells are intermediate in size, round to oval with fine granular and diffuse chromatin pattern and inconspicuous nucleoli. There is only a thin rim of cytoplasm, thereby increasing the nuclear to cytoplasmic ratio.

Paget’s Disease

Paget’s disease of the skin consists of glandular epithelium with large pleomorphic nuclei, prominent nucleoli and high nuclear to cytoplasmic ratio. The chromatin pattern is pale, and the cells can be seen singly or in small clusters.

Sebaceous Carcinoma

The cytohistologic features of sebaceous carcinomas (SC) demonstrate recognizable sebaceous differentiation. Comprising confluent aggregates (lobules) of neoplastic cells of varying shapes and sizes, SC have a large bubbly cytoplasm. Malignant cytologic features include: nuclear pleomorphism, nuclear hyperchromatism and frequent atypical mitoses. The following features support sebaceous differentiation and assist in the diagnosis: large vesicular nuclei with prominent nucleoli, a foamy vacuolated cytoplasm and the presence of lipid-laden histiocytes in the background.

Squamous Cell Carcinoma

Basal Cell Carcinoma

Basosquamous Carcinoma

Melanoma

Paget’s Disease

Merkel Cell Carcinoma

Sebaceous Carcinoma

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Copyright information

© Springer Science+Business Media LLC 2018

Authors and Affiliations

  • Kenneth B. Calder
    • 1
  • Rahel Mathew
    • 1
  • Michael B. Morgan
    • 2
  1. 1.Department of Pathology and Cell BiologyUniversity of South Florida College of MedicineTampaUSA
  2. 2.Bay Area Dermatopathology Ameripath, and Director of Primary Care Institute, Dermpath DiagnosticsUniversity of South Florida College of Medicine, and Director, Dermatopathology, Haley V.A. Hospital, and Managing DirectorTampaUSA

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