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Vol.48, No.6, 2014
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Archive-the Korean Journal of Pathology(1967~2008)
Archive-the Korean Journal of Cytopathology(1990~2008)
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  Vol.16, No.1:52-56, March 2005
Case reports
Fine Needle Aspiration Cytology of Metastatic Alveolar Rhabdomyosarcoma Misinterpreted as Carcinoma -A Case Report-

Hyun-Jung Kim, Sung-Jik Lim, Kyeong-Mee Park

Department of Pathology, Inje University, Sanggye Paik Hospital, Seoul, Korea

Fine-needle aspiration cytology (FNAC) has been used extensively in the diagnosis of metastatic malignancies.However, metastatic soft tissue sarcomas are often overlooked, primarily due to the low frequency with whichthey occur. Here, we report a rare case of metastatic rhabdomyosarcoma in both cervical lymph nodes, whichwas detected by FNAC. A 45-year-old woman presented with anosmia, postnasal drip, and sneezing, symptomswhich had persisted for 1 month. The patient was found to have a tumorous lesion at the upper portion of themid-turbinate, with multiple enlarged cervical lymph nodes, and this lesion was examined closely at our facility.FNA cytology smears obtained from both cervical lymph nodes revealed a high degree of cellularity, anddisplayed cohesive clusters with gland-like spaces, as well as single isolated cells with abundant karyorrhecticdebris. The tumor cells exhibited round to oval nuclei containing fine chromatin, occasional small nucleoli, andscanty cytoplasm, or a total lack of cytoplasm. Some of the tumor cells were arranged in multinucleated formsand abundant dense eosinophilic cytoplasms, reminiscent of a rhabdomyoblast. The histological findings of thelymph nodes revealed an outstanding sinusoidal infiltration and a prominent alveolar growth pattern, interspersedwith occasional typical rhabdomyoblasts. The immunohistochemical results [desmin (+), myoglobin (+), myogenin(+), pan CK (-), synaptophysin (-), neuron specific enolase (-)] supported a confirmative diagnosis of alveolarrhabdomyosarcoma. Alveolar rhabdomyosarcoma is a representative sarcoma, which typically manifests withnodal metastasis and carcinoma-like clustering. The cytopathologist should remain alert upon encounteringunusual morphology, so that the possibility of this condition, although somewhat remote, should not be dismissedor overlooked.
Key Words : Alveolar rhabdomyosarcoma, Lymphatic metastasis, Fine needle aspiration cytology

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