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Case of the Month



Undifferentiated Pleomorphic Sarcoma

This 61-year-old woman presented with a vascular, 9mm nodule of her left forearm. She had a history of breast cancer 14 years prior. An FNA was performed. Cytologically, there is a monotonous population of round cells with round nuclei having "salt and pepper" chromatin. The cells are positive for CD56, synaptophysin, chromogranin, EMA, CK20 and CK8/18. TTF1 is negative, ruling out a lung metastasis. Merkel cell carcinoma is diagnosed.

Merkel cell carcinoma is a rare, primary neuroendocrine carcinoma of the skin occuring most commonly at sun exposed sites in adult patients with a history of immunosupression (including history of treatment for carcinoma). The lesion is typically firm, red, rapidly growing and associated with regional lymph node metastasis. Treatment consists of wide surgical excision with radio- or chemo- therapy.