PMC9079315_01
(a) Aspirates were high cellularity with loosely cohesive clusters and dispersed population of atypical cells (Giemsa; x100), (b) Markedly pleomorphic, oval to spindled cells with plump elongated nuclei, vesicular chromatin, prominent nucleoli and ill- defined cytoplasm (Giemsa; x400), (c) Few reactive lymphoid cells in background (Papanicolaou; x400), (d) The biopsy showed sheets of large atypical cells with brisk mitoses (H and E; x400), inset: nuclear p63 in atypical cells (DAB; x400).
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F1
Fine needle aspiration (FNA) of left cervical swelling was performed [Figures 1]. Paraffin-embedded sections were studied which comprised of multiple fragments partly lined by respiratory epithelium with an underlying tumor composed of sheets of monomorphic round to oval cells with high nucleocytoplasmic ratio, round nuclei, prominent eosinophilic nucleoli, and scant cytoplasm with the presence of brisk mitoses and focal areas of fascicles of spindle cells [Figure 1d].
Contrast-enhanced computed tomography showing a heterogeneously enhancing rounded solid mass lesion involving left temporal lobe, extending into cavernous sinus.
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F2
Contrast-enhanced computed tomography and magnetic resonance imaging (MRI) of brain showed an extra-axial isointense rounded solid mass lesion measuring 2.5 x 2.2 x 1.6 cm in the left temporal lobe invading cavernous sinus and encasing internal carotid artery with mild erosion of medial aspect of petrous temporal bone and extension into nasopharynx [Figure 2].
(a) p63 positivity in atypical cells (DAB; x400), (b) some cells reveal CK5/6 positivity (DAB; x400), (c) many cells reveal CK 19 positivity (DAB; x400), (d) cells are negative for CK 7 (DAB; x400).
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F3
Immunohistochemistry (IHC) revealed p63, cytokeratin (CK) 19, and 5/6 positivity with negative CK7 and 14 [Figure 3].