PMC5259928_01
(a) Post-contrast MRI displaying multiple, discrete-to-confluent lesions (arrow) over the left shoulder. (b) FNAC smears showing cohesive cluster of cells with round-to-oval nuclei and scant cytoplasm, including relatively darker, smaller nuclei at the periphery, along with interspersed metachromatic/pink hyaline droplets (MGG, x200). (c) Higher magnification displaying rosetting arrangement of tumor cells around hyaline droplet (MGG, x400). (d) Cluster of bland cells, including cells with pale and dense chromatin, forming rosette-like structures (H&E, x400)
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F1
Post-contrast, these lesions showed moderate inhomogeneous enhancement with smooth margins [Figure 1]. Interspersed were stromal matrix cores that appeared as spherical hyaline "droplets/bodies." Diagnosis of a skin adnexal tumor was offered [Figure 1].
Histopathological findings. (a) Sharply defined cellular tumor nodules (H&E, x100). (b) Tumor comprising round-to-oval cells surrounding "pink" hyaline bodies. Occasional duct formation noted (arrowhead) (H&E, x200). (c) Dual population of small, dark, and relatively large, tumor cells with vesicular chromatin, around hyaline bodies. (H&E, x400). (d) Tumor cells arranged in tubular and trabecular arrangement, including cells with pale chromatin toward lumens and relatively darker myoepithelial cells toward the periphery. Scattered lymphocytes noted (H&E, x200)
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F2
Interspersed were numerous hyaline "droplets/pink bodies" that were periodic acid Schiff (PAS) positive, as well as diastase resistant, along with scattered lymphocytes [Figure 2].
Immunohistochemical results. (a) CK7 highlighting the luminal cells. (DAB, x400) (b) S100-P positivity within tumor cells (DAB, x400). (c). EMA highlighting the lumens within tumor cell clusters (DAB, x400). (d) Ki-67/MIB1 highlighting 5-10% tumor cell nuclei (DAB, x200). (e) Tumor cells displaying weak CD117/C-KIT positivity (DAB, x400)
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F3
Ki67/MIB1 highlighted 5-10% tumor nuclei in the most proliferating area [Figure 3].