Solid malignant metastases in the jaw bones.

Metastatic tumours to the jaw bones are rare, and usually develop during the final stages of cancer. Some, such as those of lung, breast, and kidney, are more likely to metastasise to the jaw. We have therefore analysed the clinical and epidemiological characteristics of patients with metastatic tumours. We retrieved the notes of 4 478 patients with metastatic tumours to the jawbones who were treated in the Clinical Hospital Centre Dubrava in Zagreb, Croatia, during the 15 years 2002-17 and made a retrospective analysis of patients' age, sex, site of primary tumour, site and clinical presentation of the metastases, time interval since diagnosis of the primary tumour and oral metastases, and time interval from diagnosis of oral metastases to death. Of the 10 who were diagnosed with metastases to the jaw, there were four male and six female patients (mean age 57 (range 51-84) years) and the most common primary tumours were kidney (n=5), lung (n=2), breast (n=1), colon (n=1) and unknown (n=1). The mandible was more often affected (n=7) than the maxilla (n=3), and the most common histological type was adenocarcinoma (n=6). The primary tumour in most of the patients (n=7) was diagnosed before the oral metastatic lesion. A metastasis in the jaw was the first sign of metastatic tumour in three patients, and in one case the metastasis and the primary tumour were diagnosed at the same time. Most of the patients had some oral problems. The time intervals from diagnosis of an oral metastasis to death varied from one month - five years. Because of the rarity of the presentation, the diagnosis of an oral metastatic lesion remains challenging, so metastases in the jaw should be suspected in every patient with such cancers and lesions in the jaw.

EUS-FNA of the Merkel cell carcinoma metastasis to the pancreas: Cytomorphology and immunocytochemistry on direct cytological smears.

OBJECTIVE: To report two cases of Merkel cell carcinoma (MCC) metastatic to the pancreas diagnosed with endoscopic ultrasound-guided-fine needle aspiration (EUS-FNA) and to add the case of concomitant chronic lymphocytic leukaemia/small lymphocytic lymphoma (CLL/SLL) and MCC to the literature. The aim is to alert the cytopathologists once more to the problems of differential diagnosis of pancreatic metastasis of MCC and to describe the possibilities of ancillary methods performed on direct cytological smears. METHODS: EUS-FNA procedures were performed according to standard institution protocol, using 22-G needles with cytopathologist on-site. Based on rapid on-site evaluation (ROSE), additional passes were made for immunocytochemistry (ICC). A mini panel of antibodies was used to aid the differential diagnosis. RESULTS: Smears revealed a dispersed pattern of small round cells with scant cytoplasm, round nuclei with inconspicuous nucleoli and occasional nuclear moulding, suspicious of small cell carcinoma. Results of ICC applied to the direct cytological smears were as follows: LCA negative, Cytokeratin (clone MNF116) positive, TTF-1 negative, CD 56 positive, NSE weakly positive, Chromogranin A weakly positive and CK20 positive, in one case in a dot-like perinuclear pattern. The diagnosis of MCC was made. CONCLUSION: Increasing incidence of MCC warrants the inclusion of MCC in the differential diagnosis of tumours of small round blue cell morphology even in unusual sites. The cytomorphological features coupled with an ICC panel are usually enough to make a confident diagnosis of MCC. EUS-FNA is a minimally invasive technique which enables sampling adequate tissue for all the ancillary methods eventually needed to support the diagnosis.