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The myoepithelial cells are arranged as loosely cohesive groups of large cells with pale vacuolated (clear) cytoplasm and have round-elongated nuclei and small nucleoli (Papanicolaou stain, 400Â). 32 Elsheikh et al. Figure 60 Epithelial-myoepithelial carcinoma. Dense acellular mesenchymal component is associated with the cell clusters (DQ stain, 200Â). Occasionally, there is predominance of the clear cells without appreciation of a basaloid cell component. Variable amount of acellular mesenchymal component, including pale blue material resembling mucin or dense stroma surrounding cell clusters, is usually present (Fig.

Differential diagnosis also includes plasmacytoma, which is distinguished by nuclei showing characteristic clumpy cartwheel chromatin, perinuclear hoff, and plasma cell markers (CD79a, CD138, kappa/lambda light chain). Myoepithelioma and Myoepithelial Carcinoma Figure 66 Spindle pleomorphic adenoma/myoepithelioma, showing cohesive clusters of spindle cells with overlapping nuclei and crowding and no significant atypia (Papanicolaou stain, 400Â). Table 24 Differential Diagnosis of Spindle Cell Neoplasms Cellular pleomorphic adenoma Myoepithelioma Nerve sheath tumor Leiomyoma Sarcoma, low grade and high grade Nodular fasciitis Granulomatous sialadenitis Malignant melanoma Figure 67 Hyaline (plasmacytoid) pleomorphic adenoma/ myoepithelioma.

Only be established in the presence of clusters and sheets of atypical squamous epithelium (Fig. 41), or singly scattered markedly atypical keratinized cells (Fig. 42). Cytologic features found to be more supportive of squamous carcinoma, compared with branchial cleft cyst, are the presence of necrotic debris and fewer neutrophils. We usually do not issue a diagnosis favoring branchial cleft cyst in patients older than 25 years, but rather provide a descriptive diagnosis of ‘‘cystic squamous lesion without significant atypia,’’ and provide an appropriate differential diagnosis including cystic squamous carcinoma (106,107).

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