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Year : 2008  |  Volume : 51  |  Issue : 4  |  Page : 565-566
Cercariform cells: A useful clue to the cytologic diagnosis of metastatic transitional cell carcinoma


Department of Pathology, Christian Medical College and Hospital, Ludhiana - 141 008, India

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How to cite this article:
Jacob S, Rawat P, Doomra M. Cercariform cells: A useful clue to the cytologic diagnosis of metastatic transitional cell carcinoma. Indian J Pathol Microbiol 2008;51:565-6

How to cite this URL:
Jacob S, Rawat P, Doomra M. Cercariform cells: A useful clue to the cytologic diagnosis of metastatic transitional cell carcinoma. Indian J Pathol Microbiol [serial online] 2008 [cited 2020 Feb 23];51:565-6. Available from: http://www.ijpmonline.org/text.asp?2008/51/4/565/43766


Sir,

Identification of metastatic transitional cell carcinoma is important for the correct staging and management of the disease. Aspiration cytology of metastatic transitional cell carcinoma is seldom encountered in cytology practice and this partly accounts for the difficulty in recognizing the cytomorphological features of this condition. [1] Certain peculiar shaped malignant epithelial cells, termed as "cercariform cells", are considered to be of diagnostic importance. [2],[3]

A 63-year-old male presented with dysuria and intermittent hematuria of 2 months duration. He was a known case of transitional cell carcinoma (grade III) of the urinary bladder, diagnosed and treated 5 years back. However, he was lost to follow up till date. At present, check cystoscopy revealed a broad-based sessile tumor in the anterior wall of the bladder. A transurethral resection was performed and the biopsy was reported as transitional cell carcinoma - grade III. A 3 2 cm lymph node was observed in the left inguinal region. Fine-needle aspiration of the lymph node was performed by using a 22-gauge needle and 20-ml syringe fitted in a Cameco syringe holder. The smears made were stained with May-Grunwald-Giemsa and hematoxylin and eosin stains. The aspiration smears were richly cellular with well dispersed to loosely cohesive neoplastic epithelial cells with several lymphocytes in the background. There was marked cellular pleomorphism of the neoplastic cells with numerous asymmetric shapes, ranging from round, oval, spindle, pyramidal to racquet-shaped cells. The cells contained abundant deep bluish cytoplasm and pleomorphic nuclei with prominent nucleoli. Many of the nuclei were eccentrically placed and they imparted a plasmacytoid appearance. Few cells showed prominent intracytoplasmic vacuolation and evidence of cell cannibalism. A striking feature was the presence of scattered tumor cells with peculiar morphology, "cercariform cells." These cells were characterized by a globular nuclear body and unipolar, nontapering cytoplasmic process - the ends of which were fish-tail-like, bulbous or flattened [Figure 1]. These cercariform cells were numerous (~50/smear) and scattered throughout.

The presence of spindled, pyramidal and/or racquet-shaped cells with eccentric nuclei were first identified as distinctive indicators of metastatic transitional cell carcinoma by Johnson et al. [1] Some of these malignant cells with characteristic morphology of their cytoplasmic processes were later on designated by Powers and Elbadawi as "cercariform cells". [2] The word "cercaria" has its origin in the Greek word "kerkos" meaning tail. These cells are classically described as malignant cells with a nucleated globular body and a unipolar nontapering cytoplasmic process - the ends of which could be fishtail-like, bulbous or flattened. [2] Cercariform cells may be present in moderate numbers to abundant. The characteristic morphology of cercariform cells is not a smearing artifact as these cells are consistently observed on Millipore filter preparations. [3] Other described cytomorphological features of metastatic transitional cell carcinoma are intracytoplasmic vacuoles, pearl formation and intranuclear inclusions. [1],[4]

Potential mimics of cercariform cells are malignant cells from squamous carcinomas and sarcomas. The tapering cytoplasmic processes, hyperchromatic, pyknotic or degenerated nuclei and frequent cytoplasmic keratinization of tadpole cells in squamous carcinoma are important distinguishing features. Other mimics include malignant spindle cells of mesenchymal origin with unipolar cytoplasmic processes. However, minimal nuclear atypia and the presence of malignant cells with bipolar cytoplasmic processes, in addition, aid in correctly identifying these cells. [1]

Cells resembling cercariform cells were found in a few cases of poorly differentiated malignant epithelial neoplasms. Hence, a study was performed by Hida and Gupta to determine the specificity of cercariform cells. It was inferred that although the finding of few cercariform cells is not specific for transitional origin, the presence of more than 20 cercariform cells per case is significantly more likely to occur in metastasis from transitional cell carcinoma. [3] Another similar study conducted by Renshaw and Madge compared transitional cell carcinoma with non-small cell lung carcinoma and the authors concluded that the presence of numerous cercariform cells (>10 per case) in an aspiration-smear favored transitional cell carcinoma. [5]

In conclusion, the presence of cercariform cells in adequate numbers in an aspiration smear of a metastatic tumor is a strong indicator towards its transitional cell origin.

 
   References Top

1.Johnson TL, Kini SR. Cytologic features of metastatic transitional cell carcinoma. Diagn Cytopathol 1993;9:270-8.  Back to cited text no. 1  [PUBMED]  
2.Powers CN, Elbadawi A. Cercariform cells: a clue to the cytologic diagnosis of transitional cell origin of metastatic neoplasm? Diagn Cytopathol 1995;13:15-21.  Back to cited text no. 2  [PUBMED]  
3.Hida CA, Gupta PK. Cercariform cells: are they specific for transitional cell carcinoma? Cancer 1999;87:69-74.   Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Dey P, Amir T, Jogai S, Al Jussar A. Fine needle aspiration cytology of metastatic transitional cell carcinoma. Diagn Cytopathol 2005;32:226-8.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Renshaw AA, Madge R. Cercariform cells for helping distinguish transitional cell carcinoma from non-small cell lung carcinoma in fine needle aspirates. Acta Cytol 1997;41:999-1007.  Back to cited text no. 5  [PUBMED]  

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Correspondence Address:
Sunitha Jacob
Department of Pathology, Christian Medical College and Hospital, Ludhiana-141 008
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.43766

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