Background: Immunocytochemistry involving single or double antibodies can be used to support or confirm a diagnosis in difficult cytology cases. There are a few reports on the application of a cocktail of 3 antibodies in the literature. We would like to report our experience using this technique in a difficult case of cervical lymph node fine-needle aspiration cytology (FNAC). Case: A 75-year-old woman presented with a left neck mass for which FNAC was performed. The aspirates were cellular comprising atypical cells present in loose aggregates. The cells exhibited an ovoid and spindled morphology with no evidence of keratinization or any other differentiating features. The cytology was suggestive of metastatic poorly differentiated neoplasm; however, the presence of ovoid histiocytic-looking cells required further assessment. Triple immunostaining using a cocktail of CK5/6, CK34, and CD68 was performed. The spindled atypical cells were positive for CK5/6 and CK34 (brown cytoplasmic staining) and the ovoid histiocytic-looking cells were positive for CD68 (red cytoplasmic staining). Based on immunostaining, the cytological diagnosis of metastatic squamous cell carcinoma was confirmed. Conclusion: In view of our findings, the utility of triple immunocytochemical staining in cytology smears of poorly differentiated malignancy and a brief review of the literature are highlighted in this report.

Tandon S, Shahab R, Benton JI, Ghosh SK, Sheard J, Jones TM: Fine-needle aspiration cytology in a regional head and neck cancer center: comparison with a systematic review and meta-analysis. Head Neck 2008;30:1246–1252.
Chute DJ, Stelo EB: Cytology of head and neck squamous cell carcinoma variants. Diagn Cytopathol 2009;38:65–80.
Jayaram G, Elsayed EM: Carcinosarcoma of the palate: report of a case with a diagnosis of sarcomatoid metastasis by fine needle aspiration cytology. Acta Cytol 2005;49:520–524.
Su CC, Chou CW, Yiu CY: Neck mass with marked squamous metaplasia: a diagnostic pitfall in aspiration cytology. J Oral Pathol Med 2008;37:56–58.
Elsheikh TM, Silverman JF: Fine needle aspiration cytology of metastasis to common and unusual sites. Pathol Case Rev 2001;6:161–172.
Turbat-Herrera EA, Zhu W: Diagnostic Cytopathology: Refining Diagnoses with the use of ancillary techniques. Pathol Case Rev 2002;7:173–185.
Fowler LJ, Lachar WA: Application of immunohistochemistry to cytology. Arch Pathol Lab Med 2008;132:373–383.
Taylor C: Techniques of immunohistochemistry: principles, pitfalls and standardization; in Dabbs DJ (ed): Diagnostic Immunohistochemistry. Philadelphia, Churchill Livingstone, 2002, pp 26–27.
Rosai J: Special techniques in surgical pathology; in Rosai J (ed): Rosai and Ackerman’s Surgical Pathology, ed 9. New York, Mosby, 2004, p 55.
Adley BP, Yang XJ: Application of alpha-methylacyl coenzyme A racemase immunohistochemistry in the diagnosis of prostate cancer: a review. Anal Quant Cytol Histol 2006;28:1–13.
Shidham V, Komorowski R, Macias V, Kaul S, Dawson G, Dzwierzynski W: Optimization of an immunostaining protocol for the rapid intraoperative evaluation of melanoma sentinel lymph node imprint smears with the ‘MCW melanoma cocktail’. Cytojournal 2004;1:2.
Yildiz IZ, Recavarren R, Armah HB, Bastacky S, Dhir R, Parwani AV: Utility of a dual immunostain cocktail comprising of p53 and CK20 to aid in the diagnosis of non-neoplastic and neoplastic bladder biopsies. Diagn Pathol 2009;14:35.
Bouffard JP, Sandberg GD, Golden JA, Rorke LB: Double immunolabeling of central nervous system atypical teratoid/rhabdoid tumors. Mod Pathol 2004;17:679–683.
Dabbs DJ, Wang X: Immunocytochemistry on cytologic specimens of limited quantity. Diagn Cytopathol 1998;18:166–169.
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