Hepatocellular carcinoma diagnosed by fine-needle aspiration of the parotid gland.

Hepatocellular carcinoma rarely metastasizes to the salivary glands. We report a case of a 47-yr-old man who presented with a right parotid lesion that was diagnosed by fine-needle aspiration (FNA) biopsy as a metastatic lesion suggestive of hepatocellular carcinoma with similar findings in a subsequent intraoral incisional biopsy. The patient's serum alpha-fetoprotein level was within normal limits at the time of diagnosis. CT scan revealed a mass in the liver, but a liver biopsy was not performed. The patient deteriorated rapidly and died about 4 mo later. An autopsy confirmed the presence of hepatocellular carcinoma with distant metastases to unusual sites, including the parotid gland, orbit, and calvarium, bypassing more common sites such as the lungs. This is the second known reported case in which hepatocellular carcinoma presented as a salivary gland metastasis. In both cases the diagnosis was made by FNA biopsy, illustrating the utility of this method for diagnosing uncommon metastatic salivary gland lesions.

Amelanotic malignant melanoma: two collision tumors presenting as basal cell carcinoma and atypical fibroxanthoma.

Collision (contiguous) tumors of the skin can result in misleading clinicopathological presentations, and the choice of appropriate diagnostic techniques may prevent incomplete diagnosis and management. We report 2 cases of collision tumors involving amelanotic malignant melanoma of the back. One patient is a 79-yr-old male with an 8.7 x 5.5 x 4.5 cm polypoid lesion that on shave biopsy was diagnosed as basal cell carcinoma. Subsequent excision showed that the lesion was largely composed of amelanotic melanoma underlying a relatively small and thin basal cell carcinoma, and this probably would have been demonstrated in a punch (rather than shave) biopsy. The other patient is a 71-yr-old male with a 1 cm exophytic lesion on the back, which was determined microscopically to be melanoma, and a 0.6 cm papule on the back. This lesion was composed of 2 distinct contiguous neoplastic infiltrates, the predominant component being an atypical fibroxanthoma and the smaller component an amelanotic melanoma (primary vs metastatic), with diagnostic confirmation requiring multiple immunohistochemical stains.