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Emphasizing the role of cytomorphology and immunocytochemistry in the precise pre‐operative cytodiagnosis of a rare case of metastatic penile sarcomatoid carcinoma

three decades of life. In prepubertal girls, approximately 80% are associated with isosexual pseudoprecocity. JGCTs are usually solid and unilateral, restricted to the ovary and present almost always as stage 1 disease. In contrast with the adult type, almost all nuclei lack grooves and, despite the presence of pleomorphism and frequent mitoses, only 10% behave aggressively. The cytological features of JGCT have been described by Shintaku et al. and Kavuri et al. However, cellular pleomorphism and mitotic activity, which were well documented on histology, have not been addressed on cytology. This case also highlights the utility of inhibin, a reliable marker for stromal tumours, in the diagnosis of JGCT. The juvenile form differs from adult granulosa cell tumour with respect to a lack of nuclear grooves and the presence of bizarre nuclei with abnormal mitoses. The cells are arranged in monolayers, in loose cohesive sheets and as single cells. Cytoplasm is finely granular with numerous vacuoles. The age of occurrence and bizarre cytomorphology may result in a mistaken diagnosis of malignant germ cell tumour. Cytological features of seminoma, embryonal carcinoma and yolk sac tumour are distinct. Single cells with a tigroid background characterize seminoma, whereas clustering is seen in the other two. In teratoma, the cytological features depend on the elements present. Although our case did not have features to give a definitive subtyping, the cytological atypia and age of the patient made us think of malignant germ cell tumour. Immunocytochemistry with a-inhibin perhaps would have helped to make a cytological diagnosis. Clues for suspecting JGCT on cytology in this case were monolayered sheets, the absence of numerous single cells and cells resembling theca cells. Awareness of the morphological features is necessary to avoid the pitfall of misdiagnosis as germ cell tumour, which can have an overlapping clinical presentation. Problems in the diagnosis of JGCT typically include rounded neoplastic cells with abundant acidophilic and/or vacuolated cytoplasm. Mitotic figures are abundant. Cytomegaly with macronuclei, multinucleation and bizarre multilobulated nuclei are also seen. Clues helpful for the diagnosis are macrofollicles, positivity with inhibin, negative staining for AFP, placental alkaline phosphatase (PLAP) and bHCG, and hypercalcaemia or hyperoestrinism if present. To conclude, unlike the adult type, JGCT has bizarre morphology. The presence of single cells with cytoplasmic vacuolation suggests theca differentiation.