Anemone cell tumor with neuroendocrine differentiation (presumed Merkel cell carcinoma)

A neuroendocrine tumor with ultrastructural "anemone cell" features in lymph nodes is reported. A primary tumor was not identified, but clinical and morphologic features suggested a metastatic Merkel cell carcinoma. The anemone cells were dissociated, lacked intercellular junctions, and contained cytoplasmic intermediate filament aggregates that immunohistochemically reacted with keratins, but they had only sparse neurosecretory granules. Where the tumor cells had infiltrated beyond the lymph nodes, however, they formed a trabecular pattern. A fine-needle aspirate from a later recurrence of the tumor lacked anemone cell features and was ultrastructurally typical of a Merkel cell carcinoma, with neurosecretory granules and intercellular junctions both being evident. The concept of anemone cell tumors and the morphologic variations determined by site are discussed.