Subungual amelanotic malignant melanoma

A 52-year-old man with subungual amelanotic malignant melanoma was reported. He had a dome-shaped tumor on his right thumb nail bed without any involvement. Clinically, we considered various diseases including amelanotic malignant melanoma, squamous cell carcinoma, granuloma pyogenicum, and other granulomas. Histological features of the skin biopsy taken during the first visit suggested squamous cell carcinoma. We still considered the possibility of amelanotic malignant melanoma, however, and the specimens taken during the radical operation were examined histologically and histochemically and a diagnosis of subungual amelanotic malignant melanoma was determined.     

Primary invasive signet-ring cell melanoma

The histopathological variants of malignant melanoma include the common type (lentigo maligna, superficial spreading melanoma, nodular melanoma, acrolentiginous melanoma), spindle cell, desmoplastic, balloon cell, pleomorphic (fibrohistiocytic), myxoid, small cell melanoma and malignant blue nevus. Recently, signet-ring cell melanoma was introduced as an additional cytologic variant. We describe a 72-year-old patient with a primary signet-ring cell melanoma of the skin located on the upper arm. Histopathologic examination disclosed a melanocytic tumor extending from the epidermis to the deep reticular dermis. Numerous pleomorphic tumor cells showed large, intracellular vacuoles and oval to spindle-shaped nuclei at their periphery. Mitotic figures and multinucleated melanocytes were also observed. Some of the signet-ring cells exhibited cytoplasmatic periodic acid-Schiff (PAS)-positivity. Immunohistochemistry showed positive reaction of the tumor cells for S-100, HMB-45 protein and vimentin, confirming their melanocytic differentiation. Tumor cells were negative for cytokeratins, epithelial membrane antigen (EMA), and carcinoembryonic antigen (CEA). The signet-ring cell melanoma disclosed an invasion to Clark Level IV and tumor thickness of 2.2 mm. Signet-ring cell melanoma is a rare morphologic variant of melanoma. Its recognition is important for differentiation from other tumors featuring signet ring cells.     

Primary cutaneous signet-ring cell melanoma: a clinico-pathologic and immunohistochemical study of two cases

Signet-ring cell malignant melanoma is a rare histopathologic variant of malignant melanoma with only a few described cases. We report the clinical, histopathological, and immunohistochemical features of two cases of primary cutaneous signet-ring cell malignant melanoma. Neoplastic melanocytes showed abundant clear cytoplasm compressing the nuclei to the periphery, sometimes resulting in a signet-ring appearance. Immunohistochemically, neoplastic melanocytes in both cases expressed immunoreactivity for the usual melanocytic markers S-100 protein and Melan-A, although only the second case resulted HMB-45 positive. We review the literature about this rare cytologic variant of malignant melanoma and discuss the differential diagnosis with other cutaneous neoplasms that may show a signet-ring cell appearance of their neoplastic cells.     

1333例皮肤恶性肿瘤回顾性分析

目的了解重庆地区皮肤恶性肿瘤的发病情况及特点。方法收集和回顾性分析第三军医大学西南医院皮肤科1991年～2010年经组织病理确诊的皮肤恶性肿瘤患者临床资料。结果共统计1333例皮肤恶性肿瘤患者,男女之比为1．26：1,其中基底细胞癌454例（占34．06％）、鳞状细胞癌235例（占17．63％）、鲍恩病136例（占10．20％）、恶性黑素瘤133例（占9．98％）、乳房及乳房外Paget病104例（占7．80％）。临床诊断与组织病理诊断符合率为72．4％,符合率最高的是乳房及乳房外Paget病（93．27％）。基底细胞癌主要发生于头面部和颈部,鲍恩病多见于躯干部位,恶性黑素瘤的主要发病部位在足跖。结论相对于国内外其他研究资料,重庆地区的皮肤恶性肿瘤发病情况具有一定的自身特点。     

Epidermotropic Metastatic Melanoma Clinically Resembling Agminated Spitz Nevi

Herein, we report a 36-year-old Asian male patient who presented with grouped multiple erythematous waxy papules and nodules on his right medial thigh. He had undergone amputation of the right second toe because of a stage IIa malignant melanoma, 3 years previously. At the time of surgery for the primary tumor, right inguinal lymph node dissection revealed no nodal involvement. Three years after the diagnosis of the primary tumor, crops of multiple erythematous papules and nodules developed. Initial histopathologic evaluation of the papules showed nests of small epithelioid cells similar to compound nevi. However, cytologic features, including high mitotic figures, lack of maturation, and some hyperchromatic nuclei suggested metastatic melanoma. In addition to the pathologic findings, the tumors were on the right thigh, which was the same side as the primary malignant melanoma. The patient underwent wide excision of the tumor and split-thickness skin grafting.     

双侧腹股沟淋巴结内指突状树突细胞肉瘤1例报道并文献复习

目的：探讨以阴囊肿大为主要表现就诊的双侧腹股沟淋巴结内指突状树突细胞肉瘤（IDCS）的病理特征、临床诊断及鉴别诊断.方法：对1例以阴囊肿大为主要表现的双侧腹股沟淋巴结内IDCS进行病理学检查和免疫组化染色观察,结合文献进行讨论.结果：临床表现为阴囊肿大及双侧腹股沟无痛性肿物.光镜下癌细胞位于淋巴结内,呈边界不清的束状排列,细胞呈卵圆形、梭形弥散分布,核异型性较明显,可见核分裂像.免疫组化瘤细胞S-100蛋白、CD68和CD3表达阳性.结论：IDCS是一种极为罕见的恶性肿瘤,其临床表现各不相同,临床及病理早期均有误诊可能.其诊断依靠病理检查和免疫组化,必要时辅助电镜.应与滤泡状树突细胞肉瘤、恶性黑色素瘤、恶性纤维组织细胞肉瘤、朗格汉斯细胞组织细胞增生症及未分化癌相鉴别.S-100、CD68蛋白是其特异性的标志物.     

Pigmented spindle cell tumor

Pigmented spindle cell tumor is a benign lesion and can be differentiated from benign juvenile melanoma and malignant melanoma by its uniform cytologic pattern as well as its pattern of growth.     

Combined high-grade basal cell carcinoma and malignant melanoma of the skin ("malignant basomelanocytic tumor"): report of two cases and review of the literature

We describe two cases of a malignant cutaneous neoplasm with combined phenotypical features of high-grade basal cell carcinoma and malignant melanoma. Some tumor cells showed a keratinocytic phenotype (cytokeratins, p63) and others a melanocytic phenotype (HMB-45, MART-1, Melan-A, S100-protein). We favor the hypothesis of a tumor with bidirectional keratinocytic and melanocytic differentiation, an exceptionally rare event.     

Clear cells in acral melanoma

Acral melanoma may present clinically and histologically with atypical features causing a delay in proper diagnosis. The aim of the present study was to assess the frequency of a histological variant with clear cell changes. Clinical information, hematoxylin & eosin stained paraffin sections and immunohistochemical staining profiles were reviewed in 49 cases of acral melanoma. Twenty-one (43%) specimens contained tumor cells with clear cell changes in focal areas, whereas in 7 (14%) specimens clear cells were the major tumor constituting cells. The tumor thickness ranged from melanoma in situ to 14 mm. Immunohistochemistry demonstrated weak staining for S100 and HMB45 as well as strong positivity for Melan A and NK1C3. Recognition of clear cell features is important since differential diagnosis includes a variety of other clear cell malignancies, among them metastasis from renal cell carcinoma, clear cell sarcoma and hidradenocarcinoma.     

Malignant eccrine tumor--a case report and a classification of tumors of eccrine sweat apparatus

A case of malignant eccrine tumor and its histological findings were reported. In this case, we considered basal cell carcinoma or malignant melanoma clinically; however, the histological features matched those of malignant eccrine tumor. It has been said that it is very difficult to determine the origin of tumors of sweat apparatus; to contribute to this ongoing dialogue, the classification of tumors of eccrine sweat apparatus was also discussed.     

Malignant hair matrix tumor ("malignant trichoepithelioma") arising in the setting of multiple hereditary trichoepithelioma

An unusual adnexal tumor on the scalp of a 59-year-old woman with hereditary trichoepithelioma is reported. After the initial removal, the tumor recurred twice during a 4-year period. Mohs micrographic surgery resulted in full excision of the lesion. Two years later there was no evidence of recurrence. Histologic examination of the tumor showed it to merge with adjacent areas of classic trichoepithelioma. The tumor showed cytologic atypia, mitotic figures, necrosis, deep infiltration, and features of pilar differentiation including clear cells, reminiscent of cells of the follicular outer root sheath, and focal shadow-cell formation. The differential diagnosis of this malignant follicular neoplasm included pilomatrix carcinoma and basal-cell carcinoma with matrical differentiation. The unique clinicopathologic features, however, raised consideration of a "malignant trichoepithelioma."     

Clinical and Pathological Correlation of Malignant Melanoma

We have attempted to review virtually all forms of cutaneous and mucocutaneous melanomas. Superficial spreading, lentigo maligna and nodular melanomas have been more thoroughly investigated and documented in previous studies. Lentigo maligna melanoma appears to have a longer duration and better prognosis than SSM or NM. The overall prognosis probably correlates better with the anatomic level and thickness of invasion than with type (Clark et al. 1975, Breslow 1970, 1975). It appears that certain pitfalls exist in either method of assessing prognosis, and it is recommended that both methods be applied in evaluating a malignant melanocytic lesion when feasible. With regard to in situ melanoma or Level I melanoma, it is our experience that such lesions can achieve a 100% cure rate when completely excised. Hence, we prefer to call such lesions severely atypical melanocytic hyperplasia, and thus avoid labeling these patients with a malignant diagnosis. The most difficult histologic challenge in diagnosing a lesion of malignant melanoma is the Spitz nevus. The pathologist should never be biased by the age of the patient, for a serious mistake can arise. We have seen a case of nodular melanoma in a 13-year-old girl diagnosed as Spitz nevus only to be followed by a lymph node metastasis years later. Other examples of histologic differential diagnoses of malignant melanomas include, for example, halo nevus, soft tissue sarcoma, squamous cell carcinoma with spindle cell proliferation, Paget's disease of metastatic carcinoma, (for example, from the breast). Therefore, the approach to the diagnosis of malignant melanoma necessitates an evaluation of both clinical and pathological features. Histologic study must encompass both the pattern of growth and cellular cytologic detail for successful interpretation.     

Pigmented basal cell carcinoma developing on the lower extremities--three cases masquerading as malignant melanoma

Three cases of pigmented basal cell carcinoma were reported which needed to be differentiated from malignant melanoma based on their location and clinical features. Clinicopathologically, they were characterized by a large number of melanophages in the stroma, blockade melanocytes in the parenchyma, and phagocytosis of melanosomes in tumor cells as well as a large number of intraparenchymal melanophages. Two cases were characterized by the aggregation of melanophages in cystic spaces caused by stellate atrophy.     

Unusual histological variants of cutaneous malignant melanoma with some clinical and possible prognostic correlations

Malignant melanoma is known for the wide range of histological patterns it can assume mimicking other malignant tumors. We present a review of most of the unusual histological variants of cutaneous melanoma and describe their immunohistochemical features, associate clinical findings, and possible behavior related to the histological subtype. In addition, we propose their classification into four groups corresponding to the (1) architectural patterns; (2) cytologic features; (3) stromal changes; and (4) the possible association of these findings (i.e. architectural + cytologic features). Although most of these unusual variants have the same prognosis as conventional melanomas, with Breslow thickness and ulceration, being the most important predictor of survival in clinical stage I, some of them have a peculiar biologic behavior that the clinicians and the dermatopathologists should know in order to give melanoma patients all educational information available.     

Panfollicular carcinoma or trichoblastic carcinoma with panfollicular differentiation?

Herein, we report two cases of a follicular neoplasm with panfollicular differentiation showing architectural and cytologic findings suggestive of a malignancy. Immunohistochemical analysis of β‐catenin expression in the neoplasm showed nuclear and cytoplasmic immunoreactivity, with no reactivity in the transitional and shadow cells, consistent with β‐catenin expression of pilomatrical tumors. Staining for BerEp4 was positive at the periphery of both neoplasms, suggesting germinative differentiation of the neoplastic cells, whereas staining for the follicular stem‐cell marker PHLDA‐1 (TDAG51) showed strong focal expression in the tumor cells of both cases. Given these findings, these neoplasms show features of both panfollicular neoplasms and basal cell carcinoma with panfollicular/matrical differentiation. These are the first cases of this neoplasm reported to date. More reports are needed to assess their malignant potential.     

Tumors composed of malignant epithelial and melanocytic populations: a case series and review of the literature

Over the last 30 years, there have been approximately 49 case reports of tumors composed of both malignant epithelial and malignant melanocytic populations. Herein, we present four additional cases of combined tumors that consist of two phenotypically distinct but intermingled populations of malignant cells. Each tumor was composed of an invasive melanoma closely associated with either a basal cell carcinoma or a squamous cell carcinoma. We review all previous case reports in the English literature and attempt to clarify the terminology and summarize what is currently known about these unique tumors.     

Studies of cellular mediated immunity in malignant melanoma patients by leukocyte adherence inhibition test

Summary Sixteen malignant melanoma patients with different levels of tumor progression, two patients with melanoma in situ (Clark 1) two bronchogenic carcinoma patients and nine healthy controls were tested by means of the leukocyte adherence inhibition (LAI) test to assess the function of their cellular mediated immunity. Blood leukocytes were incubated with allogeneic melanoma-associated antigen obtained from potassium chloride extract of tumor cells.Fifteen malignant melanoma patients with clinical stage I–III (Clark level 2–5) showed positive LAI-reaction when leukocytes were tested with melanoma associated antigen. Leukocyte adherence inhibition was neither monitored in healthy controls, in patients with melanoma in situ, nor in those two patients with squamous and oat cell type bronchogenic carcinoma. Extracts prepared from normal skin showed no inhibitive effect on leukocyte adherence in malignant melanoma patients and controls.A decreased percentage of LAI was observed in malignant melanoma patients with disseminated disease due to an increased spontaneous leukocyte adherence in these patients. This increase in spontaneous leukocyte adherence was probably caused by non-specific activation of adherent cells (macrophages) as a result of the prolonged therapy and/or the progressive tumor levels in these patients.This work was supported by the Agnes-and Georg-Blumenthal-Stiftung 26/7/4     

恶性黑素瘤患者T细胞化学趋化功能

目的　探讨恶性黑素瘤患者循环T细胞在体外对单核细胞化学趋化蛋白 1 (MCP 1 )的化学趋化功能及其与肿瘤浸润淋巴细胞 (TIL)及与肿瘤转移之间的关系。方法　用微量化学趋化装置和免疫组化方法测定患者T细胞对MCP 1的化学趋化功能和TIL计数。结果　原发性和转移性黑素瘤患者T细胞对MCP 1的化学趋化功能均明显低下 ,而基底细胞癌患者T细胞的化学趋化功能正常。免疫组化研究发现原发性恶性黑素瘤TIL数量与T细胞的化学趋化功能之间无关。结论　原发性和转移性恶性黑素瘤患者循环T细胞特异性地对MCP 1的化学趋化反应低下。这可能是由于这些细胞上的MCP 1受体表达或调节异常所致