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Whaley RD, Agaimy A, Bridge JA, Stoehr R, Din NU, Gagan J, Rampisela D, Folpe AL, Bishop JA. Xanthogranulomatous epithelial tumors/keratin-positive giant cell-rich tumors involving the head and neck: report of seven cases and review of the literature. Virchows Arch 2024:10.1007/s00428-024-03892-8. [PMID: 39162814 DOI: 10.1007/s00428-024-03892-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 07/31/2024] [Accepted: 08/05/2024] [Indexed: 08/21/2024]
Abstract
Xanthogranulomatous epithelial tumor (XGET) and HMGA2::NCOR2 fusion keratin-positive giant cell-rich tumor (KPGCT) are recently described morphologically overlapping rare neoplastic entities characterized by HMGA2::NCOR2 fusions, low-grade biological behavior, and a strong predilection for young females. To date, 47 cases have been reported with only four occurring in head and neck anatomic locations. In this study, we describe the clinicopathologic, immunohistochemical, and molecular findings of seven XGET/KPGCTs occurring in the head and neck region. The patients were six females and one male, aged 3.5-59 years old (median, 25 years). The tumors involved the ear, vocal cord, skull, neck soft tissue, and sinonasal cavity. Tumor sizes ranged from 1.5 to 6.7 cm. Histologically, the tumors were characterized by xanthogranulomatous histiocytes, osteoclast-like giant cells, and keratin-positive epithelioid cells. The XGET/KPGCTs involving the ear was remarkable for more cytologic atypia than previously described. Four cases had the HMGA2::NCOR2 fusion identified by NGS and three had HMGA2 gene locus alterations by FISH. Follow-up information was available for 3 of 7 patients (range 6-46 months). The patient with a vocal cord XGET/KPGCTs developed a local recurrence treated with excision. This study illustrates that XGET/KPGCTs involves the head and neck region as well, where it may be unexpected and hence under-recognized, and expands the anatomic locations of involvement to include unreported sites (ear, vocal cord, and sinonasal tract).
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Affiliation(s)
- Rumeal D Whaley
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Abbas Agaimy
- Institute of Pathology, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Julia A Bridge
- ProPath, Division of Cytogenetic and Molecular Pathology, Dallas, TX, USA
- Department of Pathology, Microbiology and Immunology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Robert Stoehr
- Institute of Pathology, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center, European Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Nasir Ud Din
- Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Wang BG, Li W, Lee IH, Mani H. Mimickers of neuroendocrine tumors on endoscopic ultrasound-guided fine-needle aspirate material: Need for caution. Diagn Cytopathol 2023; 51:E308-E313. [PMID: 37533282 DOI: 10.1002/dc.25204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/17/2023] [Accepted: 07/23/2023] [Indexed: 08/04/2023]
Abstract
Cytologic diagnosis of neuroendocrine tumors can be straightforward on cytologic preparations, given the classical neuroendocrine morphology and expression of neuroendocrine markers confirmed by immunohistochemistry. However, overreliance on neuroendocrine markers can lead to misdiagnosis even if individual cell features suggest a neuroendocrine tumor. We present three unusual cases, two of which were initially diagnosed as neuroendocrine tumors and the third one carried preliminary diagnosis of neuroendocrine tumor on endoscopic ultrasound-guided fine-needle aspirates. These cases subsequently turned out to be cholangioblastic cholangiocarcinoma, metastatic melanoma, and gastric glomus tumor, respectively. We suggest approaches that could have pointed us towards the correct diagnosis at the outset and discuss potential pitfalls.
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Affiliation(s)
- Brant G Wang
- Department of Pathology, Inova Fairfax Hospital, Falls Church, Virginia, USA
- School of Medicine Inova Campus, University of Virginia, Falls Church, Virginia, USA
- Department of Pathology, Georgetown University Medical Center, Washington, DC, USA
| | - Wenping Li
- Department of Pathology, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Iris H Lee
- Division of Gastroenterology, Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Haresh Mani
- Department of Pathology, Inova Fairfax Hospital, Falls Church, Virginia, USA
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3
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Neuroendocrine Transdifferentiation in Cutaneous Melanoma: A Case Report and Review of the Literature. Am J Dermatopathol 2023; 45:264-268. [PMID: 36921302 DOI: 10.1097/dad.0000000000002377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/01/2022] [Indexed: 03/17/2023]
Abstract
ABSTRACT Neuroendocrine transdifferentiation refers to the progressive transformation of a nonneuroendocrine tumor to the one showing evidence of neuroendocrine differentiation on morphological and immunohistochemical grounds. Although this phenomenon has been well-documented in certain malignancies, particularly prostatic adenocarcinoma after androgen deprivation, cases of neuroendocrine transdifferentiation in melanomas are exceptionally rare. Herein, we report a case of a conventional superficial spreading melanoma occurring on the skin of the leg in a young male which showed progressive neuroendocrine transdifferentiation as it progressed through 2 in-transit metastases and a nodal metastatic deposit over a 4-year period. The tumor retained the BRAF V600E mutation throughout the disease process, and disease control was achieved through dual BRAF inhibition therapy. The possibility of melanoma masquerading as a high-grade neuroendocrine malignancy when investigating tumors of unknown primary should be kept in the mind of clinicians and histopathologist alike as a potential diagnostic pitfall, thus helping avoid misdiagnosis and guide appropriate treatment strategies.
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Ulici V, Hornick JL, Davis JL, Mehrotra S, Meis JM, Halling KC, Fletcher CD, Kao E, Folpe AL. "E-MGNET": Extra-Enteric Malignant Gastrointestinal Neuroectodermal Tumor- A Clinicopathological and Molecular Genetic Study of 11 Cases. Mod Pathol 2023; 36:100160. [PMID: 36934861 DOI: 10.1016/j.modpat.2023.100160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/28/2023] [Accepted: 03/12/2023] [Indexed: 03/19/2023]
Abstract
Malignant gastrointestinal neuroectodermal tumors (MGNET), also known as "gastrointestinal clear cell sarcoma-like tumor", are very rare, aggressive sarcomas characterized by enteric location, distinctive pathologic features, and EWSR1/FUS::ATF1/CREB1 fusions. Despite identical genetics, the clinicopathologic features of MGNET are otherwise quite different from clear cell sarcoma of soft parts (CCS). Only exceptional extra-enteric MGNET (E-MGNET) have been reported. We report a series of 11 E-MGNET, the largest to date. Cases diagnosed as MGNET and occurring in non-intestinal locations were retrieved. Clinical follow-up was obtained. The tumors occurred in 3 males and 8 females (14-70 years of age, median 33 years) and involved the soft tissues of the neck (3), shoulder (1), buttock (2), orbit (1), and tongue/parapharyngeal space (1), the urinary bladder (1) and the falciform ligament/liver (1). Tumors showed morphologic features of enteric MGNET (small, relatively uniform, round to ovoid cells with round, regular nuclei containing small nucleoli, growing in multinodular and vaguely lobular patterns, with solid, pseudoalveolar and pseudopapillary architecture). Immunohistochemical results were: S100 protein (11/11), SOX10 (11/11), synaptophysin (3/10), CD56 (7/9), CD117 (3/9), DOG1 (0/4), ALK (4/8), chromogranin A (0/10), HMB45 (0/11), Melan-A (0/11), tyrosinase (0/4), MiTF (0/11). NGS results were: EWSR1::ATF1 (7 cases), EWSR1::CREB1 (3 cases) and EWSR1::PBX1 (1 case). The EWSR1::PBX1-positive tumor was similar to other cases, including osteoclast-like giant cells, and negative for myoepithelial markers. Clinical follow-up (range: 10 to 70 months; median 34 months) showed 4 patients dead of disease (10.5, 12, 25 and 64 months after diagnosis), 1 patient alive with extensive metastases (43 months after diagnosis), 1 patient alive with persistent local disease (11 months after diagnosis), and 4 alive without disease (10, 47, 53 and 70 months after diagnosis). One case is too recent for follow-up. The clinicopathologic and molecular genetic features of rare E-MGNET are essentially identical to those occurring in intestinal locations. Otherwise-typical E-MGNET may harbor EWSR1::PBX1, a finding previously unreported in this tumor type. As in enteric locations, the behavior of E-MGNET is aggressive, with metastases and/or death from disease in at least 50% of patients. E-MGNET should be distinguished from CCS and other tumors with similar fusions. ALK expression appears to be a common feature of tumors harboring EWSR1/FUS::ATF1/CREB1 fusion but is unlikely to predict therapeutic response to ALK inhibition. Future advances in our understanding of these unusual tumors will hopefully lead to improved nomenclature.
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Affiliation(s)
- Veronica Ulici
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jessica L Davis
- Department of Pathology, University of Indiana, Indianapolis, IN
| | - Swati Mehrotra
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, IL
| | - Jeanne M Meis
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kevin C Halling
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | | | - Erica Kao
- Department of Pathology, Brooke Army Medical Center, San Antonio, TX
| | - Andrew L Folpe
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN.
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Rothrock AT, Hameed N, Cho WC, Nagarajan P, Ivan D, Torres-Cabala CA, Prieto VG, Curry JL, Aung PP. BRAF V600E immunohistochemistry as a useful tool in the diagnosis of melanomas with ambiguous morphologies and immunophenotypes. J Cutan Pathol 2023; 50:223-229. [PMID: 36377266 DOI: 10.1111/cup.14359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 11/04/2022] [Accepted: 11/13/2022] [Indexed: 11/17/2022]
Abstract
We report three melanoma cases in which BRAF V600E immunohistochemistry (IHC) was valuable for diagnosis. Patient 1: In a patient with a history of primary melanoma on the chest and metastatic melanoma to right breast after undergoing multiple local and systemic therapies, a lung metastasis exhibited chondroid differentiation, aberrant myofibroblastic marker expression, and rare pancytokeratin positivity, without melanocytic marker expression. Patient 2: After targeted and immunotherapy for primary melanoma on the scalp as well as regional and distant metastatic melanoma, an omental metastasis showed CDX2-positive glandular structures that were negative for melanocytic markers. It was initially misdiagnosed as primary gastrointestinal adenocarcinoma. Patient 3: A patient with history of melanoma showing epithelioid morphology on the right thigh presented with multiple soft tissue nodules on skin, lymph nodes and internal organs after being lost to follow-up for 4 years. A biopsy specimen from the right thigh showed spindled cells with scattered pancytokeratin cocktail positivity and ambiguous staining for melanocytic markers. For melanomas with ambiguous morphologies and/or immunophenotypes in each of the three patients, BRAF V600E expression by IHC was maintained in both primary and metastatic melanoma specimens examined. These cases highlight the utility of BRAF V600E IHC in the diagnosis of melanoma.
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Affiliation(s)
- Aimi T Rothrock
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York, USA
| | - Nadia Hameed
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Woo Cheal Cho
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Doina Ivan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carlos A Torres-Cabala
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Victor G Prieto
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jonathan L Curry
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Im S, Kim JA, Park G, Cho U. Aberrant synaptophysin expression in classic Hodgkin lymphoma. Diagn Pathol 2022; 17:90. [PMID: 36401284 PMCID: PMC9675263 DOI: 10.1186/s13000-022-01272-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
Background Synaptophysin is an immunohistochemical marker for neuroendocrine differentiation and is widely used in pathologic diagnosis. Its expression in malignant lymphoma has not yet been described. However, we experienced an index case of classic Hodgkin lymphoma with synaptophysin expression. This experience prompted us to investigate synaptophysin expression in classic Hodgkin lymphoma. Method Immunohistochemical staining of synaptophysin was performed in 59 diagnosed cases of classic Hodgkin lymphoma, 10 anaplastic large cell lymphomas, 16 diffuse large B-cell lymphomas, and 5 extranodal marginal zone lymphoma of the mucosa-associated tissue. Synaptophysin-positive cases were stained for both chromogranin and CD56a. Result Of 59 classic Hodgkin lymphoma cases, 11 (19%) were positive for synaptophysin. None of the anaplastic large cell lymphomas expressed synaptophysin. Synaptophysin showed weak but specific expression in the cytoplasm of the Hodgkin lymphoma tumor cells. Other background inflammatory cells (such as macrophages, B-, and T-lymphocytes) were all negative for synaptophysin expression. Chromogranin and CD56a were not expressed in the synaptophysin-positive classic Hodgkin lymphomas. Conclusions Synaptophysin is an integral glycoprotein present in presynaptic vesicles of neurons and neuroendocrine cells. It is a diagnostic marker for neuroendocrine tumors. Aberrant synaptophysin expression has been reported in non-neuroendocrine tumors but not in lymphoma or leukemia. To the best of our knowledge, synaptophysin positivity has only been reported in a single case of precursor T-lymphoblastic leukemia/lymphoma to date. Our study showed that aberrant synaptophysin expression in classic Hodgkin lymphoma is an unexpectedly frequent finding. The mechanism underlying, and prognostic significance of, such aberrant expression is unclear. Thus, in a small biopsy, aberrant synaptophysin expression could be a diagnostic pitfall and should be carefully avoided.
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7
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Tzanavaris K, Pettas E, Thermos G, Georgaki M, Piperi E, Nikitakis NG. Base of tongue metastasis of cutaneous malignant melanoma with rhabdoid and neuroendocrine features: Report of a rare case and review of the literature. Head Neck Pathol 2022; 16:1230-1241. [PMID: 35524032 PMCID: PMC9729478 DOI: 10.1007/s12105-022-01437-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/19/2022] [Accepted: 02/22/2022] [Indexed: 01/01/2023]
Abstract
Metastatic malignant melanoma (MM) represents a highly aggressive cancer associated with overall poor prognosis. Various anatomic sites can be affected, including the oral cavity and the oropharynx. It may mimic other entities by assuming a variety of clinical appearances and exhibiting a plethora of microscopic variations. Herein, we present a case of a 63-year-old male with a MM metastasizing to the base of tongue, which developed 5 years after the original diagnosis and treatment of cutaneous MM of the chest and heralded its relapse; subsequently, neurological symptoms developed as a result of metastasis to the brain. Diagnostic challenges were encountered, as the tongue lesion clinically masqueraded as a pedunculated reactive lesion and microscopically displayed unusual rhabdoid and neuroendocrine features. Tumor cells expressed S-100, HMB-45, Melan-A, and SOX-10, while most cells with rhabdoid morphology were also positive for myogenin and Myo-D1. Chromogranin and synaptophysin positivity was further noticed in a subset of cells, suggestive of focal neuroendocrine differentiation. Molecular investigation revealed mutations for the BRAF V600E gene. Divergent differentiation of tumor cells may cause diagnostic pitfalls necessitating thorough immunohistochemical analysis. The presence of rhabdoid features and neuroendocrine differentiation are very uncommon, while their co-existence is extremely rare. Better characterization of such microscopic variations in MMs with evaluation of their potential biologic significance is warranted.
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Affiliation(s)
| | - Efstathios Pettas
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Grigorios Thermos
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Georgaki
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Piperi
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos G. Nikitakis
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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Cham J, Shavit A, Ebrahimi A, Viray M, Gibbs P, Bhangoo MS. Malignant Melanoma With Neuroendocrine Differentiation: A Case Report and Literature Review. Front Oncol 2021; 11:763992. [PMID: 34926265 PMCID: PMC8671631 DOI: 10.3389/fonc.2021.763992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background Melanoma has a wide range of histologic variants and cytomorphologic features that make its diagnosis challenging. Melanoma can also rarely have neuroendocrine markers adding further diagnostic uncertainty particularly given that unrelated tumor types, such as prostate cancer, can also display focal neuroendocrine differentiations. Case presentation Our patient is a 74-year-old Caucasian man found to have a lung mass. Initial biopsy revealed typical microscopic morphology and neuroendocrine differentiation consistent with small cell carcinoma. Despite standard chemoradiation treatment, the patient continued to progress with new metastasis in the brain, liver and bone. Subsequent chest wall biopsy revealed golden-brown pigment associated with melanin. Further tumor immunohistochemistry revealed extensive neuroendocrine differentiation with CD56, synaptophysin, and INSM1, as well as strong immunoreactivity for melanocyte markers including SOX10, S100, PRAME, and MITF, consistent with metastatic melanoma with neuroendocrine differentiation. Genomic testing revealed increased tumor mutational burden and alterations in NF1, BRAF, CDKN2A/B, TERT. The patient was transitioned to checkpoint inhibitor therapy with nivolumab and ipilimumab and had resolution of his intracranial mass and decrease in size of other metastatic lesions. Conclusion Often the combination of anatomic findings such as a lung mass, typical microscopic morphology, and confirmation of neuroendocrine differentiation correctly identifies a patient with small cell carcinoma. However, in a patient who fails to respond to treatment, a broader immunohistochemical workup along with molecular testing with additional tissue may be warranted.
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Affiliation(s)
- Jason Cham
- Department of Internal Medicine, Scripps Clinic/Scripps Green Hospital, La Jolla, CA, United States
- *Correspondence: Jason Cham,
| | - Ayal Shavit
- Department of Internal Medicine, Scripps Clinic/Scripps Green Hospital, La Jolla, CA, United States
| | - Aren Ebrahimi
- Department of Internal Medicine, Scripps Clinic/Scripps Green Hospital, La Jolla, CA, United States
| | - Miguel Viray
- Department of Pathology, Scripps Clinic/Scripps Memorial Hospital, Encinitas, Encinitas, CA, United States
| | - Paul Gibbs
- Department of Pathology, Scripps Clinic/Scripps Memorial Hospital, Encinitas, Encinitas, CA, United States
| | - Munveer S. Bhangoo
- Department of Hematology and Oncology, Scripps Clinic/Scripps Green Hospital, La Jolla, CA, United States
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Hu R, Zhao S, Su J, Chen X, Yin M. Establishment of cultured primary acral melanoma cells and animal models for Chinese patients. Pigment Cell Melanoma Res 2021; 34:1131-1137. [PMID: 34097822 PMCID: PMC9291188 DOI: 10.1111/pcmr.12996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/06/2021] [Accepted: 05/27/2021] [Indexed: 12/02/2022]
Abstract
Acral melanoma is the major subtype of melanoma in Chinese patients. However, a majority of current studies focused on non-acral melanoma. Most immortalized melanoma cell lines and primary cells were not from acral melanoma. Besides, there are rarely reports about methods for establishing primary acral melanoma cell cultures and related animal models. Here, we present four new human primary acral melanoma cell lines. To determine the mutational profile of the established primary melanoma cells for future targeted use, we performed exome sequencing. We next examined cell proliferation of the primary acral melanoma cells by colony-formation assays and CCK8 assay. We also evaluated the proliferative and metastatic potential of XYAM-4 in vivo. We report a detailed protocol for establishing cultured primary acral melanoma cells for Chinese patients and related animal models. We also summarize the features in our acral melanoma cell lines and the existing acral melanoma cell lines. This will provide an effective research tool for research on drug responses and individualized treatment for Chinese patients and comparative studies of melanomas between western and Chinese populations.
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Affiliation(s)
- Rui Hu
- Department of DermatologyXiangya HospitalCentral South UniversityChangshaChina
- Hunan Engineering Research Center of Skin Health and DiseaseChangshaChina
- Hunan Key Laboratory of Skin Cancer and PsoriasisXiangya HospitalCentral South UniversityChangshaChina
| | - Shuang Zhao
- Department of DermatologyXiangya HospitalCentral South UniversityChangshaChina
- Hunan Engineering Research Center of Skin Health and DiseaseChangshaChina
- Hunan Key Laboratory of Skin Cancer and PsoriasisXiangya HospitalCentral South UniversityChangshaChina
| | - Juan Su
- Department of DermatologyXiangya HospitalCentral South UniversityChangshaChina
- Hunan Engineering Research Center of Skin Health and DiseaseChangshaChina
- Hunan Key Laboratory of Skin Cancer and PsoriasisXiangya HospitalCentral South UniversityChangshaChina
| | - Xiang Chen
- Department of DermatologyXiangya HospitalCentral South UniversityChangshaChina
- Hunan Engineering Research Center of Skin Health and DiseaseChangshaChina
- Hunan Key Laboratory of Skin Cancer and PsoriasisXiangya HospitalCentral South UniversityChangshaChina
| | - Mingzhu Yin
- Department of DermatologyXiangya HospitalCentral South UniversityChangshaChina
- Hunan Engineering Research Center of Skin Health and DiseaseChangshaChina
- Hunan Key Laboratory of Skin Cancer and PsoriasisXiangya HospitalCentral South UniversityChangshaChina
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10
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Vyberg M, Nielsen S, Bzorek M, Røge R. NordiQC Assessments of Synaptophysin Immunoassays. Appl Immunohistochem Mol Morphol 2021; 29:643-647. [PMID: 34545849 DOI: 10.1097/pai.0000000000000975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 08/25/2021] [Indexed: 11/26/2022]
Abstract
This paper is number 8 in a series developed through a partnership between ISIMM and NordiQC with the purpose of reporting research assessing the performance characteristics of immunoassays in an external proficiency testing program.
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Affiliation(s)
- Mogens Vyberg
- Institute of Pathology
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg
| | | | - Michael Bzorek
- Department of Surgical Pathology, Zealand University Hospital, Roskilde, Denmark
| | - Rasmus Røge
- Institute of Pathology
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg
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11
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Plotzke JM, Zhao R, Hrycaj SM, Harms PW, Mehra R, Chan MP. Immunohistochemical expression of PAX8, PAX2, and cytokeratin in melanomas. J Cutan Pathol 2021; 48:1246-1251. [PMID: 33934372 DOI: 10.1111/cup.14041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Deviations from the classic melanocytic immunophenotype in melanoma can present a diagnostic challenge. PAX8 and PAX2 are common markers for renal or Müllerian differentiation. While most PAX8+ or PAX2+ carcinomas are seldom confused with melanoma, some cases may show a more ambiguous immunophenotype, especially when MiTF family altered renal cell carcinoma (MiTF-RCC) is in the differential diagnosis. Neither PAX8 nor PAX2 expression has been reported in melanoma to date. We aimed to better characterize PAX8, PAX2, and cytokeratin immunoreactivity in a large series of melanomas. METHODS Tissue microarrays consisting of 263 melanomas were immunostained for PAX8, PAX2, and cytokeratin and graded by an h-score. RESULTS PAX8 expression was seen in 7.9% of melanomas and was significantly associated with spindle cytomorphology. PAX2 was positive in one (0.4%) melanoma. Cytokeratin positivity was seen in three (1.2%) cases and was associated with metastases. CONCLUSIONS PAX8 is expressed in a subset of melanomas and may be strong/extensive. As PAX8 positivity does not exclude a diagnosis of melanoma, it should be used in conjunction with other immunohistochemical markers, such as cytokeratin and PAX2, when melanoma, MiTF-RCC, and other PAX8+ tumors are in the differential diagnosis.
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Affiliation(s)
- Jaclyn M Plotzke
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Raymond Zhao
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Steven M Hrycaj
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul W Harms
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Rohit Mehra
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - May P Chan
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
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12
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Wu Y, Lai Y, Zhang M, Li Z. Prognostic significance of the aberrant expression of neuroendocrine markers in melanomas. Diagn Pathol 2021; 16:78. [PMID: 34454530 PMCID: PMC8403415 DOI: 10.1186/s13000-021-01135-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/22/2021] [Indexed: 01/12/2023] Open
Abstract
Background Melanoma is a highly malignant tumor with diverse histopathological morphology and frequent aberrant expression of immunohistochemical markers. An occasionally reported phenomenon is the abnormal expression of neuroendocrine markers. Awareness of this situation is essential because such tumors need to be differentiated from neuroendocrine tumors because of their significant therapeutic and prognostic implications. Methods We retrospectively analyzed the expression of chromogranin A (CgA), synaptophysin (Syn) and CD56 as neuroendocrine markers in 308 cases with melanomas. Kaplan-Meier curves and Cox regression analyses were used for overall survival (OS) and progression-free survival (PFS) evaluation and comparison between neuroendocrine markers expression status in all melanoma cases or stage I–II cases. Results The expression of neuroendocrine markers in melanomas is not uncommon. CgA was positive in 6/304 (2.0%) cases, Syn in 26/304 (8.6%), and CD56 in 56/189 (29.6%). None of the cases co-expressed all the three markers. Focal or weak expression of at least one neuroendocrine marker was identified in 70/188 (37.2%) cases. The expression of CgA was correlated with age (p = 0.019), while the positive expression of Syn and CD56 showed borderline significance (p = 0.078 and 0.083, respectively), but not for any neuroendocrine marker expression. The expression of any neuroendocrine marker showed borderline significance with staging (p = 0.066). The expression of CgA, Syn, CD56, or any neuroendocrine marker did not correlate with clinicopathological features including sex, specimen type, origin, location, and histology subtype. Survival analyses revealed that the expression of neuroendocrine markers was not associated with OS or PFS. Conclusions Our study confirms that neuroendocrine marker expression is a common phenomenon in melanomas, but it has no prognostic significance. Nevertheless, awareness can avoid misdiagnosis in cases of melanomas with unusual morphology and immunophenotypes.
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Affiliation(s)
- Yan Wu
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China
| | - Yumei Lai
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China
| | - Miao Zhang
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China
| | - Zhongwu Li
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, No. 52, Fucheng Road, Haidian District, Beijing, 100142, China.
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13
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Dayton VJ, Beckman A, Linden M. Myeloid Sarcoma Expressing Keratins and Mimicking Carcinoma-Case Report and Literature Review. Lab Med 2021; 53:100-106. [PMID: 34388257 DOI: 10.1093/labmed/lmab025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Unusual presentations of otherwise common hematopoietic neoplasms are a well-recognized diagnostic challenge. Herein, we present a case study of a previously healthy 64 year old woman with myeloid sarcoma whose diagnosis was delayed by an unusual immunohistochemical staining pattern, including cytokeratin expression, by the neoplastic cells and by possible anchoring bias introduced by radiographic and flow cytometric immunophenotyping reports. This case study emphasizes the need to integrate clinical, radiographic, histologic, and immunophenotyping data for rapid and accurate tissue diagnoses while being wary of the lack of specificity for many common immunophenotypic markers.
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Affiliation(s)
- Vanessa J Dayton
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center-Fairview, Minneapolis, Minnesota, USA
| | - Amy Beckman
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center-Fairview, Minneapolis, Minnesota, USA
| | - Michael Linden
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center-Fairview, Minneapolis, Minnesota, USA
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14
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Kasajima A, Konukiewitz B, Schlitter AM, Weichert W, Bräsen JH, Agaimy A, Klöppel G. Mesenchymal/non-epithelial mimickers of neuroendocrine neoplasms with a focus on fusion gene-associated and SWI/SNF-deficient tumors. Virchows Arch 2021; 479:1209-1219. [PMID: 34350470 PMCID: PMC8724147 DOI: 10.1007/s00428-021-03156-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 12/24/2022]
Abstract
Mimickers of neuroendocrine neoplasms (NEN) include a number of important pitfall tumors. Here, we describe our experience with mesenchymal mimics of NENs to illustrate their spectrum and draw the attention particularly to a group of mesenchymal/non-epithelial neoplasms (MN) that combine epithelioid histology with neuroendocrine (NE-) features and peculiar genetic abnormalities. In a consultation series of 4498 cases collected between 2009 and 2021, 2099 neoplasms expressing synaptophysin and/or chromograninA were reviewed and analyzed. A total of 364 (18%) were diagnosed as non-NENs, while the remaining tumors were NEN. The group of mesenchymal/non-epithelial neoplasms with NE-features (MN-NE) included 31/364 (8%) cases. These mostly malignant neoplasms showed an epithelioid morphology. While all but one tumor expressed synaptophysin, mostly patchy, only 10/29 (34%) co-expressed chromograninA. A total of 13/31 (42%) of the MN-NE showed EWSR1-related gene fusions (6 Ewing sarcomas, 5 clear cell sarcomas, and 1 desmoplastic small round cell tumor, 1 neoplasm with FUS-CREM gene fusion) and 7 (23%) were SWI/SNF (SMARCB1 or SMARCA4)-deficient neoplasms. The remaining MN-NE included synovial sarcoma, sclerosing epithelioid mesenchymal neoplasm, melanoma, alveolar soft part sarcoma, solitary fibrous tumor, and chordoma. A total of 27/31 MN-NE were from the last 8 years, and 6 of them were located in the pancreas. Eleven MN-NE were initially diagnosed as neuroendocrine carcinomas (NECs). MN-NE with epithelioid features play an increasing role as mimickers of NECs. They mostly belong to tumors with gene fusions involving the EWSR1 gene, or with SWI/SNF complex deficiency. Synaptophysin expression is mostly patchy and chromograninA expression is infrequent in MN-NE of this series and data extracted from literature.
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Affiliation(s)
- Atsuko Kasajima
- Department of Pathology, Technical University Munich, Trogerstr. 18, 81675, Munich, Germany.
- The German Cancer Consortium (DKTK), Heidelberg, Germany.
| | - Björn Konukiewitz
- Department of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Anna Melissa Schlitter
- Department of Pathology, Technical University Munich, Trogerstr. 18, 81675, Munich, Germany
- The German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Wilko Weichert
- Department of Pathology, Technical University Munich, Trogerstr. 18, 81675, Munich, Germany
- The German Cancer Consortium (DKTK), Heidelberg, Germany
| | | | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-University, Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Günter Klöppel
- Department of Pathology, Technical University Munich, Trogerstr. 18, 81675, Munich, Germany
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15
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Saliba E, Bhawan J. Aberrant Expression of Immunohistochemical Markers in Malignant Melanoma: A Review. Dermatopathology (Basel) 2021; 8:359-370. [PMID: 34449584 PMCID: PMC8395931 DOI: 10.3390/dermatopathology8030040] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022] Open
Abstract
Immunohistochemical stains are increasingly used to aid in the diagnosis of malignant melanoma, especially when the differentiation of the tumor is unclear based on examination with hematoxylin and eosin. However, aberrant expression of non-melanocytic markers has been reported in melanomas, which can sometimes be further complicated by the loss of conventional melanocytic markers. This review aims to summarize available data regarding unusual staining patterns in primary and metastatic malignant melanoma. It also raises awareness of the potential pitfalls and highlights the importance of appropriate use and interpretation of broad immunohistochemical markers in the context of clinical and histopathologic findings to facilitate the diagnosis of atypical cases of malignant melanoma.
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16
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Immunohistochemistry in Bone and Soft Tissue Tumours. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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17
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Nakra T, Dadhwal R, Nayyar R, Rastogi S, Kakkar A, Sharma MC, Yadav R. Primary urethral small cell melanoma with neuroendocrine differentiation: a case report. J Egypt Natl Canc Inst 2020; 32:40. [PMID: 33043406 DOI: 10.1186/s43046-020-00051-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 09/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary malignant melanoma of the female urethra is an exceedingly rare tumor. It represents 0.2% of all malignant melanomas. Divergent differentiation towards non-melanocytic lineages has not been reported in urethral melanoma. CASE PRESENTATION We report a rare case of neuroendocrine differentiation in a large primary small cell malignant melanoma involving the urethra, in a 62-year-old lady, who presented with obstructive urinary symptoms. Clinical and radiological workup revealed a large urethral mass with liver and lymph nodal metastases. A biopsy was performed from the urethral and liver lesions which showed poorly differentiated tumor cells with small cell morphology and presence of melanin pigment. These cells were immunopositive for melanocytic and neuroendocrine markers. Ultrastructural examination showed presence of melanosomes and neurosecretory granules in the tumor cells. CONCLUSIONS Although malignant melanoma with neuroendocrine differentiation is exceptionally rare, it needs to be recognized among the other well-known variants of malignant melanoma.
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Affiliation(s)
- Tripti Nakra
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Rohit Dadhwal
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Rishi Nayyar
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Sameer Rastogi
- Department of Medical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Mehar Chand Sharma
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Rajni Yadav
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
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18
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Newman J, Brahmbhatt M, Stoff BK, Martinez AP. S-100 protein and SOX10-positive breast carcinoma mimicking metastatic melanoma. J Cutan Pathol 2020; 47:1187-1191. [PMID: 32710508 DOI: 10.1111/cup.13822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 11/28/2022]
Abstract
We present a case detailing a 70-year-old female with a history of triple-negative breast carcinoma (TNBC) of the left breast and contralateral stage pT2a nodular melanoma of the right upper arm who underwent sentinel lymph node biopsy of the right axilla demonstrating a metastatic epithelioid tumor that was strongly positive for S-100 protein and SOX10. The tumor cells were negative for HMB-45 and Melan-A and positive for CK7 and other breast markers (GCDFP15, mammaglobin, and GATA3). While concerning for metastatic melanoma based on clinical history and initial immunohistochemistry, tumor morphology and subsequent immunohistochemistry was supportive of metastatic breast adenocarcinoma. This case demonstrates a rare but perilous diagnostic pitfall of triple-negative breast carcinomas that strongly and diffusely express S-100 protein and SOX10 mimicking melanoma.
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Affiliation(s)
- John Newman
- Emory School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Meera Brahmbhatt
- Department of Dermatology, Emory University, Atlanta, Georgia, USA
| | - Benjamin K Stoff
- Department of Dermatology, Emory University, Atlanta, Georgia, USA.,Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Anthony P Martinez
- Department of Dermatology, Emory University, Atlanta, Georgia, USA.,Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
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19
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Steppert C, Krugmann J, Sterlacci W. Simultaneous endocrine expression and loss of melanoma markers in malignant melanoma metastases, a retrospective analysis. Pathol Oncol Res 2020; 26:1777-1779. [PMID: 31654227 DOI: 10.1007/s12253-019-00761-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
Abstract
Malignant melanoma metastases are chameleons of histopathology. In 4 primary malignant melanomas and 20 melanoma metastases expression of S-100, HMB-45 and melan-A as melanoma markers and CD56, synaptophysin and chromogranin-A as neuroendocrine markers was retrospectively analyzed. While all primary tumors expressed all 3 melanoma markers 7/20 of melanoma metastases had lost at least one melanoma marker, one had lost all three markers. Conversely about half of the samples stained for CD56, only 6/20 metastases were negative for all 3 neuroendocrine markers. None expressed chromogranin-A. Partial loss of melanoma markers and expression of neuroendocrine markers seems not to be infrequent. In patients with a history of malignant melanoma and suspected metastases, losing melanoma markers while expressing neuroendocrine markers is a potential diagnostic pitfall. Therefore all 3 melanoma markers should be performed as well as chromogranin-A staining. In doubt, metastases of the melanoma should be assumed.
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Affiliation(s)
- Claus Steppert
- Department of Pulmonology and Thoracic Oncology, Klinikum Bayreuth, Preuschwitzer Str. 101, D-95445, Bayreuth, Germany.
| | - Jens Krugmann
- Department of Pathology, Klinikum Bayreuth, Preuschwitzer Str. 101, D-95445, Bayreuth, Germany
| | - William Sterlacci
- Department of Pathology, Klinikum Bayreuth, Preuschwitzer Str. 101, D-95445, Bayreuth, Germany
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20
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Guglielmi L, Nardella M, Musa C, Cifola I, Porru M, Cardinali B, Iannetti I, Di Pietro C, Bolasco G, Palmieri V, Vilardo L, Panini N, Bonaventura F, Papi M, Scavizzi F, Raspa M, Leonetti C, Falcone G, Felsani A, D’Agnano I. Circulating miRNAs in Small Extracellular Vesicles Secreted by a Human Melanoma Xenograft in Mouse Brains. Cancers (Basel) 2020; 12:cancers12061635. [PMID: 32575666 PMCID: PMC7352810 DOI: 10.3390/cancers12061635] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 12/21/2022] Open
Abstract
The identification of liquid biomarkers remains a major challenge to improve the diagnosis of melanoma patients with brain metastases. Circulating miRNAs packaged into tumor-secreted small extracellular vesicles (sEVs) contribute to tumor progression. To investigate the release of tumor-secreted miRNAs by brain metastasis, we developed a xenograft model where human metastatic melanoma cells were injected intracranially in nude mice. The comprehensive profiles of both free miRNAs and those packaged in sEVs secreted by the melanoma cells in the plasma demonstrated that most (80%) of the sEV-associated miRNAs were also present in serum EVs from a cohort of metastatic melanomas, included in a publicly available dataset. Remarkably, among them, we found three miRNAs (miR-224-5p, miR-130a-3p and miR-21-5p) in sEVs showing a trend of upregulation during melanoma progression. Our model is proven to be valuable for identifying miRNAs in EVs that are unequivocally secreted by melanoma cells in the brain and could be associated to disease progression.
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Affiliation(s)
- Loredana Guglielmi
- Institute for Biomedical Technologies (ITB), CNR, 20090 Segrate, Italy; (L.G.); (I.C.); (L.V.)
| | - Marta Nardella
- Department of Neurosciences, Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy;
| | - Carla Musa
- Institute of Biochemistry and Cell Biology (IBBC), CNR, 00015 Monterotond, Italy; (C.M.); (B.C.); (I.I.); (C.D.P.); (F.B.); (F.S.); (M.R.); (G.F.)
| | - Ingrid Cifola
- Institute for Biomedical Technologies (ITB), CNR, 20090 Segrate, Italy; (L.G.); (I.C.); (L.V.)
| | - Manuela Porru
- UOSD SAFU–IRCCS-Regina Elena Cancer Institute, 00168 Rome, Italy; (M.P.); (C.L.)
| | - Beatrice Cardinali
- Institute of Biochemistry and Cell Biology (IBBC), CNR, 00015 Monterotond, Italy; (C.M.); (B.C.); (I.I.); (C.D.P.); (F.B.); (F.S.); (M.R.); (G.F.)
| | - Ilaria Iannetti
- Institute of Biochemistry and Cell Biology (IBBC), CNR, 00015 Monterotond, Italy; (C.M.); (B.C.); (I.I.); (C.D.P.); (F.B.); (F.S.); (M.R.); (G.F.)
| | - Chiara Di Pietro
- Institute of Biochemistry and Cell Biology (IBBC), CNR, 00015 Monterotond, Italy; (C.M.); (B.C.); (I.I.); (C.D.P.); (F.B.); (F.S.); (M.R.); (G.F.)
| | | | - Valentina Palmieri
- Fondazione Policlinico Universitario A. Gemelli IRCSS, 00168 Rome, Italy; (V.P.); (M.P.)
- Istituto di Fisica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Laura Vilardo
- Institute for Biomedical Technologies (ITB), CNR, 20090 Segrate, Italy; (L.G.); (I.C.); (L.V.)
| | - Nicolò Panini
- Laboratory of Cancer Pharmacology, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy;
| | - Fabrizio Bonaventura
- Institute of Biochemistry and Cell Biology (IBBC), CNR, 00015 Monterotond, Italy; (C.M.); (B.C.); (I.I.); (C.D.P.); (F.B.); (F.S.); (M.R.); (G.F.)
| | - Massimiliano Papi
- Fondazione Policlinico Universitario A. Gemelli IRCSS, 00168 Rome, Italy; (V.P.); (M.P.)
- Istituto di Fisica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ferdinando Scavizzi
- Institute of Biochemistry and Cell Biology (IBBC), CNR, 00015 Monterotond, Italy; (C.M.); (B.C.); (I.I.); (C.D.P.); (F.B.); (F.S.); (M.R.); (G.F.)
| | - Marcello Raspa
- Institute of Biochemistry and Cell Biology (IBBC), CNR, 00015 Monterotond, Italy; (C.M.); (B.C.); (I.I.); (C.D.P.); (F.B.); (F.S.); (M.R.); (G.F.)
| | - Carlo Leonetti
- UOSD SAFU–IRCCS-Regina Elena Cancer Institute, 00168 Rome, Italy; (M.P.); (C.L.)
| | - Germana Falcone
- Institute of Biochemistry and Cell Biology (IBBC), CNR, 00015 Monterotond, Italy; (C.M.); (B.C.); (I.I.); (C.D.P.); (F.B.); (F.S.); (M.R.); (G.F.)
| | | | - Igea D’Agnano
- Institute for Biomedical Technologies (ITB), CNR, 20090 Segrate, Italy; (L.G.); (I.C.); (L.V.)
- Correspondence:
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21
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Cheuk W, Shum KS, Ng WK, Chan JKC. Composite Hemangioendothelioma With Neuroendocrine Marker Expression: Report of a "Paraganglioma-Like" Paravertebral Case. Int J Surg Pathol 2020; 28:759-763. [PMID: 32418470 DOI: 10.1177/1066896920924120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Composite hemangioendothelioma is a rare vascular tumor morphologically comprising several distinct vascular components and exhibits a borderline malignant potential. We described the case of a 53-year-old female who presented with an infiltrative mass in the paravertebral soft tissue. The tumor showed discrete nests of synaptophysin-expressing epithelioid cells accompanied by rich vasculature, features highly reminiscent of sympathetic paraganglioma. Further analysis revealed areas resembling spindle cell hemangioma, retiform hemangioendothelioma, cavernous hemangioma/lymphangioma, and epithelioid hemangioendothelioma without the myxohyaline matrix in the tumor, and a final diagnosis of composite hemangioendothelioma with synaptophysin expression was made. Critical appraisal of this recently described entity and its possible pathogenic relationship with retiform hemangioendothelioma were discussed.
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Affiliation(s)
- W Cheuk
- Queen Elizabeth Hospital, Hong Kong SAR China
| | - K S Shum
- St Teresa's Hospital, Hong Kong SAR China
| | - W K Ng
- St Teresa's Hospital, Hong Kong SAR China
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22
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An Algorithmic Immunohistochemical Approach to Define Tumor Type and Assign Site of Origin. Adv Anat Pathol 2020; 27:114-163. [PMID: 32205473 DOI: 10.1097/pap.0000000000000256] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Immunohistochemistry represents an indispensable complement to an epidemiology and morphology-driven approach to tumor diagnosis and site of origin assignment. This review reflects the state of my current practice, based on 15-years' experience in Pathology and a deep-dive into the literature, always striving to be better equipped to answer the age old questions, "What is it, and where is it from?" The tables and figures in this manuscript are the ones I "pull up on the computer" when I am teaching at the microscope and turn to myself when I am (frequently) stuck. This field is so exciting because I firmly believe that, through the application of next-generation immunohistochemistry, we can provide better answers than ever before. Specific topics covered in this review include (1) broad tumor classification and associated screening markers; (2) the role of cancer epidemiology in determining pretest probability; (3) broad-spectrum epithelial markers; (4) noncanonical expression of broad tumor class screening markers; (5) a morphologic pattern-based approach to poorly to undifferentiated malignant neoplasms; (6) a morphologic and immunohistochemical approach to define 4 main carcinoma types; (7) CK7/CK20 coordinate expression; (8) added value of semiquantitative immunohistochemical stain assessment; algorithmic immunohistochemical approaches to (9) "garden variety" adenocarcinomas presenting in the liver, (10) large polygonal cell adenocarcinomas, (11) the distinction of primary surface ovarian epithelial tumors with mucinous features from metastasis, (12) tumors presenting at alternative anatomic sites, (13) squamous cell carcinoma versus urothelial carcinoma, and neuroendocrine neoplasms, including (14) the distinction of pheochromocytoma/paraganglioma from well-differentiated neuroendocrine tumor, site of origin assignment in (15) well-differentiated neuroendocrine tumor and (16) poorly differentiated neuroendocrine carcinoma, and (17) the distinction of well-differentiated neuroendocrine tumor G3 from poorly differentiated neuroendocrine carcinoma; it concludes with (18) a discussion of diagnostic considerations in the broad-spectrum keratin/CD45/S-100-"triple-negative" neoplasm.
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Juhlin CC, Zedenius J, Haglund F. Metastatic malignant melanoma with neuroendocrine differentiation: a case report and review of the literature. J Med Case Rep 2020; 14:44. [PMID: 32234068 PMCID: PMC7110723 DOI: 10.1186/s13256-020-02367-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 03/05/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Metastatic neuroendocrine carcinoma often presents as carcinoma of unknown primary. Although most cases display immunohistochemical positivity for neuroendocrine markers, subsets of cases display reduced or negative expression for some of these proteins. The identification of metastatic neuroendocrine carcinomas is even more complicated by the occurrence of unrelated tumor types with focal neuroendocrine differentiation. CASE PRESENTATION Our patient was a 74-year-old man of Middle Eastern ethnicity. An initial biopsy of a soft tissue metastasis displayed a neuroendocrine profile indicative of a metastatic neuroendocrine carcinoma, positive for CD56 and synaptophysin, and focally for ISL LIM homeobox 1 and insulinoma-associated protein 1. The Ki-67 index was 50%. Chemotherapy was initiated, but our patient progressed. Scrapings from a pathological hip fracture 3 months later revealed focal synaptophysin immunoreactivity and widespread melanoma antigen, human melanoma black 45, and SOX10 positivity, which are indicative of metastatic malignant melanoma with focal neuroendocrine differentiation. CONCLUSIONS Malignant melanoma may display neuroendocrine differentiation, and the entity should be considered a rare differential diagnosis when assessing biopsies of suspected neuroendocrine carcinomas.
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Affiliation(s)
- Carl Christofer Juhlin
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
- Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden.
| | - Jan Zedenius
- Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Felix Haglund
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
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Olson NJ, Fritchie KJ, Torres-Mora J, Folpe AL. MyoD1 expression in fibroepithelial stromal polyps. Hum Pathol 2020; 99:75-79. [PMID: 32217091 DOI: 10.1016/j.humpath.2020.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/17/2020] [Indexed: 11/16/2022]
Abstract
Fibroepithelial stromal polyps (FESPs) are benign polypoid mesenchymal lesions thought to arise from desmin-positive specialized stromal cells of the female genital tract. Although most cases are easily diagnosed by morphology alone, the morphology of FESPs is variable and in some instances can contain hypercellular stroma with numerous atypical desmin-positive cells, simulating botryoid embryonal rhabdomyosarcoma (ERMS). Recently, we encountered a cellular FESP showing desmin expression as well as nuclear immunoreactivity for the skeletal muscle-associated transcription factor MyoD1. Although these lesions are widely known to express desmin, there are very few studies examining expression of the more specific markers of skeletal muscle differentiation, myogenin and MyoD1. The aim of our study was to examine desmin, MyoD1, and myogenin expression in a series of 25 FESPs. Of the 25 cases, desmin expression was present in 23 (92%), at least focal MyoD1 expression was present in 10 (40%), and all cases were negative for myogenin. Follow-up data were available for all 25 cases, and none recurred or behaved in a malignant fashion. Awareness of this potential immunohistochemical pitfall and careful morphologic evaluation should allow for the confident distinction of MyoD1-positive FESP from botyroid ERMS in almost all instances.
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Affiliation(s)
- Nicholas J Olson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55902, USA
| | - Karen J Fritchie
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55902, USA
| | - Jorge Torres-Mora
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55902, USA
| | - Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55902, USA.
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Saggini A, Cerroni L, Casini B, Baciorri F, Cota C. Primary intrafascial desmoplastic melanoma with pseudoglandular differentiation and aberrant cytokeratins expression: An exceptional presentation. Pathol Res Pract 2019; 215:152668. [DOI: 10.1016/j.prp.2019.152668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/22/2019] [Accepted: 09/24/2019] [Indexed: 11/25/2022]
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Wakely PE. Diagnostic traps awaiting the head/neck pathologist: "Cytoplasm-poor" neoplasms. Ann Diagn Pathol 2019; 42:78-86. [PMID: 31382078 DOI: 10.1016/j.anndiagpath.2019.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
Abstract
CONTEXT Beyond squamous carcinoma, a variety of diagnostically challenging neoplasms arise within various head and neck sites. This is particularly the situation with neoplasms where little cellular cytoplasm is present to assist the pathologist in categorizing such lesions. OBJECTIVE To highlight diagnostic pitfalls that accompanying neoplasms composed primarily of 'cytoplasmically-poor' cells. These pitfalls include morphologic and immunohistochemical traps that emerge from this class of neoplasms. DATA SOURCES Selection of pathologic specimens from the author's personal files, and literature review. CONCLUSIONS Interpretative pitfalls regarding the histopathology and immunophenotype of small 'cytoplasmically-poor' neoplasms are a diagnostic hazard in head and neck surgical pathology practice, and require knowledge of histomorphologic plasticity and aberrant immunophenotyping.
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Affiliation(s)
- Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, 405 Doan Hall, 410 W. 10th Ave., Columbus, OH 43210, United States of America.
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Strauss RA, Allbaugh RA, Haynes J, Ben‐Shlomo G. Primary corneal malignant melanoma in a horse. EQUINE VET EDUC 2019. [DOI: 10.1111/eve.12815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- R. A. Strauss
- Department of Veterinary Clinical SciencesandIowa State University College of Veterinary Medicine Ames USA
| | - R. A. Allbaugh
- Department of Veterinary Clinical SciencesandIowa State University College of Veterinary Medicine Ames USA
| | - J. Haynes
- Department of Veterinary Pathology Iowa State University College of Veterinary Medicine Ames USA
| | - G. Ben‐Shlomo
- Department of Veterinary Clinical SciencesandIowa State University College of Veterinary Medicine Ames USA
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28
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Bagge RO, Demir A, Karlsson J, Alaei-Mahabadi B, Einarsdottir BO, Jespersen H, Lindberg MF, Muth A, Nilsson LM, Persson M, Svensson JB, Söderberg EMV, de Krijger RR, Nilsson O, Larsson E, Stenman G, Nilsson JA. Mutational Signature and Transcriptomic Classification Analyses as the Decisive Diagnostic Tools for a Cancer of Unknown Primary. JCO Precis Oncol 2018; 2:1800002. [PMID: 32913988 PMCID: PMC7446430 DOI: 10.1200/po.18.00002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose Cancer of unknown primary is a group of metastatic tumors in which the standard diagnostic workup fails to identify the site of origin of the tumor. The potential impact of precision oncology on this group of patients is large, because actionable driver mutations and a correct diagnosis could provide treatment options otherwise not available for patients with these fatal cancers. This study investigated if comprehensive genomic analyses could provide information on the origin of the tumor. Patients and Methods Here we describe a patient whose tumor was misdiagnosed at least three times. Next-generation sequencing, a patient-derived xenograft mouse model, and bioinformatics were used to identify an actionable mutation, predict resistance development to the targeted therapy, and correctly diagnose the origin of the tumor. Transcriptomic classification was benchmarked using The Cancer Genome Atlas (TCGA). Results Despite the lack of a known primary tumor site and the absence of diagnostic immunohistochemical markers, the origin of the patient’s tumor was established using the novel bioinformatic workflow. This included a mutational signature analysis of the sequenced metastases and comparison of their transcriptomic profiles to a pan-cancer panel of tumors from TCGA. We further discuss the strengths and limitations of the latter approaches in the context of three potentially incorrectly diagnosed TCGA lung tumors. Conclusion Comprehensive genomic analyses can provide information on the origin of tumors in patients with cancer of unknown primary.
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Affiliation(s)
- Roger Olofsson Bagge
- , , , , , , , , , , and , Sahlgrenska Academy, University of Gothenburg; , , , , , , , , , and , Sahlgrenska Cancer Center, University of Gothenburg; , , , , Sahlgrenska University Hospital, Gothenburg, Sweden; and , Reinier de Graaf Hospital, Delft; and University Medical Center Utrecht/Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Akif Demir
- , , , , , , , , , , and , Sahlgrenska Academy, University of Gothenburg; , , , , , , , , , and , Sahlgrenska Cancer Center, University of Gothenburg; , , , , Sahlgrenska University Hospital, Gothenburg, Sweden; and , Reinier de Graaf Hospital, Delft; and University Medical Center Utrecht/Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Joakim Karlsson
- , , , , , , , , , , and , Sahlgrenska Academy, University of Gothenburg; , , , , , , , , , and , Sahlgrenska Cancer Center, University of Gothenburg; , , , , Sahlgrenska University Hospital, Gothenburg, Sweden; and , Reinier de Graaf Hospital, Delft; and University Medical Center Utrecht/Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Babak Alaei-Mahabadi
- , , , , , , , , , , and , Sahlgrenska Academy, University of Gothenburg; , , , , , , , , , and , Sahlgrenska Cancer Center, University of Gothenburg; , , , , Sahlgrenska University Hospital, Gothenburg, Sweden; and , Reinier de Graaf Hospital, Delft; and University Medical Center Utrecht/Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Berglind O Einarsdottir
- , , , , , , , , , , and , Sahlgrenska Academy, University of Gothenburg; , , , , , , , , , and , Sahlgrenska Cancer Center, University of Gothenburg; , , , , Sahlgrenska University Hospital, Gothenburg, Sweden; and , Reinier de Graaf Hospital, Delft; and University Medical Center Utrecht/Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Henrik Jespersen
- , , , , , , , , , , and , Sahlgrenska Academy, University of Gothenburg; , , , , , , , , , and , Sahlgrenska Cancer Center, University of Gothenburg; , , , , Sahlgrenska University Hospital, Gothenburg, Sweden; and , Reinier de Graaf Hospital, Delft; and University Medical Center Utrecht/Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Mattias F Lindberg
- , , , , , , , , , , and , Sahlgrenska Academy, University of Gothenburg; , , , , , , , , , and , Sahlgrenska Cancer Center, University of Gothenburg; , , , , Sahlgrenska University Hospital, Gothenburg, Sweden; and , Reinier de Graaf Hospital, Delft; and University Medical Center Utrecht/Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Andreas Muth
- , , , , , , , , , , and , Sahlgrenska Academy, University of Gothenburg; , , , , , , , , , and , Sahlgrenska Cancer Center, University of Gothenburg; , , , , Sahlgrenska University Hospital, Gothenburg, Sweden; and , Reinier de Graaf Hospital, Delft; and University Medical Center Utrecht/Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Lisa M Nilsson
- , , , , , , , , , , and , Sahlgrenska Academy, University of Gothenburg; , , , , , , , , , and , Sahlgrenska Cancer Center, University of Gothenburg; , , , , Sahlgrenska University Hospital, Gothenburg, Sweden; and , Reinier de Graaf Hospital, Delft; and University Medical Center Utrecht/Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Marta Persson
- , , , , , , , , , , and , Sahlgrenska Academy, University of Gothenburg; , , , , , , , , , and , Sahlgrenska Cancer Center, University of Gothenburg; , , , , Sahlgrenska University Hospital, Gothenburg, Sweden; and , Reinier de Graaf Hospital, Delft; and University Medical Center Utrecht/Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Johanna B Svensson
- , , , , , , , , , , and , Sahlgrenska Academy, University of Gothenburg; , , , , , , , , , and , Sahlgrenska Cancer Center, University of Gothenburg; , , , , Sahlgrenska University Hospital, Gothenburg, Sweden; and , Reinier de Graaf Hospital, Delft; and University Medical Center Utrecht/Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Elin M V Söderberg
- , , , , , , , , , , and , Sahlgrenska Academy, University of Gothenburg; , , , , , , , , , and , Sahlgrenska Cancer Center, University of Gothenburg; , , , , Sahlgrenska University Hospital, Gothenburg, Sweden; and , Reinier de Graaf Hospital, Delft; and University Medical Center Utrecht/Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Ronald R de Krijger
- , , , , , , , , , , and , Sahlgrenska Academy, University of Gothenburg; , , , , , , , , , and , Sahlgrenska Cancer Center, University of Gothenburg; , , , , Sahlgrenska University Hospital, Gothenburg, Sweden; and , Reinier de Graaf Hospital, Delft; and University Medical Center Utrecht/Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Ola Nilsson
- , , , , , , , , , , and , Sahlgrenska Academy, University of Gothenburg; , , , , , , , , , and , Sahlgrenska Cancer Center, University of Gothenburg; , , , , Sahlgrenska University Hospital, Gothenburg, Sweden; and , Reinier de Graaf Hospital, Delft; and University Medical Center Utrecht/Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Erik Larsson
- , , , , , , , , , , and , Sahlgrenska Academy, University of Gothenburg; , , , , , , , , , and , Sahlgrenska Cancer Center, University of Gothenburg; , , , , Sahlgrenska University Hospital, Gothenburg, Sweden; and , Reinier de Graaf Hospital, Delft; and University Medical Center Utrecht/Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Göran Stenman
- , , , , , , , , , , and , Sahlgrenska Academy, University of Gothenburg; , , , , , , , , , and , Sahlgrenska Cancer Center, University of Gothenburg; , , , , Sahlgrenska University Hospital, Gothenburg, Sweden; and , Reinier de Graaf Hospital, Delft; and University Medical Center Utrecht/Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Jonas A Nilsson
- , , , , , , , , , , and , Sahlgrenska Academy, University of Gothenburg; , , , , , , , , , and , Sahlgrenska Cancer Center, University of Gothenburg; , , , , Sahlgrenska University Hospital, Gothenburg, Sweden; and , Reinier de Graaf Hospital, Delft; and University Medical Center Utrecht/Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Dimonitsas E, Liakea A, Sakellariou S, Thymara I, Giannopoulos A, Stratigos A, Soura E, Saetta A, Korkolopoulou P. An update on molecular alterations in melanocytic tumors with emphasis on Spitzoid lesions. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:249. [PMID: 30069451 DOI: 10.21037/atm.2018.05.23] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Significant progress in the molecular pathology of melanocytic tumors have revealed that benign neoplasms, so-called nevi, are initiated by gain-of-function mutations in one of several primary oncogenes, such as BRAF in acquired melanocytic nevi, NRAS in congenital nevi or GNAQ/GNA11 in blue nevi, with consequent MAPK and PI3K/AKT/mTOR activation. Secondary genetic alterations overcome tumor suppressive mechanisms and allow the progression to intermediate lesions characterized by TERT-p mutation or to invasive melanomas displaying disruption of tumor suppressor genes. Currently, melanoma is molecularly regarded as four different diseases, namely BRAF, NRAS, NF1 and the "triple wild type" subtypes, which are associated with particular clinicopathological features. Melanocytic Spitzoid lesions include benign Spitz nevus, atypical Spitz tumor (AST) and Spitzoid melanoma. This is a challenging diagnostic group, particularly with regard to the distinction between AST and Spitzoid melanoma on clinical and histological grounds. Molecular analysis has identified the presence of HRAS mutation, BAP1 loss (often accompanying by BRAF mutations) or several kinase fusions in distinct categories of Spitz tumors. These aberrations account for the rapid growth characteristic of Spitz nevi. Subsequent growth is halted by various tumor suppressive mechanisms abrogation of which allow the development of AST, now better classified as low-grade melanocytic tumor. Although at present ancillary genetic techniques have not been very helpful in the prediction of biological behavior of AST, they have defined distinct tumor subsets differing with regard to biology and histology. Finally, we discuss how novel molecular markers may assist the differential diagnosis of melanoma, particularly from malignant peripheral nerve sheath tumor (MPNST). It is anticipated that the significant progress in the field of molecular pathology regarding the various types of melanocytic tumors, will eventually contribute to a more accurate histologic categorization, prediction of biologic behavior and personalized treatment.
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Affiliation(s)
- Emmanouil Dimonitsas
- Second Department of General Surgery, Airforce General and Veterans Hospital, Athens, Greece
| | - Aliki Liakea
- First Department of Pathology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Stratigoula Sakellariou
- First Department of Pathology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Irene Thymara
- First Department of Pathology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Andreas Giannopoulos
- Haematology Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Alexandros Stratigos
- First Department of Dermatology/University Clinic, "Andreas Sygros" Hospital, Athens, Greece
| | - Efthymia Soura
- First Department of Dermatology/University Clinic, "Andreas Sygros" Hospital, Athens, Greece
| | - Angelica Saetta
- First Department of Pathology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Penelope Korkolopoulou
- First Department of Pathology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Folpe AL, Graham RP, Martinez A, Schembri-Wismayer D, Boland J, Fritchie KJ. Mesenchymal chondrosarcomas showing immunohistochemical evidence of rhabdomyoblastic differentiation: a potential diagnostic pitfall. Hum Pathol 2018; 77:28-34. [PMID: 29559236 DOI: 10.1016/j.humpath.2018.03.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/01/2018] [Accepted: 03/07/2018] [Indexed: 11/25/2022]
Abstract
The diagnosis of mesenchymal chondrosarcoma, a distinctive biphasic malignant neoplasm harboring the HEY1-NCOA2 gene fusion and consisting of primitive round to spindled cells admixed with foci of relatively mature hyaline cartilage, is usually straightforward by morphologic evaluation alone. However, in the setting of a limited biopsy, specimens lacking cartilage generate a broad differential diagnosis, encompassing a variety of other primitive sarcomas, including spindle cell/sclerosing rhabdomyosarcoma. Although a small number of cases of mesenchymal chondrosarcoma with aberrant skeletal muscle marker expression have been reported, pathologists are largely unaware of this potential diagnostic pitfall. We report 6 additional cases of mesenchymal chondrosarcoma showing expression of multiple skeletal muscle markers, including one case initially misdiagnosed as "spindle cell/sclerosing rhabdomyosarcoma" on needle biopsy. Awareness of this phenomenon and judicious application of molecular diagnostic testing for the HEY1-NCOA2 fusion are critical to avoid misclassification of mesenchymal chondrosarcoma as rhabdomyosarcoma, with potentially adverse patient impact.
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Affiliation(s)
- Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55902, USA
| | - Rondell P Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55902, USA
| | - Anthony Martinez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55902, USA
| | | | - Jennifer Boland
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55902, USA
| | - Karen J Fritchie
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55902, USA.
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31
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Wong KS, Jo VY. Cytologic diagnosis of round cell sarcomas in the era of ancillary testing: an updated review. J Am Soc Cytopathol 2018; 7:119-132. [PMID: 31043308 DOI: 10.1016/j.jasc.2017.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 11/29/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
Abstract
Round cell sarcomas constitute a large proportion of "small round blue cell tumors," which encompass a broad differential diagnosis and can be difficult to distinguish on cytomorphologic grounds alone. Numerous pathogenetic insights and advances in ancillary testing in soft tissue pathology over the last several decades have made accurate classification of soft tissue neoplasms increasingly feasible. Immunohistochemistry and genetic/molecular testing can now be performed on all cytologic preparations, including unstained smears, needle rinses, cell blocks, and liquid-based preparations, and this has greatly increased our diagnostic abilities. Nevertheless, there remain numerous diagnostic challenges, including variable sensitivity and specificity of available immunohistochemical markers, overlapping immunophenotypes between entities, and "promiscuity" of genetic alterations such as EWSR1 rearrangements, present in a multitude of tumor types. Herein we provide a review on the cytologic, immunohistochemical, and genetic features of the more frequently encountered round cell sarcomas, as well as recently described entities, with an emphasis on diagnostic pitfalls and judicious use of ancillary studies.
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Affiliation(s)
- Kristine S Wong
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Vickie Y Jo
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
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32
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Criteria for Risk Stratification of Vulvar and Vaginal Smooth Muscle Tumors: An Evaluation of 71 Cases Comparing Proposed Classification Systems. Am J Surg Pathol 2017; 42:84-94. [PMID: 28786880 DOI: 10.1097/pas.0000000000000920] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Accurate risk stratification of smooth muscle tumors (SMTs) is essential for appropriate patient management. Yet, the rarity of SMTs of the vagina and vulva makes development of a prognostically meaningful classification system challenging. While 2 classification methods for vulvar SMTs and 1 for vaginal SMTs have been proposed, it is our experience that many pathologists tend to apply criteria for uterine SMTs when evaluating vulvovaginal tumors. We retrospectively reviewed a large cohort of vulvovaginal SMTs with clinical follow-up and evaluated which method most accurately classified tumors according to patient outcome. A total of 71 tumors, 53 vaginal (75%) and 18 vulvar (25%), from 71 patients were identified. All tumors were centrally examined for degree of cytologic atypia, morphology (spindled, epithelioid, myxoid), mitotic index per 10 high power fields, atypical mitotic figures, tumor cell necrosis, ischemic necrosis, tumor interface (circumscribed or infiltrative) and margin status. Clinical features were recorded for each patient. Follow-up was available for 63 patients (89%), and ranged from 1 to 234 months (median: 64 mo). While site-specific and uterine criteria showed equally excellent sensitivity in classifying smooth muscle neoplasms as leiomyosarcoma according to patient outcome, uterine criteria showed improved specificity relatively to site-specific methods in classifying tumors as nonsarcoma according to patient outcome. We recommend that uterine SMT criteria and nomenclature be adopted for evaluation and classification of vulvovaginal SMTs.
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Primary Esophageal Melanoma with Aberrant CD56 Expression: A Potential Diagnostic Pitfall. Case Rep Pathol 2017; 2017:9052637. [PMID: 29230340 PMCID: PMC5694584 DOI: 10.1155/2017/9052637] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/07/2017] [Accepted: 10/17/2017] [Indexed: 12/23/2022] Open
Abstract
Primary esophageal malignant melanoma (MM) is rare and extremely aggressive. For pathologists, it can be challenging to diagnose and differentiate from other poorly differentiated malignant neoplasms in the esophagus. Complicating this fact, MM can have divergent differentiation and express nonmelanocytic immunohistochemical markers including epithelial markers (cytokeratins) and rarely neuroendocrine markers. Lack of awareness of this fact by a pathologist can lead to an erroneous diagnosis and delay treatment for an already aggressive disease. Herein, we report a case of primary esophageal malignant melanoma with aberrant CD56 expression without accompanying synaptophysin or chromogranin expression.
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Composite hemangioendothelioma with neuroendocrine marker expression: an aggressive variant. Mod Pathol 2017; 30:1589-1602. [PMID: 28731049 DOI: 10.1038/modpathol.2017.83] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/16/2017] [Accepted: 05/20/2017] [Indexed: 11/08/2022]
Abstract
Aberrant expression of neuroendocrine markers is extremely rare in endothelial neoplasms, with only a single report describing three cases. Although originally classified as conventional angiosarcoma, further assessment of these tumors revealed a strikingly composite morphology composed of retiform and epithelioid elements reminiscent of composite hemangioendothelioma, a rare subtype of hemangioendothelioma. To further investigate these findings, available materials from 11 morphologically distinctive endothelial tumors showing neuroendocrine marker expression were retrieved from our archives. Immunohistochemistry for CD31, CD34, FLI-1, synaptophysin, chromogranin, D2-40, ERG, keratin (OSCAR), and CAMTA1 was performed. Total RNA from five cases were extracted and subjected to whole transcriptome sequencing. Clinical follow-up was obtained. These tumors were found to arise in five males and six females in patients from 9 to 55 years in age (median 47 years). They arose both in superficial (wrist, ankle, scalp, hip, and foot) and deep (periaortic tissues, C5 vertebra, pulmonary vein, and liver) locations. All contained elongated, retiform vascular channels lined by hyperchromatic 'hobnail' endothelial cells and a solid growth of uniform epithelioid cells reminiscent of epithelioid hemangioendothelioma. Hemangioma-like foci also lined by hobnail endothelial cells were frequently present. Mitotic activity was typically <1/10 HPF, and necrosis or areas of conventional angiosarcoma was absent. The results of immunohistochemistry were: CD31 (10/10), FLI-1 (10/10), ERG (9/9), CD34 (5/10), D2-40 (7/10), synaptophysin (11/11), chromogranin A (1/11), CD56 (5/11), keratin (0/11), and CAMTA1 (0/6). Sequencing analysis showed one case with PTBP1-MAML2 and one case with EPC1-PHC2 fusion transcripts; fusion transcripts were not identified in the remaining cases. Follow-up (8 cases) revealed local recurrence in one patient and metastatic spread in four individuals (bone, lung, liver, and brain). One person died of disease. Although the morphological features of these tumors are characteristic of composite hemangioendothelioma, this distinctive subset with neuroendocrine differentiation more often involves deep locations and displays more aggressive behavior than typically described in other cases of composite hemangioendothelioma.
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Hung YP, Lee JP, Bellizzi AM, Hornick JL. PHOX2B reliably distinguishes neuroblastoma among small round blue cell tumours. Histopathology 2017. [DOI: 10.1111/his.13288] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Yin P Hung
- Department of Pathology; Brigham and Women's Hospital and Harvard Medical School; Boston MA USA
| | - John P Lee
- Department of Pathology; University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Andrew M Bellizzi
- Department of Pathology; University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Jason L Hornick
- Department of Pathology; Brigham and Women's Hospital and Harvard Medical School; Boston MA USA
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Røe OD, Wahl SGF. The undifferentiated carcinoma that became a melanoma: Re-biopsy of a cancer of an unknown primary site: a case report. J Med Case Rep 2017; 11:82. [PMID: 28343447 PMCID: PMC5367002 DOI: 10.1186/s13256-017-1238-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 02/07/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Cancer of unknown primary site is still a demanding condition as it is per definition metastatic, with heterogeneous biological behavior, and it is often resistant to therapy. Cancer of unknown primary site accounts for approximately 1 to 5 % of all cancers, but is currently among the top six causes of cancer deaths in Western countries. To correctly identify the biological origin of the tumor, a large spectrum of differential diagnoses must be considered and scrutinized. At progression, re-biopsy might be necessary to reveal the true origin of the tumor or actionable targets. CASE PRESENTATION A 62-year-old Norwegian woman, with a fast growing lump in her left groin, was primarily diagnosed as having undifferentiated carcinoma that was BRAF V600 positive. There was complete response with paclitaxel-carboplatin and she was recurrence-free for 18 months. She had recurrence in both lungs and subcutaneously in her left groin and thigh; a re-biopsy revealed transformation to a malignant melanoma. She was resistant to BRAF inhibitors, then treated with ipilimumab and is currently a long-term survivor of 4 years and 4 months since the first diagnosis, with no clinical or radiological evidence of recurrence. CONCLUSIONS A biopsy from patients with metastasis of unknown primary should be analyzed thoroughly to identify organ of origin, molecular make-up, and possible molecular targets. Re-biopsy of cancer of unknown primary site at progression can reveal the true cellular origin of the tumor as well as provide novel therapeutic opportunities, including immunotherapy.
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Affiliation(s)
- Oluf Dimitri Røe
- Cancer Clinic, Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Kirkegata 2, N-7600 Levanger, Norway
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Prinsesse Kristinsgt. 1, N-7491 Trondheim, Norway
- Clinical Cancer Research Center, Department of Clinical Medicine, Aalborg University Hospital, Hobrovej 18-22, DK-9100 Aalborg, Denmark
| | - Sissel Gyrid Freim Wahl
- Department of Pathology and Medical Genetics, St. Olavs Hospital, Erling Skjalgssons gt. 1, N-7491 Trondheim, Norway
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Use of New Techniques in Addition to IHC Applied to the Diagnosis of Melanocytic Lesions, With Emphasis on CGH, FISH, and Mass Spectrometry. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:17-30. [DOI: 10.1016/j.ad.2016.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/03/2016] [Accepted: 05/09/2016] [Indexed: 02/08/2023] Open
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Nagarajan P, Tetzlaff M, Curry J, Prieto V. Use of New Techniques in Addition to IHC Applied to the Diagnosis of Melanocytic Lesions, With Emphasis on CGH, FISH, and Mass Spectrometry. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2016.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Truchan HK, Cockburn CL, May LJ, VieBrock L, Carlyon JA. Anaplasma phagocytophilum-Occupied Vacuole Interactions with the Host Cell Cytoskeleton. Vet Sci 2016; 3:vetsci3030025. [PMID: 29056733 PMCID: PMC5606578 DOI: 10.3390/vetsci3030025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 09/08/2016] [Accepted: 09/13/2016] [Indexed: 01/09/2023] Open
Abstract
Anaplasma phagocytophilum is an obligate intracellular bacterial pathogen of humans and animals. The A. phagocytophium-occupied vacuole (ApV) is a critical host-pathogen interface. Here, we report that the intermediate filaments, keratin and vimentin, assemble on the ApV early and remain associated with the ApV throughout infection. Microtubules localize to the ApV to a lesser extent. Vimentin, keratin-8, and keratin-18 but not tubulin expression is upregulated in A. phagocytophilum infected cells. SUMO-2/3 but not SUMO-1 colocalizes with vimentin filaments that surround ApVs. PolySUMOylation of vimentin by SUMO-2/3 but not SUMO-1 decreases vimentin solubility. Consistent with this, more vimentin exists in an insoluble state in A. phagocytophilum infected cells than in uninfected cells. Knocking down the SUMO-conjugating enzyme, Ubc9, abrogates vimentin assembly at the ApV but has no effect on the bacterial load. Bacterial protein synthesis is dispensable for maintaining vimentin and SUMO-2/3 at the ApV. Withaferin A, which inhibits soluble vimentin, reduces vimentin recruitment to the ApV, optimal ApV formation, and the bacterial load when administered prior to infection but is ineffective once vimentin has assembled on the ApV. Thus, A. phagocytophilum modulates cytoskeletal component expression and co-opts polySUMOylated vimentin to aid construction of its vacuolar niche and promote optimal survival.
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Affiliation(s)
- Hilary K Truchan
- Department of Microbiology and Immunology, School of Medicine, Virginia Commonwealth University Medical Center, Richmond, VA 23298, USA.
| | - Chelsea L Cockburn
- Department of Microbiology and Immunology, School of Medicine, Virginia Commonwealth University Medical Center, Richmond, VA 23298, USA.
| | - Levi J May
- Department of Microbiology and Immunology, School of Medicine, Virginia Commonwealth University Medical Center, Richmond, VA 23298, USA.
| | - Lauren VieBrock
- Department of Microbiology and Immunology, School of Medicine, Virginia Commonwealth University Medical Center, Richmond, VA 23298, USA.
| | - Jason A Carlyon
- Department of Microbiology and Immunology, School of Medicine, Virginia Commonwealth University Medical Center, Richmond, VA 23298, USA.
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Antonov NK, Niedt GW. Malignant Melanoma With Rhabdomyosarcomatous Differentiation: A Case Report. Am J Dermatopathol 2016; 38:456-60. [PMID: 27205908 DOI: 10.1097/dad.0000000000000478] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Malignant melanoma may exhibit morphologic characteristics of nonmelanocytic cell or tissue components, a phenomenon termed divergent differentiation. Melanoma with rhabdomyosarcomatous differentiation is rare, with 6 definite cases in adults reported in the literature. The authors describe a 75-year-old man with a cutaneous lesion of the right ear initially diagnosed as malignant melanoma. Three months later, biopsy of a right cervical lymph node showed changes suggestive of rhabdomyosarcoma. Reexamination of the initial skin biopsy with muscle markers confirmed a diagnosis of malignant melanoma with rhabdomyosarcomatous differentiation. This case serves to highlight the diagnostic challenges associated with this rare subtype of melanoma.
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Affiliation(s)
- Nina K Antonov
- *Department of Dermatology, Columbia University Medical Center, New York, NY; and †Department of Dermatology, Division of Dermatopathology, Columbia University Medical Center, New York, NY
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Abstract
The sinonasal cavities host a wide variety of undifferentiated malignancies with round cell morphology, including neoplasms of epithelial, mesenchymal, neuroectodermal, and hematolymphoid lineage. The differential diagnosis may be difficult, especially in small biopsy material, due to overlapping morphology, but their correct classification is clinically relevant. The aim of this review is to provide practical guidelines for the differential diagnosis of these malignancies, with emphasis on recently described entities and special reference to the role of ancillary techniques.
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