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Bofan L, Xiaofei X, Jingwen Z, Zuzhuo Z, Tianxiao M, Feng G, Guochuan Z, Zhou Z. Neurosarcomatous amelanotic transformation of malignant melanoma presenting as malignant periopheral nerve sheath tumor: Rare case report. Medicine (Baltimore) 2023; 102:e34034. [PMID: 37352079 PMCID: PMC10289641 DOI: 10.1097/md.0000000000034034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/25/2023] Open
Abstract
RATIONALE Malignant melanoma (MM) is notorious for its remarkable morphological variation and aberrant histopathological patterns. In addition, Malignant Periopheral Nerve Sheath Tumor (MPNST) is an uncommon but aggressive soft tissue sarcoma. Because of the common embryological origin of melanocytes and Schwann cells in the neural crest, discriminating between a particular type of MM and MPNST can be difficult, particularly when they are amelanotic. Our goal is to increase awareness among clinicians of the rare variations of MM and the importance of medical history in improving the accuracy of the final clinical diagnosis. PATIENT CONCERNS A 68-year-old man was admitted to the hospital due to pain in his right ankle, which had persisted for 8 months, along with swelling for 4 months. Medical history revealed delayed healing of right plantar for 5 years after a traumatic injury. DIAGNOSES The ankle mass was initially diagnosed as MPNST through biopsy. After reviewing the patient's medical history and receiving the final pathological report following amputation, we have revised the diagnosis to metastatic amelanotic desmoplastic melanoma in the ankle part and lentigo maligna melanoma in the plantar part. This is due to both lesions displaying positive markers or mutated genes in immunohistology and Gene Mutation Detection, indicating homology between the 2 tumors. INTERVENTIONS Due to the malignant characteristics of the tumor and the patient's wishes, amputation of the right lower leg was carried out. OUTCOMES Subsequently, the patient was treated with interferon-γ and immunosuppressant PD-1 inhibitor, and survived for 1 year after amputation. LESSONS Clinical data, immunohistochemisty biomarkers and genes detection results can serve as valuable evidence for pathologists and clinicians in identifying the disease process. Collaborative efforts between clinicians and scientists are crucial in order to identify specific markers that can effectively differentiate between the 2 tumors, thereby enhancing the conclusiveness of the diagnosis.
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Affiliation(s)
- Lu Bofan
- Clinical medicine of Basic Medical College, HeBei Medical university, Shijiazhuang, Hebei, P. R. China
| | - Xiu Xiaofei
- Department of Pathology, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Zhang Jingwen
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhang Zuzhuo
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ma Tianxiao
- Department of Orthopedic Oncology, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Gao Feng
- Department of Pathology, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Zhang Guochuan
- Department of Orthopedic Oncology, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhuang Zhou
- Department of Orthopedic Oncology, Third Hospital of Hebei Medical University, Shijiazhuang, China
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Peripheral Palisading in Melanoma Mimicking Basal Cell Carcinoma: A Case Report. Am J Dermatopathol 2021; 42:677-679. [PMID: 32195676 DOI: 10.1097/dad.0000000000001636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The incidence of melanoma has been increasing over the past few decades. Because of its phenotypic diversity, melanoma may present in various clinical and histopathological manifestations, and it can mimic varieties of skin lesions from benign to malignant and from epithelial to nonepithelial. Accurate diagnosis of melanoma is crucial because delayed treatment leads to worse prognoses. Here, we describe a case of melanoma in an 82-year-old man with an unusual histopathologic presentation, namely, the presence of neoplastic aggregates with a palisaded periphery resembling basal cell carcinoma.
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Abstract
PURPOSE OF REVIEW Although tumors with nerve sheath differentiation are vast, the main clinically significant problems faced by the pathologist are the separation of malignant peripheral nerve sheath tumors (MPNSTs) from histologic mimics, the diagnosis of neurofibromatous neoplasms with atypical features, and the separation of cutaneous neurofibromatous neoplasms from melanoma. This review briefly discusses a variety of common nerve sheath tumors and summarizes recent advances on these diagnostic fronts. RECENT FINDINGS Much of recent work has focused on abnormalities in polycomb repressive complex 2, and the ways in which these abnormalities may be exploited in the diagnosis of MPNSTs. Progress has been made in the diagnostic and clinical understanding of atypical neurofibromatous neoplasms and low-grade MPNSTs. A number of reports have explored the diagnostic distinction between cutaneous neurofibroma and melanoma. SUMMARY New discoveries show promise in the diagnosis of peripheral nerve sheath tumors, but challenges - old and new - remain.
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Biglow LR, Cuda J, Dotson J. A Rare Case of Epithelioid Malignant Peripheral Nerve Sheath Tumor Mimicking Malignant Melanoma. Cureus 2021; 13:e13424. [PMID: 33763318 PMCID: PMC7980783 DOI: 10.7759/cureus.13424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Malignant peripheral nerve sheath tumors are rare soft tissue sarcomas that are often associated with neurofibromatosis type-1. These tumors share common immunohistochemistry findings which can make diagnosis difficult. We present the case of a woman who presented with a diagnosis of metastatic melanoma of the index finger of her left hand but was eventually diagnosed with primary epithelioid malignant peripheral nerve sheath tumor. We will be highlighting the diagnostic challenge of differentiating between these two very different malignancies.
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Affiliation(s)
- Layana R Biglow
- Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Jonathan Cuda
- Pathology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Jennifer Dotson
- Oncology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
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Prendergast SC, Strobl A, Cross W, Pillay N, Strauss SJ, Ye H, Lindsay D, Tirabosco R, Chalker J, Mahamdallie SS, Sosinsky A, Flanagan AM, Amary F. Sarcoma and the 100,000 Genomes Project: our experience and changes to practice. J Pathol Clin Res 2020; 6:297-307. [PMID: 32573957 PMCID: PMC7578291 DOI: 10.1002/cjp2.174] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 11/06/2022]
Abstract
The largest whole genome sequencing (WGS) endeavour involving cancer and rare diseases was initiated in the UK in 2015 and ran for 5 years. Despite its rarity, sarcoma ranked third overall among the number of patients' samples sent for sequencing. Herein, we recount the lessons learned by a specialist sarcoma centre that recruited close to 1000 patients to the project, so that we and others may learn from our experience. WGS data was generated from 597 patients, but samples from the remaining approximately 400 patients were not sequenced. This was largely accounted for by unsuitability due to extensive necrosis, secondary to neoadjuvant radiotherapy or chemotherapy, or being placed in formalin. The number of informative genomes produced was reduced further by a PCR amplification step. We showed that this loss of genomic data could be mitigated by sequencing whole genomes from needle core biopsies. Storage of resection specimens at 4 °C for up to 96 h overcame the challenge of freezing tissue out of hours including weekends. Removing access to formalin increased compliance to these storage arrangements. With over 70 different sarcoma subtypes described, WGS was a useful tool for refining diagnoses and identifying novel alterations. Genomes from 350 of the cohort of 597 patients were analysed in this study. Overall, diagnoses were modified for 3% of patients following review of the WGS findings. Continued refinement of the variant-calling bioinformatic pipelines is required as not all alterations were identified when validated against histology and standard of care diagnostic tests. Further research is necessary to evaluate the impact of germline mutations in patients with sarcoma, and sarcomas with evidence of hypermutation. Despite 50% of the WGS exhibiting domain 1 alterations, the number of patients with sarcoma who were eligible for clinical trials remains small, highlighting the need to revaluate clinical trial design.
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Affiliation(s)
- Sophie C Prendergast
- Research Department of PathologyUniversity College London Cancer InstituteLondonUK
| | - Anna‐Christina Strobl
- Research Department of PathologyUniversity College London Cancer InstituteLondonUK
- Department of HistopathologyRoyal National Orthopaedic Hospital NHS TrustStanmoreUK
| | - William Cross
- Research Department of PathologyUniversity College London Cancer InstituteLondonUK
| | - Nischalan Pillay
- Research Department of PathologyUniversity College London Cancer InstituteLondonUK
- Department of HistopathologyRoyal National Orthopaedic Hospital NHS TrustStanmoreUK
| | - Sandra J Strauss
- Research Department of PathologyUniversity College London Cancer InstituteLondonUK
- Department of OncologyUniversity College London Hospital NHS Foundation TrustLondonUK
| | - Hongtao Ye
- Department of HistopathologyRoyal National Orthopaedic Hospital NHS TrustStanmoreUK
| | - Daniel Lindsay
- Department of HistopathologyRoyal National Orthopaedic Hospital NHS TrustStanmoreUK
| | - Roberto Tirabosco
- Department of HistopathologyRoyal National Orthopaedic Hospital NHS TrustStanmoreUK
| | - Jane Chalker
- SHIMDS Acquired GenomicsGreat Ormond Street Hospital for Children NHS TrustLondonUK
| | - Shazia S Mahamdallie
- Rare and Inherited Disease LaboratoryGreat Ormond Street Hospital for Children NHS TrustLondonUK
| | | | | | | | - Adrienne M Flanagan
- Research Department of PathologyUniversity College London Cancer InstituteLondonUK
- Department of HistopathologyRoyal National Orthopaedic Hospital NHS TrustStanmoreUK
| | - Fernanda Amary
- Research Department of PathologyUniversity College London Cancer InstituteLondonUK
- Department of HistopathologyRoyal National Orthopaedic Hospital NHS TrustStanmoreUK
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Correlative study of epigenetic regulation of tumor microenvironment in spindle cell melanomas and cutaneous malignant peripheral nerve sheath tumors. Sci Rep 2020; 10:12996. [PMID: 32747660 PMCID: PMC7398924 DOI: 10.1038/s41598-020-69787-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/10/2020] [Indexed: 12/15/2022] Open
Abstract
The tumor microenvironment (TME) plays critical roles in tumor growth and progression, however key regulators of gene expression in the TME of cutaneous malignant peripheral nerve sheath tumor (C-MPNST) and spindle cell melanoma (SCM) have not been well elucidated. Herein, we investigate the epigenetic regulation of promoters and gene bodies and their effect on the TME composition of C-MPNSTs and SCMs. A cohort of 30 patients was analyzed using differential gene expression (DGE) and gene set enrichment analysis (GSEA) using the Nanostring platform. Methylation analysis was carried out utilizing an Infinium Methylation EPIC array targeting 866,562 methylation site (CpG) islands. DGE revealed overexpression of genes related to mast cells in the TME of SCMs, and a predominance of exhausted CD8+ T cells and macrophages in the TME of C-MPNSTs. Interestingly, we further observed promoter hypermethylation in key overexpressed genes and corresponding gene body hypomethylation. Analysis using ENCODE ChIP-sequencing data identified CTCF as the common transcription factor at the site of the hypomethylated probe. These findings support that the TME composition of C-MPNSTs and SCMs is at least partially independent on promoter methylation status, suggesting a possible relationship between gene body enhancers and expression of key TME genes in both entities.
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Elder DE, Bastian BC, Cree IA, Massi D, Scolyer RA. The 2018 World Health Organization Classification of Cutaneous, Mucosal, and Uveal Melanoma: Detailed Analysis of 9 Distinct Subtypes Defined by Their Evolutionary Pathway. Arch Pathol Lab Med 2020; 144:500-522. [PMID: 32057276 DOI: 10.5858/arpa.2019-0561-ra] [Citation(s) in RCA: 224] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— There have been major advances in the understanding of melanoma since the last revision of the World Health Organization (WHO) classification in 2006. OBJECTIVE.— To discuss development of the 9 distinct types of melanoma and distinguishing them by their epidemiology, clinical and histologic morphology, and genomic characteristics. Each melanoma subtype is placed at the end of an evolutionary pathway that is rooted in its respective precursor, wherever appropriate and feasible, based on currently known data. Each precursor has a variable risk of progression culminating in its fully evolved, invasive melanoma. DATA SOURCES.— This review is based on the "Melanocytic Tumours" section of the 4th edition of the WHO Classification of Skin Tumours, published in 2018. CONCLUSIONS.— Melanomas were divided into those etiologically related to sun exposure and those that are not, as determined by their mutational signatures, anatomic site, and epidemiology. Melanomas on the sun-exposed skin were further divided by the histopathologic degree of cumulative solar damage (CSD) of the surrounding skin, into low and high CSD, on the basis of degree of associated solar elastosis. Low-CSD melanomas include superficial spreading melanomas and high-CSD melanomas incorporate lentigo maligna and desmoplastic melanomas. The "nonsolar" category includes acral melanomas, some melanomas in congenital nevi, melanomas in blue nevi, Spitz melanomas, mucosal melanomas, and uveal melanomas. The general term melanocytoma is proposed to encompass "intermediate" tumors that have an increased (though still low) probability of disease progression to melanoma.
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Affiliation(s)
- David E Elder
- From the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia (Dr Elder); the Department of Dermatology, University of California San Francisco, San Francisco (Dr Bastian); International Agency for Research on Cancer, Lyon, France (Dr Cree); Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy (Dr Massi); and the Department of Pathology and Melanoma Institute Australia, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (Dr Scolyer)
| | - Boris C Bastian
- From the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia (Dr Elder); the Department of Dermatology, University of California San Francisco, San Francisco (Dr Bastian); International Agency for Research on Cancer, Lyon, France (Dr Cree); Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy (Dr Massi); and the Department of Pathology and Melanoma Institute Australia, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (Dr Scolyer)
| | - Ian A Cree
- From the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia (Dr Elder); the Department of Dermatology, University of California San Francisco, San Francisco (Dr Bastian); International Agency for Research on Cancer, Lyon, France (Dr Cree); Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy (Dr Massi); and the Department of Pathology and Melanoma Institute Australia, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (Dr Scolyer)
| | - Daniela Massi
- From the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia (Dr Elder); the Department of Dermatology, University of California San Francisco, San Francisco (Dr Bastian); International Agency for Research on Cancer, Lyon, France (Dr Cree); Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy (Dr Massi); and the Department of Pathology and Melanoma Institute Australia, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (Dr Scolyer)
| | - Richard A Scolyer
- From the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia (Dr Elder); the Department of Dermatology, University of California San Francisco, San Francisco (Dr Bastian); International Agency for Research on Cancer, Lyon, France (Dr Cree); Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy (Dr Massi); and the Department of Pathology and Melanoma Institute Australia, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (Dr Scolyer)
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Cubas Farinha N, Belo D, Freitas H, Coiteiro D. Giant Malignant Peripheral Nerve Sheath Tumor of the Scalp: Case Report and Review of the Literature. World Neurosurg 2020; 138:246-252. [PMID: 32179188 DOI: 10.1016/j.wneu.2020.03.039] [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: 02/07/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Malignant peripheral nerve sheath tumors (MPNSTs) are rare nervous system tumors that rarely appear on the scalp. About half of the scalp MPNSTs described in the literature have reached giant dimensions at the time of diagnosis. The surgical treatment is the gold standard for this type of tumor. Some authors suggest adjuvant radiotherapy for local tumor control, although there is uncertainty about its advantages and its use is not without risks. CASE DESCRIPTION We present the case of a 31-year-old man who presented with a large necrotic scalp tumor of the left frontoparietal convexity. magnetic resonance imaging showed a large extra-axial tumor, measuring 17 x 17 x 8 cm, centered on the soft tissues, with skull erosion and signs of dural invasion, although with no intradural component. The tumor was surgically removed and the osteocutaneous defect was reconstructed with a latissimus dorsi muscle free flap. The anatomopathologic diagnosis was MPNST. The patient then underwent adjuvant radiotherapy. After 7 months he developed a progressive right hemiparesis and magnetic resonance imaging showed results compatible with cerebral radiation necrosis. This motor deficit improved with corticotherapy. After 9 months the patient went back to his home country and was subsequently lost to follow-up. CONCLUSIONS Giant MPNSTs of the scalp are highly aggressive lesions that should primarily be treated in a surgical fashion. Although adjuvant radiotherapy has been used routinely for local tumor control, there is uncertainty about its advantages.
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Affiliation(s)
- Nuno Cubas Farinha
- Department of Neurosurgery, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal.
| | - Diogo Belo
- Department of Neurosurgery, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
| | - Hugo Freitas
- Department of Plastic and Reconstructive Surgery, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
| | - Domingos Coiteiro
- Department of Neurosurgery, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
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Shi P, Xu Z, Lei X, Yibulayin F, Wushou A. Desmoplastic melanoma: Demographic and clinicopathological features and disease-specific prognostic factors. Oncol Lett 2019; 17:5619-5627. [PMID: 31186784 PMCID: PMC6507310 DOI: 10.3892/ol.2019.10259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 03/14/2019] [Indexed: 01/19/2023] Open
Abstract
Desmoplastic melanoma (DM) is a rare morphological subtype of melanoma that remains uncharacterized. The aim of the present study was to investigate the incidence of DM, its general demographics, clinicopathological features and disease-specific prognostic factors. DM cases were sampled from the Surveillance, Epidemiology and End Results (SEER) program from between 1973 and 2017. A total of 3,657 cases (median age, 68 years) were identified. The results indicated that DM primarily occurred in Caucasian subjects, with a male-to-female ratio of 2:1. Statistically significant overall survival (OS) and disease-specific survival (DSS) rate differences were identified according to sex, age, treatment, T stage, N stage and SEER historic tumor stage (P<0.05). In multivariate Cox regression analysis, age >68 years, male sex, American Joint Committee on Cancer (AJCC) stage II and III, and SEER historic tumor stage of the regional tumor were all factors associated with poorer OS and DSS rates. The findings also revealed that surgical treatment was associated with favorable DSS and OS rates. In conclusion, DM occurred primarily in Caucasian subjects of 60–80 years of age, with predominance in males. Furthermore, age, sex, AJCC stage, SEER historic tumor stage and surgical treatment were identified as independent prognostic factors of DM in terms of DSS and OS.
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Affiliation(s)
- Ping Shi
- Department of Stomatology, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong 518110, P.R. China
| | - Zhe Xu
- Department of Stomatology, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong 518110, P.R. China
| | - Xin Lei
- Department of Stomatology, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong 518110, P.R. China
| | - Feiluore Yibulayin
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai 200001, P.R. China
| | - Alimujiang Wushou
- Department of Oral and Maxillofacial Surgery, Shanghai Stomatological Hospital, Fudan University, Shanghai 200001, P.R. China
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Melanoma Mimicking Malignant Peripheral Nerve Sheath Tumor with Spread to the Cerebellopontine Angle: Utility of Next-Generation Sequencing in Diagnosis. Case Rep Pathol 2018; 2018:9410465. [PMID: 30050716 PMCID: PMC6046181 DOI: 10.1155/2018/9410465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 05/28/2018] [Accepted: 06/07/2018] [Indexed: 01/02/2023] Open
Abstract
Cutaneous spindle cell malignancy is associated with a broad differential diagnosis, particularly in the absence of a known primary melanocytic lesion. We present an unusually challenging patient who presented with clinical symptoms involving cranial nerves VII and VIII and a parotid-region mass, which was S100-positive while lacking in melanocytic pigment and markers. Over a year after resection of the parotid mass, both a cutaneous primary lentigo maligna melanoma and a metastatic CP angle melanoma were diagnosed in the same patient, prompting reconsideration of the diagnosis in the original parotid-region mass. Next-generation sequencing of a panel of cancer-associated genes demonstrated 19 identical, clinically significant mutations as well as a high tumor mutation burden in both the parotid-region and CP angle tumors, indicating a metastatic relationship between the two and a melanocytic identity of the parotid-region tumor.
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