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Erdem ZB, Ameline B, Bovée JVMG, van Boven H, Baumhoer D, Chrisinger JSA, Fritchie KJ. The utility of DNA methylation profiling in the diagnosis of un-, de- and trans-differentiated melanoma: a series of 11 cases. Histopathology 2024. [PMID: 39223066 DOI: 10.1111/his.15309] [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: 06/14/2024] [Revised: 08/11/2024] [Accepted: 08/12/2024] [Indexed: 09/04/2024]
Abstract
AIMS Melanomas are recognised for their remarkable morphological plasticity. Some tumours may lose conventional features and/or acquire non-melanocytic characteristics, referred to as undifferentiated, dedifferentiated and transdifferentiated melanoma. Despite this phenotypical variability, melanomas typically maintain their cancer driver aberrations, affecting genes such as BRAF, NRAS and NF1. Currently, little is known about whether the DNA methylation profile follows the loss or change of differentiation or is retained despite extensive morphological transformation. METHODS AND RESULTS In this study we analysed 11 melanoma cases, comprising six males and five females, with a median age of 67 years, including five undifferentiated, four trans-differentiated and two de-differentiated melanomas. Undifferentiated and trans-differentiated tumours either arose in a patient with known melanoma and/or presented in the groin/axilla with molecular alterations consistent with melanoma. Cases with heterologous differentiation resembled chondrosarcoma, osteosarcoma, angiosarcoma and rhabdomyosarcoma both morphologically and immunohistochemically, while undifferentiated tumours resembled undifferentiated pleomorphic sarcoma. Methylome profiling was performed, and unsupervised clustering analysis revealed nine cases (five undifferentiated, three trans-differentiated and one de-differentiated) to cluster closely together with conventional melanomas from a reference set. Two cases clustered separately with a distinct group of conventional melanomas exhibiting H3K27me3 loss. CONCLUSIONS Despite loss of differentiation and phenotypical plasticity, methylation patterns seem to be retained in undifferentiated, de-differentiated and trans-differentiated melanomas and represent useful diagnostic tools to enhance diagnostic precision in these diagnostically challenging cases.
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Affiliation(s)
- Zeynep Betul Erdem
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Baptiste Ameline
- Bone Tumor Reference Center at the Institute of Pathology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hester van Boven
- Department of Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Daniel Baumhoer
- Bone Tumor Reference Center at the Institute of Pathology, University Hospital Basel and University of Basel, Basel, Switzerland
- Basel Research Centre for Child Health, Basel, Switzerland
| | - John S A Chrisinger
- Department of Pathology and Immunology, Division of Anatomic and Molecular Pathology, Washington University School of Medicine, St Louis, MO, USA
| | - Karen J Fritchie
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
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2
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Dumitru AV, Țăpoi DA, Costache M, Ciongariu AM, Ionescu AI, Liscu HD, Alius C, Tampa M, Marin A, Furtunescu AR. Metastatic Nodular Melanoma with Angiosarcomatous Transdifferentiation-A Case Report and Review of the Literature. Diagnostics (Basel) 2024; 14:1323. [PMID: 39001214 PMCID: PMC11240390 DOI: 10.3390/diagnostics14131323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024] Open
Abstract
Diagnosing cutaneous melanomas relies mainly on histopathological analysis, which, in selected cases, can be aided by immunohistochemical evaluation of conventional melanocytic markers. Nevertheless, these malignancies, particularly in metastatic settings, may display divergent differentiation with unusual histological and immunohistochemical features. In this context, we present the case of a 65-year-old male diagnosed with typical superficial spreading melanoma who developed recurrence and metastatic lesions featuring angiosarcomatous differentiation. The diagnosis of the initial tumour and the subsequently dedifferentiated lesions was confirmed by ample immunohistochemical analysis, which included several melanocytic markers, as well as mesenchymal and vascular markers. The recurrent tumour and lymph nodes metastases were completely negative for Melan-A and PRAME, and focally positive for SOX10. Additionally, they also displayed diffuse, intense positivity for CD10 and WT1 and focal positivity for CD99, ERB, and CD31. Thus, the diagnosis of primary cutaneous melanoma with recurrent and metastatic divergent angiosarcomatous differentiation was established. This occurrence is particularly rare and can pose important diagnostic challenges. Therefore, in addition to presenting this highly unusual case, we also performed a comprehensive review of the literature on divergent differentiation in melanomas.
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Affiliation(s)
- Adrian Vasile Dumitru
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.V.D.); (M.C.); (A.M.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Dana Antonia Țăpoi
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.V.D.); (M.C.); (A.M.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Mariana Costache
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.V.D.); (M.C.); (A.M.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Ana Maria Ciongariu
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.V.D.); (M.C.); (A.M.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Andreea Iuliana Ionescu
- Department of Oncological Radiotherapy and Medical Imaging, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.I.I.); (H.D.L.)
- Department of Medical Oncology, Colțea Clinical Hospital, 030167 Bucharest, Romania
| | - Horia Dan Liscu
- Department of Oncological Radiotherapy and Medical Imaging, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.I.I.); (H.D.L.)
- Department of Radiotherapy, Colțea Clinical Hospital, 030167 Bucharest, Romania
| | - Catalin Alius
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania;
- Fourth Department of General Surgery, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Mircea Tampa
- Department of Dermatology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.T.); (A.R.F.)
- Department of Dermatology, “Victor Babes” Clinical Hospital for Infectious Diseases, 030303 Bucharest, Romania
| | - Andrei Marin
- Department of Plastic Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Andreea Roxana Furtunescu
- Department of Dermatology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.T.); (A.R.F.)
- Department of Dermatology, “Victor Babes” Clinical Hospital for Infectious Diseases, 030303 Bucharest, Romania
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3
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Watter H, Milkins R, Chambers C, O'Brien B. Melanoma with rhabdomyosarcomatous features: a potential diagnostic pitfall. BMJ Case Rep 2023; 16:e256427. [PMID: 37879714 PMCID: PMC10603449 DOI: 10.1136/bcr-2023-256427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
Malignant melanoma is well-known for phenotypic plasticity, and rare cases of divergent differentiation have been described. This case report is of a tumour diagnosed as 'rhabdomyosarcoma' on the face of a man in his 80s. However, given the recent excision of an ulcerated melanoma (Breslow thickness 5.8 mm) from the same site, the more likely diagnosis would be recurrent melanoma with rhabdomyosarcomatous differentiation. This highlights a rare form of divergent differentiation and a potential diagnostic pitfall.
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Affiliation(s)
- Henry Watter
- General Surgery, Queensland Health, Hervey Bay, Queensland, Australia
- General Surgery, Hervey Bay Hospital, Hervey Bay, Queensland, Australia
| | - Russell Milkins
- General Surgery, Hervey Bay Hospital, Hervey Bay, Queensland, Australia
| | - Claire Chambers
- Histopathology, Sullivan Nicolaides Pathology Central Laboratory Bowen Hills, Fortitude Valley, Queensland, Australia
| | - Blake O'Brien
- Histopathology, Sullivan Nicolaides Pathology Central Laboratory Bowen Hills, Fortitude Valley, Queensland, Australia
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4
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Rana HS, Dertinger JE, Clabeaux C, Makepeace N, Lewis J. Metastatic Melanoma to the Orbit With Dedifferentiation: A Case Report. Cureus 2023; 15:e41591. [PMID: 37559849 PMCID: PMC10408357 DOI: 10.7759/cureus.41591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2023] [Indexed: 08/11/2023] Open
Abstract
We present the first documented case of metastatic melanoma to the orbit with dedifferentiation. A patient with a history of melanoma of the lip and other poorly differentiated carcinomas presented with both a sub-brow and an intraorbital mass. Radiographically and intraoperatively, the sub-brow mass communicated with the intraorbital mass via perineural spread along the supraorbital nerve. Histopathology confirmed the diagnosis of melanoma based on the melanocytic markers, SOX-10 and Melan-A; dedifferentiation was demonstrated within the orbital tumor. Two weeks following surgical debulking, the intraorbital mass returned to its full size. Local radiotherapy and immunotherapy were performed, which initially led to a dramatic improvement; however, the patient succumbed to his systemic metastases six months later. Dedifferentiation serves as a prognostic indicator and should be considered in patients when histopathology does not lead to a definitive diagnosis.
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Affiliation(s)
- Harkaran S Rana
- Ophthalmology, Walter Reed National Military Medical Center, Bethesda, USA
| | - Jake E Dertinger
- Ophthalmology, California Health Sciences University College of Osteopathic Medicine, Clovis, USA
| | | | - Nicole Makepeace
- Ophthalmology, Walter Reed National Military Medical Center, Bethesda, USA
| | - Jason Lewis
- Ophthalmology, Walter Reed National Military Medical Center, Bethesda, USA
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5
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O'Neill P, Amanuel B, Mesbah Ardakani N. Cutaneous Malignant Melanoma With Rhabdomyosarcomatous Dedifferentiation: an Immunohistological and Molecular Case Study With Literature Review. Am J Dermatopathol 2023; 45:470-474. [PMID: 37130217 DOI: 10.1097/dad.0000000000002451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
ABSTRACT Cutaneous malignant melanoma can show a wide range of cytomorphological variability, in particular exhibiting a rhabdoid appearance is not uncommon in melanoma cells; however, the phenomenon of "dedifferentiation" with loss of melanocytic immunohistochemical properties and expression of skeletal muscle immunomarkers is exceedingly rare. Owing to the rarity of such melanomas, their clinicopathological features and molecular profile remain largely unknown. In this report, we describe the clinical, immunomorphological, and molecular features of melanomas with rhabdomyosarcomatous dedifferentiation by presenting a new case and exploring the literature for the previously reported cases.
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Affiliation(s)
- Paul O'Neill
- Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia
| | - Benhur Amanuel
- Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia
- School of Pathology and Laboratory Medicine, University of Western Australia, Perth, WA, Australia; and
| | - Nima Mesbah Ardakani
- Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia
- School of Medicine, University of Notre Dame, Fremantle, WA, Australia
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6
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Țăpoi DA, Gheorghișan-Gălățeanu AA, Dumitru AV, Ciongariu AM, Furtunescu AR, Marin A, Costache M. Primary Undifferentiated/Dedifferentiated Cutaneous Melanomas-A Review on Histological, Immunohistochemical, and Molecular Features with Emphasis on Prognosis and Treatment. Int J Mol Sci 2023; 24:9985. [PMID: 37373134 DOI: 10.3390/ijms24129985] [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: 05/29/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Diagnosing cutaneous melanoma is usually straightforward based on these malignancies' histopathological and immunohistochemical features. Nevertheless, melanomas can imitate various other neoplasms, sometimes lacking the expression of conventional melanocytic markers and expressing non-melanocytic ones. Furthermore, divergent differentiation is more often encountered in metastatic melanomas and is still poorly described in primary cutaneous melanomas, and little is known about these patients' prognosis and therapeutic approach. Therefore, we reviewed the literature on undifferentiated/dedifferentiated cutaneous melanomas, and we discuss the histological, immunohistochemical, and molecular profiles of undifferentiated/dedifferentiated cutaneous melanomas to understand these peculiar lesions better and improve their diagnostic algorithm. In addition to this, we also discuss how different genetic mutations may influence prognosis and become potential therapeutic targets.
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Affiliation(s)
- Dana Antonia Țăpoi
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Ancuța-Augustina Gheorghișan-Gălățeanu
- Department of Cellular and Molecular Biology and Histology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- C.I. Parhon National Institute of Endocrinology, 011863 Bucharest, Romania
| | - Adrian Vasile Dumitru
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Ana Maria Ciongariu
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Andreea Roxana Furtunescu
- Doctoral School, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Dermatology, Victor Babes Clinical Hospital, 030303 Bucharest, Romania
| | - Andrei Marin
- Department of Plastic Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mariana Costache
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania
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7
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Saeed F, Osunkoya AO. Secondary Tumors of the Kidney: A Comprehensive Clinicopathologic Analysis. Adv Anat Pathol 2022; 29:241-251. [PMID: 35249993 DOI: 10.1097/pap.0000000000000338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Metastases to the kidney are rare and were historically described in autopsy series, and the incidence ranged between 2.36% and 12.6%. However, in the contemporary literature with the improvements in imaging modalities (computed tomography scan and magnetic resonance imaging) and other health care screening services, metastatic tumors to the kidney are being diagnosed more frequently in surgical specimens. The utility of needle core biopsies in the primary evaluation of renal masses has also increased the number of sampled metastases, and as a result, only limited histologic material is available for evaluation in some cases and may potentially lead to diagnostic pitfalls. In the last decade, a few large clinical series have been published. In these series, the majority of metastatic tumors to the kidney are carcinomas, with the lung being the most common primary site. A significant number of the various tumor types with metastasis to the kidney are also associated with widespread metastases to other organs, and the renal metastasis may present several years after diagnosis of the primary tumor. The majority of secondary tumors of the kidney are asymptomatic, incidentally discovered, and solitary. There should be a high index of suspicion of metastasis to the kidney in patients with an associated enlarging renal lesion with minimal to no enhancement on imaging and tumor progression of a known high-grade nonrenal malignancy. Secondary tumors of the kidney can be accurately diagnosed by correlating histopathologic features with clinical and radiographic findings and the judicious use of ancillary studies.
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Affiliation(s)
| | - Adeboye O Osunkoya
- Departments of Pathology
- Urology, Emory University School of Medicine
- Winship Cancer Institute of Emory University, Atlanta
- Department of Pathology, Veterans Affairs Medical Center, Decatur, GA
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8
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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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9
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Boyraz B, Hung YP. Spindle Cell Tumors of the Pleura and the Peritoneum: Pathologic Diagnosis and Updates. APMIS 2021; 130:140-154. [PMID: 34942046 DOI: 10.1111/apm.13203] [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: 09/06/2021] [Accepted: 09/23/2021] [Indexed: 11/30/2022]
Abstract
A diverse group of both benign and malignant spindle cell tumors can involve the pleura or the peritoneum. Due to their rarity and overlapping morphologic features, these tumors can pose considerable diagnostic difficulty in surgical pathology. As these tumors differ in their prognosis and clinical management, their correct pathologic diagnosis is critical. In addition to histologic assessment, select immunohistochemical and molecular tools can aid the distinction among these tumors. In this review, we consider some of the major histologic differential diagnosis of spindle cell tumors involving these serosal membranes. This list of tumors includes: solitary fibrous tumor, inflammatory myofibroblastic tumor, desmoid fibromatosis, synovial sarcoma, sarcomatoid carcinoma, spindle cell melanoma, dedifferentiated liposarcoma, epithelioid hemangioendothelioma, and sarcomatoid mesothelioma. We describe their salient clinicopathologic and genetic findings, with a review on some of the recent discoveries on their molecular pathogenesis.
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Affiliation(s)
- Baris Boyraz
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Yin P Hung
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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10
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Cazzato G, Lospalluti L, Colagrande A, Cimmino A, Romita P, Foti C, Demarco A, Arezzo F, Loizzi V, Cormio G, Sablone S, Resta L, Rossi R, Ingravallo G. Dedifferentiated Melanoma: A Diagnostic Histological Pitfall-Review of the Literature with Case Presentation. Dermatopathology (Basel) 2021; 8:494-501. [PMID: 34698090 PMCID: PMC8544555 DOI: 10.3390/dermatopathology8040051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/10/2021] [Accepted: 10/12/2021] [Indexed: 02/05/2023] Open
Abstract
Dedifferentiated melanoma is a particular form of malignant melanoma with a progressive worsening of the patient's clinical outcome. It is well known that melanoma can assume different histo-morphological patterns, to which specific genetic signatures correspond, sometimes but not always. In this review we address the diagnostic difficulties in correctly recognizing this entity, discuss the major differential diagnoses of interest to the dermatopathologist, and conduct a review of the literature with particular attention and emphasis on the latest molecular discoveries regarding the dedifferentiation/undifferentiation mechanism and more advanced therapeutic approaches.
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Affiliation(s)
- Gerardo Cazzato
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (A.C.); (L.R.); (R.R.)
- Correspondence: (G.C.); (G.I.)
| | - Lucia Lospalluti
- Section of Dermatology, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (L.L.); (P.R.); (C.F.); (A.D.)
| | - Anna Colagrande
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (A.C.); (L.R.); (R.R.)
| | - Antonietta Cimmino
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (A.C.); (L.R.); (R.R.)
| | - Paolo Romita
- Section of Dermatology, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (L.L.); (P.R.); (C.F.); (A.D.)
| | - Caterina Foti
- Section of Dermatology, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (L.L.); (P.R.); (C.F.); (A.D.)
| | - Aurora Demarco
- Section of Dermatology, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (L.L.); (P.R.); (C.F.); (A.D.)
| | - Francesca Arezzo
- Section of Ginecology and Obstetrics, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.A.); (V.L.); (G.C.)
| | - Vera Loizzi
- Section of Ginecology and Obstetrics, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.A.); (V.L.); (G.C.)
| | - Gennaro Cormio
- Section of Ginecology and Obstetrics, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.A.); (V.L.); (G.C.)
| | - Sara Sablone
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Bari Policlinico Hospital, University of Bari, 70124 Bari, Italy;
| | - Leonardo Resta
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (A.C.); (L.R.); (R.R.)
| | - Roberta Rossi
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (A.C.); (L.R.); (R.R.)
| | - Giuseppe Ingravallo
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (A.C.); (L.R.); (R.R.)
- Correspondence: (G.C.); (G.I.)
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11
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Dedifferentiated and Undifferentiated Melanomas: Report of 35 New Cases With Literature Review and Proposal of Diagnostic Criteria. Am J Surg Pathol 2021; 45:240-254. [PMID: 33428337 DOI: 10.1097/pas.0000000000001645] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Dedifferentiated melanoma (DM) and undifferentiated melanoma (UM) is defined as a primary or metastatic melanoma showing transition between conventional and undifferentiated components (DM) or lacking histologic and immunophenotypic features of melanoma altogether (UM). The latter is impossible to verify as melanoma by conventional diagnostic tools alone. We herein describe our experience with 35 unpublished cases to expand on their morphologic, phenotypic, and genotypic spectrum, along with a review of 50 previously reported cases (total: 85) to establish the diagnostic criteria. By definition, the dedifferentiated/undifferentiated component lacked expression of 5 routinely used melanoma markers (S100, SOX10, Melan-A, HMB45, Pan-melanoma). Initial diagnoses (known in 66 cases) were undifferentiated/unclassified pleomorphic sarcoma (n=30), unclassified epithelioid malignancy (n=7), pleomorphic rhabdomyosarcoma (n=5), other specific sarcoma types (n=6), poorly differentiated carcinoma (n=2), collision tumor (n=2), atypical fibroxanthoma (n=2), and reactive osteochondromatous lesion (n=1). In only 11 cases (16.6%) was a diagnosis of melanoma considered. Three main categories were identified: The largest group (n=56) comprised patients with a history of verified previous melanoma who presented with metastatic DM or UM. Axillary or inguinal lymph nodes, soft tissue, bone, and lung were mainly affected. A melanoma-compatible mutation was detected in 35 of 48 (73%) evaluable cases: BRAF (n=20; 40.8%), and NRAS (n=15; 30.6%). The second group (n=15) had clinicopathologic features similar to group 1, but a melanoma history was lacking. Axillary lymph nodes (n=6) was the major site in this group followed by the lung, soft tissue, and multiple site involvement. For this group, NRAS mutation was much more frequent (n=9; 60%) than BRAF (n=3; 20%) and NF1 (n=1; 6.6%). The third category (n=14) comprised primary DM (12) or UM (2). A melanoma-compatible mutation was detected in only 7 cases: BRAF (n=2), NF1 (n=2), NRAS (n=2), and KIT exon 11 (n=1). This extended follow-up study highlights the high phenotypic plasticity of DM/UM and indicates significant underrecognition of this aggressive disease among general surgical pathologists. The major clues to the diagnosis of DM and UM are: (1) presence of minimal differentiated clone in DM, (2) earlier history of melanoma, (3) undifferentiated histology that does not fit any defined entity, (4) locations at sites that are unusual for undifferentiated/unclassified pleomorphic sarcoma (axilla, inguinal, neck, digestive system, etc.), (5) unusual multifocal disease typical of melanoma spread, (6) detection of a melanoma-compatible gene mutation, and (7) absence of another genuine primary (eg, anaplastic carcinoma) in other organs.
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12
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Kodet O, Kučera J, Strnadová K, Dvořánková B, Štork J, Lacina L, Smetana K. Cutaneous melanoma dissemination is dependent on the malignant cell properties and factors of intercellular crosstalk in the cancer microenvironment (Review). Int J Oncol 2020; 57:619-630. [PMID: 32705148 PMCID: PMC7384852 DOI: 10.3892/ijo.2020.5090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 06/15/2020] [Indexed: 12/17/2022] Open
Abstract
The incidence of cutaneous malignant melanoma has been steadily increasing worldwide for several decades. This phenomenon seems to follow the trend observed in many types of malignancies caused by multiple significant factors, including ageing. Despite the progress in cutaneous malignant melanoma therapeutic options, the curability of advanced disease after metastasis represents a serious challenge for further research. In this review, we summarise data on the microenvironment of cutaneous malignant melanoma with emphasis on intercellular signalling during the disease progression. Malignant melanocytes with features of neural crest stem cells interact with non‑malignant populations within this microenvironment. We focus on representative bioactive factors regulating this intercellular crosstalk. We describe the possible key factors and signalling cascades responsible for the high complexity of the melanoma microenvironment and its premetastatic niches. Furthermore, we present the concept of melanoma early becoming a systemic disease. This systemic effect is presented as a background for the new horizons in the therapy of cutaneous melanoma.
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Affiliation(s)
- Ondřej Kodet
- Institute of Anatomy, First Faculty of Medicine, Charles University, 128 00 Prague 2
- Department of Dermatovenereology, First Faculty of Medicine, Charles University and General University Hospital, 120 00 Prague
- Biotechnology and Biomedicine Center of the Academy of Sciences and Charles University in Vestec (BIOCEV), First Faculty of Medicine, Charles University, 252 50 Vestec, Czech Republic
| | - Jan Kučera
- Institute of Anatomy, First Faculty of Medicine, Charles University, 128 00 Prague 2
- Department of Dermatovenereology, First Faculty of Medicine, Charles University and General University Hospital, 120 00 Prague
| | - Karolína Strnadová
- Institute of Anatomy, First Faculty of Medicine, Charles University, 128 00 Prague 2
- Biotechnology and Biomedicine Center of the Academy of Sciences and Charles University in Vestec (BIOCEV), First Faculty of Medicine, Charles University, 252 50 Vestec, Czech Republic
| | - Barbora Dvořánková
- Institute of Anatomy, First Faculty of Medicine, Charles University, 128 00 Prague 2
- Biotechnology and Biomedicine Center of the Academy of Sciences and Charles University in Vestec (BIOCEV), First Faculty of Medicine, Charles University, 252 50 Vestec, Czech Republic
| | - Jiří Štork
- Department of Dermatovenereology, First Faculty of Medicine, Charles University and General University Hospital, 120 00 Prague
| | - Lukáš Lacina
- Institute of Anatomy, First Faculty of Medicine, Charles University, 128 00 Prague 2
- Department of Dermatovenereology, First Faculty of Medicine, Charles University and General University Hospital, 120 00 Prague
- Biotechnology and Biomedicine Center of the Academy of Sciences and Charles University in Vestec (BIOCEV), First Faculty of Medicine, Charles University, 252 50 Vestec, Czech Republic
| | - Karel Smetana
- Institute of Anatomy, First Faculty of Medicine, Charles University, 128 00 Prague 2
- Biotechnology and Biomedicine Center of the Academy of Sciences and Charles University in Vestec (BIOCEV), First Faculty of Medicine, Charles University, 252 50 Vestec, Czech Republic
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13
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Massi D, Mihic-Probst D, Schadendorf D, Dummer R, Mandalà M. Dedifferentiated melanomas: Morpho-phenotypic profile, genetic reprogramming and clinical implications. Cancer Treat Rev 2020; 88:102060. [PMID: 32619863 DOI: 10.1016/j.ctrv.2020.102060] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 01/12/2023]
Abstract
Phenotypic plasticity of malignant melanoma is a well-known phenomenon. Several translational studies and small case series have reported this clinical and biological entity, particularly in metastatic melanoma, showing frequent aberrant expression of non-melanocytic differentiation markers of different lineages, posing remarkable challenges due to several alternative differential diagnoses including undifferentiated carcinoma and sarcomas. When melanoma loses its typical morpho-phenotype by routinely used diagnostic immunohistochemical markers, it is defined as "dedifferentiated melanoma". Historically, this process was closely related to diagnostic interpretative difficulties. In recent years, however, dedifferentiation has been increasingly recognized as an important biological phenomenon that demonstrates the phenotypic and genetic plasticity of melanoma, and specifically the non-irreversibility of the multistep cancerogenesis. Furthermore, dedifferentiation emerged as a general hallmark of cancer evolution and a common denominator of cross-resistance to both targeted and immunotherapy. In this review, we summarize the histopathological features, the genetic and epigenetic bases underlying the dedifferentiated phenotype in melanomas and provide additional support that dedifferentiation is a mechanism of resistance to immunotherapy and targeted therapy.
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Affiliation(s)
- Daniela Massi
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Italy
| | - Daniela Mihic-Probst
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Dirk Schadendorf
- Department of Dermatology ,University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Reinhard Dummer
- University Hospital Zürich Skin Cancer Center, Zürich, Switzerland
| | - Mario Mandalà
- Unit of Melanoma, Division of Medical Oncology, Department of Oncology and Haematology, Papa Giovanni XXIII Cancer Center Hospital, Bergamo, Italy.
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14
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Macagno N, Bouvier C, Le Loarer F. [Pleomorphic soft tissue tumor: Case No. 6]. Ann Pathol 2020; 40:293-299. [PMID: 32147192 DOI: 10.1016/j.annpat.2020.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Nicolas Macagno
- Aix Marseille université, anatomie pathologique, CHU Timone, AP-HM, rue Saint-Pierre, 13385 Marseille, France.
| | - Corinne Bouvier
- Aix Marseille université, anatomie pathologique, CHU Timone, AP-HM, rue Saint-Pierre, 13385 Marseille, France
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15
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Mejbel HA, Arudra SKC, Pradhan D, Torres-Cabala CA, Nagarajan P, Tetzlaff MT, Curry JL, Ivan D, Duose DY, Luthra R, Prieto VG, Ballester LY, Aung PP. Immunohistochemical and Molecular Features of Melanomas Exhibiting Intratumor and Intertumor Histomorphologic Heterogeneity. Cancers (Basel) 2019; 11:E1714. [PMID: 31684113 PMCID: PMC6896082 DOI: 10.3390/cancers11111714] [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: 10/02/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 12/11/2022] Open
Abstract
Melanoma is a heterogeneous neoplasm at the histomorphologic, immunophenotypic, and molecular levels. Melanoma with extreme histomorphologic heterogeneity can pose a diagnostic challenge in which the diagnosis may predominantly rely on its immunophenotypic profile. However, tumor survival and response to therapy are linked to tumor genetic heterogeneity rather than tumor morphology. Therefore, understating the molecular characteristics of such melanomas become indispensable. In this study, DNA was extracted from 11 morphologically distinct regions in eight formalin-fixed, paraffin-embedded melanomas. In each region, mutations in 50 cancer-related genes were tested using next-generation sequencing (NGS). A tumor was considered genetically heterogeneous if at least one non-overlapping mutation was identified either between the histologically distinct regions of the same tumor (intratumor heterogeneity) or among the histologically distinct regions of the paired primary and metastatic tumors within the same patient (intertumor heterogeneity). Our results revealed that genetic heterogeneity existed in all tumors as non-overlapping mutations were detected in every tested tumor (n = 5, 100%; intratumor: n = 2, 40%; intertumor: n = 3, 60%). Conversely, overlapping mutations were also detected in all the tested regions (n = 11, 100%). Melanomas exhibiting histomorphologic heterogeneity are often associated with genetic heterogeneity, which might contribute to tumor survival and poor response to therapy.
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Affiliation(s)
- Haider A Mejbel
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Sri Krishna C Arudra
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Dinesh Pradhan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Carlos A Torres-Cabala
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Priyadharsini Nagarajan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Michael T Tetzlaff
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Jonathan L Curry
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Doina Ivan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Dzifa Y Duose
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Raja Luthra
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Victor G Prieto
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Leomar Y Ballester
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
| | - Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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16
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Gupta A, Wagman R, Kuwadekar A, Scoppetuolo M, Dardik M, Smith F. Use of Immunotherapy and Radiation Treatment in the Management of Metastatic Melanoma With Rhabdomyosarcomatous Differentiation. Adv Radiat Oncol 2019; 5:134-139. [PMID: 32051900 PMCID: PMC7004934 DOI: 10.1016/j.adro.2019.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 07/09/2019] [Accepted: 07/24/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Apar Gupta
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Raquel Wagman
- Department of Radiation Oncology, Saint Barnabas Medical Center, Livingston, New Jersey
| | - Aditya Kuwadekar
- Department of Pathology, Saint Barnabas Medical Center, Livingston, New Jersey
| | - Michael Scoppetuolo
- Department of Medical Oncology, Saint Barnabas Medical Center, Livingston, New Jersey
| | - Michael Dardik
- Department of Pathology, Saint Barnabas Medical Center, Livingston, New Jersey
| | - Franz Smith
- Department of Surgery, Saint Barnabas Medical Center, Livingston, New Jersey
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17
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Dedifferentiated Melanoma With Expression of Cytokeratin and GATA3 in a Patient With History of Breast Carcinoma. Am J Dermatopathol 2019; 41:502-504. [DOI: 10.1097/dad.0000000000001322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Bell PD, Israel AK, Dunn AL, Liao X. Primary Dedifferentiated Amelanotic Anorectal Melanoma: Report of a Rare Case. Int J Surg Pathol 2019; 27:923-928. [DOI: 10.1177/1066896919857148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Anorectal melanoma (ARM) is an uncommon aggressive malignancy that comprises 0.5% to 1.6% of all melanoma manifestations. Dedifferentiated melanoma is very rare with loss of all melanocytic differentiation markers and is usually seen in metastatic melanoma of cutaneous origin. In this article, we report the first case of primary dedifferentiated amelanotic ARM in a 68-year-old male who presented with anal discomfort that was initially treated as inflamed hemorrhoids. Physical examination revealed a large protruding anal mass, biopsy of which showed biphasic malignant tumor cells with distinct immunoprofiles: a superficial spindled/sarcomatoid component positive for SOX10 and S100, and a deeper epithelioid/rhabdoid component positive for desmin, AE1/AE3, and EMA. Both components were negative for HMB-45, Melan-A/MART-1, c-Kit, and other lineage markers. Molecular analysis by polymerase chain reaction demonstrated wild-type BRAF and KRAS genes. A diagnosis of dedifferentiated ARM was made based on the coexistence of a differentiated component (spindled: S100 and SOX10 positive) and a dedifferentiated component (epithelioid: all melanoma markers including S100 and SOX10 negative). Shortly afterwards, the patient developed extensive pulmonary and liver metastases and expired 20 days after the diagnosis was rendered, reinforcing the highly aggressive nature of this disease entity.
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Affiliation(s)
| | | | - Andrew L. Dunn
- University of Rochester Medical Center, Rochester, NY, USA
| | - Xiaoyan Liao
- University of Rochester Medical Center, Rochester, NY, USA
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Tran TAN. Undifferentiated Sarcoma as Intermediate Step in Rhabdomyosarcomatous Transformation of a Metastatic Malignant Melanoma Resistant to Anti-BRAF Therapy: A Phenomenon Associated With Significant Diagnostic and Therapeutic Pitfalls. Int J Surg Pathol 2019; 27:669-677. [DOI: 10.1177/1066896919839143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Undifferentiated sarcoma has been hypothesized as an intermediate step in the progression of malignant melanoma to rhabdomyosarcoma. The current report describes a new case of rhabdomyosarcomatous transformation in a malignant melanoma and documents the temporal progression of the malignant melanoma to rhabdomyosarcoma in different metastatic sites via undifferentiated sarcoma. A 65-year-old female with a past medical history of malignant melanoma presented with a new lung mass. A core biopsy revealed a malignant spindle cell neoplasm that was negative for all melanocytic markers, suggesting the possibility of a primary pulmonary sarcomatoid carcinoma or sarcoma. The subsequent lobectomy demonstrated an undifferentiated spindle cell neoplasm with areas of rhabdomyoblastic differentiation. Review of the skin lesion and lymph nodes confirmed the diagnosis of the primary cutaneous malignant melanoma, but also revealed that the nodal metastases had largely transformed into an undifferentiated sarcoma with similar morphology as the spindle cell neoplasm in the lung. Molecular studies demonstrated an identical BRAFV600E mutation in both the primary malignant melanoma and the lung tumor. Interestingly, the metastatic malignant melanoma with rhabdomyosarcomatous transformation was the single metastasis resistant to anti-BRAF therapy, whereas other metastases displayed dramatic clinical responses. The case report provides further supportive evidence that undifferentiated sarcoma is an intermediate step in the progression of malignant melanoma to rhabdomyosarcoma. Pathologists should be aware of this phenomenon as proper documentation of an undifferentiated sarcoma or newly acquired phenotypic variations in a malignant melanoma could considerably improve diagnostic accuracy and therapeutic management of subsequent recurrences.
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20
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Undifferentiated Sarcoma as Intermediate Step in the Progression of Malignant Melanoma to Rhabdomyosarcoma: Histologic, Immunohistochemical, and Molecular Studies of a New Case of Malignant Melanoma With Rhabdomyosarcomatous Differentiation. Am J Dermatopathol 2019; 41:221-229. [DOI: 10.1097/dad.0000000000001236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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21
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Saleh J, Wang ML, Harms PW, Patel RM, Fullen DR. Malignant melanoma with osteosarcomatous differentiation in a lymph node metastasis. J Cutan Pathol 2018; 45:701-704. [PMID: 29781204 DOI: 10.1111/cup.13283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/25/2018] [Accepted: 05/15/2018] [Indexed: 01/16/2023]
Abstract
Osteocartilaginous differentiation in malignant melanoma is rare and can pose a diagnostic challenge. In previously reported cases, melanomas were predominantly located on acral and mucosal sites, with osteocartilaginous differentiation present in either primary or recurrent lesions. We report a case of a 52-year-old female with malignant melanoma located on the right upper back exhibiting osteosarcomatous differentiation only in the axillary lymph node metastasis. This case serves to highlight that the divergent differentiation can occur in lymph node metastases while being absent in the primary lesion. The patient's medical history, careful histological examination, and immunohistochemistry may be necessary for establishing the correct diagnosis.
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Affiliation(s)
- Jasmine Saleh
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michael L Wang
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Paul W Harms
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - Rajiv M Patel
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - Douglas R Fullen
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
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