1
|
Gowda VV, Vijayanarasimha D, Srihari SM, Kumar RV, Srinath BS. Cartilaginous Transdifferentiation in Melanoma: A Diagnostic Challenge. Indian J Surg Oncol 2024; 15:474-477. [PMID: 39239432 PMCID: PMC11372010 DOI: 10.1007/s13193-024-01930-0] [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: 10/14/2023] [Accepted: 03/18/2024] [Indexed: 09/07/2024] Open
Abstract
Malignant melanoma is a formidable tumor originating from melanocytes of neural crest origin, found in various anatomical locations, primarily in the skin, followed by the eyes and mucosal membranes. This tumor stands out due to its remarkable phenotypic diversity. Transdifferentiation, the process of differentiation into cell lineages other than the one from which the tumor originated, and phenotypic plasticity, characterized by changes in behavior, morphology, and physiology in response to different environmental conditions, can make melanoma a diagnostic conundrum for unwary pathologists. In this case report, we present a challenging case of melanoma with cartilaginous transdifferentiation to shed light on its clinical, pathological, and molecular aspects.
Collapse
Affiliation(s)
- Veeksha V Gowda
- Department of Oncopathology, Sri Shankara Cancer Hospital and Research Centre, 'Nandagokula', 301 A Block, Laksh Royal Manor, Bharat Nagar, 2nd Phase, Off Magadi Main Road, Bangalore, 560091 India
| | - Divya Vijayanarasimha
- Department of Oncopathology, Sri Shankara Cancer Hospital and Research Centre, 'Nandagokula', 301 A Block, Laksh Royal Manor, Bharat Nagar, 2nd Phase, Off Magadi Main Road, Bangalore, 560091 India
| | - Sulakshana M Srihari
- Department of Oncopathology, Sri Shankara Cancer Hospital and Research Centre, 'Nandagokula', 301 A Block, Laksh Royal Manor, Bharat Nagar, 2nd Phase, Off Magadi Main Road, Bangalore, 560091 India
| | - Rekha V Kumar
- Department of Oncopathology, Sri Shankara Cancer Hospital and Research Centre, 'Nandagokula', 301 A Block, Laksh Royal Manor, Bharat Nagar, 2nd Phase, Off Magadi Main Road, Bangalore, 560091 India
| | - B S Srinath
- Department of Surgical Oncology, Sri Shankara Cancer Hospital and Research Centre, Bangalore, India
| |
Collapse
|
2
|
Kostelecky N, Wadhwani N, Golubovich I, Vormittag-Nocito E, Gao J, Jennings L, Caron M, Jamshidi P, Ahrendsen JT, Castellani R, Brat D, Horbinski C. Transdifferentiation of metastatic melanoma into cerebellar angiosarcoma. J Neuropathol Exp Neurol 2024:nlae075. [PMID: 38964372 DOI: 10.1093/jnen/nlae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024] Open
Affiliation(s)
- Nicolas Kostelecky
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Nitin Wadhwani
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Ivana Golubovich
- Department of Pathology, Northwestern Medicine McHenry Hospital, Lake Forest, IL, United States
| | - Erica Vormittag-Nocito
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Juehua Gao
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lawrence Jennings
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Michael Caron
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Pouya Jamshidi
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jared T Ahrendsen
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Rudolph Castellani
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Daniel Brat
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Craig Horbinski
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Hegazy S, Kamaluddin Z, Naous R. Cytomorphology of metastatic dedifferentiated/undifferentiated melanoma to the gallbladder: A case report and review of literature. Diagn Cytopathol 2024; 52:E120-E123. [PMID: 38380948 DOI: 10.1002/dc.25292] [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] [Received: 12/22/2023] [Revised: 01/24/2024] [Accepted: 02/15/2024] [Indexed: 02/22/2024]
Abstract
Dedifferentiated/undifferentiated melanoma (DM/UM) is a distinct subtype of malignant melanoma that tends to lose all melanocytic markers of differentiation. DM/UM pose major diagnostic challenges as they could be easily confused with UM sarcoma or carcinoma, thus necessitating the use of molecular studies such as Next Generation Sequencing (NGS) for detecting melanoma-compatible mutations to confirm such diagnosis. The capability of performing NGS molecular studies on small biopsy material with confirmation of adequacy via rapid on-site evaluation (ROSE) has tremendous value in diagnosing DM/UM. Herein, we present the first reported case of metastatic DM/UM to the gall bladder arising in a 60-year-old female with a prior history of right knee melanoma. We also shed light on the cytomorphology of DM/UM, review the literature on such a challenging entity, and emphasize the crucial role of molecular testing in their diagnosis.
Collapse
Affiliation(s)
- Shaymaa Hegazy
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Zarine Kamaluddin
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rana Naous
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
5
|
Hornick JL, Plaza JA, Mentzel T, Gru AA, Brenn T. PRAME Expression Is a Useful Tool in the Diagnosis of Primary and Metastatic Dedifferentiated and Undifferentiated Melanoma. Am J Surg Pathol 2023; 47:1390-1397. [PMID: 37727938 DOI: 10.1097/pas.0000000000002125] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Although mostly recognized in the metastatic setting dedifferentiated and undifferentiated melanomas are increasingly recognized as cutaneous and, less commonly, mucosal primary tumors. Their diagnosis is challenging and dependent on sampling and recognition of a conventional melanoma precursor and/or detection of a mutation in a conventional melanoma driver gene. PRAME immunohistochemistry has recently become an important ancillary tool in the separation of melanoma from benign nevi, but no comprehensive studies exist regarding its value in the detection of dedifferentiated and undifferentiated melanomas and their separation from atypical fibroxanthoma and pleomorphic dermal sarcoma, the main differential diagnoses on sun-damaged skin. After retrieval from archival files, we performed PRAME immunohistochemistry on 11 primary and 10 metastatic dedifferentiated and undifferentiated melanomas, 11 atypical fibroxanthomas, and 10 pleomorphic dermal sarcomas. Nuclear staining was assigned extent (ranging from 0 to 4 and reflecting the percentage of PRAME-positive tumor nuclei) and intensity scores (graded as absent, weak, moderate, and strong, with assigned scores ranging from 0 to 3) with combined scores ranging from 0 to 7. Both primary and metastatic dedifferentiated and undifferentiated melanomas showed strong and diffuse nuclear PRAME staining with median combined scores of 7. Strong and diffuse staining was also seen in all conventional melanoma precursors except for desmoplastic melanoma. In contrast, PRAME staining in atypical fibroxanthoma and pleomorphic dermal sarcoma was patchy and weak with median combined scores of 2. Our data emphasize the diagnostic utility of PRAME staining as a first screening tool in the detection and workup of dedifferentiated and undifferentiated melanomas, both in the primary and metastatic settings. PRAME immunohistochemistry is particularly helpful as it is also positive in tumors without a recognizable conventional melanoma precursor and in those associated with desmoplastic melanomas, where PRAME is typically found to be negative.
Collapse
Affiliation(s)
- Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jose A Plaza
- Division of Dermatopathology, Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Thomas Mentzel
- MVZ Dermatopathologie Friedrichshafen/Bodensee PartG, Friedrichshafen, Germany
| | - Alejandro A Gru
- Department of Pathology, University of Virginia, Charlottesville, VA
| | - Thomas Brenn
- Department of Pathology and Laboratory Medicine
- Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
6
|
Wiedemeyer K, Brenn T. Dedifferentiated and undifferentiated melanomas: a practical approach to a challenging diagnosis. Hum Pathol 2023; 140:22-31. [PMID: 37001740 DOI: 10.1016/j.humpath.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
Dedifferentiation, defined as the loss of cellular features of terminal differentiation resulting in a more primitive, unspecialized phenotype, is a rare phenomenon in melanoma and more commonly observed in the metastatic setting than in primary melanomas. The diagnosis of dedifferentiated melanoma poses a significant challenge, and the tumors need to be carefully sampled and worked up to identify any residual morphologic, immunohistochemical, or molecular evidence of their melanocytic lineage. This article reviews our current knowledge of the clinical, histopathological, immunohistochemical, and molecular features of these rare tumors and provides a practical diagnostic approach and discussion of the relevant differential diagnoses and associated diagnostic pitfalls.
Collapse
Affiliation(s)
- Katharina Wiedemeyer
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2L 2K8, Canada
| | - Thomas Brenn
- Departments of Pathology and Laboratory Medicine and Medicine, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2L 2K8, Canada.
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Fernandez-Flores A, Singh R, Cassarino DS. Top 10 Differential Diagnoses for Desmoplastic Melanoma. Head Neck Pathol 2023; 17:143-153. [PMID: 36928737 PMCID: PMC10063748 DOI: 10.1007/s12105-023-01536-y] [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: 11/02/2022] [Accepted: 01/16/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Desmoplastic melanoma is a rare subtype of melanoma mainly appearing on sun-exposed skin. Clinically, it is many times non-pigmented and therefore the diagnosis is often not suspected. METHODS Review article. RESULTS In this paper we review the main histopathological, immunohistochemical, and molecular features of desmoplastic melanoma, as well as the top 10 morphologic differential diagnoses which should be considered in most cases. The histopathological pattern can be many times deceptive, mimicking a scar, a fibrous reaction, a fibrohistiocytic tumor such as a dermatofibroma, a vascular tumor such as angiosarcoma, a smooth muscle tumor such as leiomyosarcoma, or a neural tumor. Although an overlying atypical junctional melanocytic proliferation may be seen in most cases, it is absent in a significant percentage (up to 30%) of cases, making the diagnosis even more difficult in those instances. The range of diagnostic pitfalls is wide, which may present disastrous prognostic consequences. CONCLUSION Desmoplastic melanoma is often a difficult diagnosis to make, as it frequently shows nonspecific clinical findings and overlapping histologic features with many other tumors. However, the potential clinical and prognostic consequences of misdiagnosis as another entity are great. Therefore, this diagnosis must always be kept in mind when encountering spindle cell tumors affecting the head and neck area.
Collapse
Affiliation(s)
- Angel Fernandez-Flores
- Department of Histopathology, University Hospital El Bierzo, Ponferrada, Spain
- Department of Cellular Pathology, Hospital de la Reina, Ponferrada, Spain
- Research Department, Institute for Biomedical Research of A Coruña (INIBIC), University of A Coruña (UDC), A Coruña, Spain
| | | | - David S Cassarino
- Departments of Pathology and Dermatology, Los Angeles Medical Center (LAMC), Southern California Kaiser Permanente, Los Angeles, CA, USA.
- Department of Pathology, Southern California Permanent Medical Group, Los Angeles Medical Center, 3867 Sunset Blvd, Los Angeles, CA, 90027, USA.
| |
Collapse
|
9
|
Ramírez-Hernández C, García-Márquez LJ, Ramírez-Romero R. Primary Angiomatoid Melanomas in Dogs. J Comp Pathol 2022; 199:8-11. [DOI: 10.1016/j.jcpa.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/25/2022] [Accepted: 09/14/2022] [Indexed: 10/31/2022]
|
10
|
Ferreira I, Arends MJ, Weyden L, Adams DJ, Brenn T. Primary de‐differentiated, trans‐differentiated and undifferentiated melanomas: overview of the clinicopathological, immunohistochemical and molecular spectrum. Histopathology 2021; 80:135-149. [PMID: 34958502 DOI: 10.1111/his.14545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Ingrid Ferreira
- Experimental Cancer Genetics Wellcome Sanger Institute Wellcome Genome Campus Cambridge UK
- Université Libre de Bruxelles Brussels Belgium
| | - Mark J Arends
- Division of Pathology Cancer Research UK Edinburgh Centre Edinburgh UK
| | - Louise Weyden
- Experimental Cancer Genetics Wellcome Sanger Institute Wellcome Genome Campus Cambridge UK
| | - David J Adams
- Experimental Cancer Genetics Wellcome Sanger Institute Wellcome Genome Campus Cambridge UK
| | - Thomas Brenn
- Division of Pathology Cancer Research UK Edinburgh Centre Edinburgh UK
- Department of Pathology and Laboratory Medicine and the Arnie Charbonneau Cancer Institute Cumming School of Medicine University of Calgary Calgary AB Canada
| |
Collapse
|
11
|
Kilsdonk MJ, Romeijn TR, Kelder W, van Kempen LC, Diercks GF. Angiosarcomatous transdifferentiation of metastatic melanoma. J Cutan Pathol 2020; 47:1211-1214. [PMID: 32865830 PMCID: PMC7756493 DOI: 10.1111/cup.13857] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/20/2020] [Accepted: 08/23/2020] [Indexed: 11/29/2022]
Abstract
Melanoma is known to show considerable variation in its histopathological presentation. In exceptional cases, heterologous or divergent differentiation (metaplastic melanoma) can be observed. We report a case of a 69-year-old man who was diagnosed with nodular melanoma on the right upper leg. One year later, the patient presented with an inguinal lymph node metastasis and a lymph node dissection was carried out. In two out of five positive lymph nodes, an angiosarcomatous component was found next to a conventional melanoma component. Shortly after, the patient developed two in-transit metastases in which again an angiosarcomatous component was seen. The vascular component stained positive for ERG and CD31 and negative for melanocytic markers (Mart-1, S100, SOX-10), while the conventional melanoma had an opposite staining pattern. Molecular analysis on both components showed an identical mutation in the NRAS gene, which in our opinion proves the divergent differentiation. To the best of our knowledge, this is the first case report describing angiosarcomatous transdifferentiation of melanoma.
Collapse
Affiliation(s)
- Melvin J. Kilsdonk
- Department of PathologyUniversity Medical Centre Groningen, University of GroningenGroningenThe Netherlands
| | | | - Wendy Kelder
- Department of SurgeryMartini HospitalGroningenThe Netherlands
| | - Léon C. van Kempen
- Department of PathologyUniversity Medical Centre Groningen, University of GroningenGroningenThe Netherlands
| | - Gilles F. Diercks
- Department of PathologyUniversity Medical Centre Groningen, University of GroningenGroningenThe Netherlands
| |
Collapse
|