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Leblebici C, Mod BN, Cin M, Özcan B. Perineural differentiation in neurotized nevi. Pathol Res Pract 2024; 255:155184. [PMID: 38324967 DOI: 10.1016/j.prp.2024.155184] [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: 07/28/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Perineuriomatous melanocytic nevi are rare and this may indicate the similar embryological source of melanocytes and peripheral nerves in the neural crest. Neurotized melanocytic nevi may resemble nerve sheath tumors histologically, and show schwannian differentiation. However, literature on whether neurotized nevi differentiate into perineural cells is controversial. We examined our cases of neurotized nevi for evidence of perineural differentiation. MATERIALS AND METHODS A total of 100 benign nevi with large neurotized component (microscopically involved a low power field 4.2 mm in diameter) were prospectively evaluated in excisional biopsy samples. Immunohistochemical stainings for EMA, Claudin1, Glut1 and neurofilament were performed. RESULTS Perineural differentiation was immunohistochemically detected in the neurotized component of the nevi in 61% of the cases with EMA and in all the cases with Glut1 and Claudin1. Axonal differentiation was not detected with neurofilament. The expression pattern, especially with Glut1, was usually in form of partial or complete staining surrounding the Meissner's corpuscle-like structure (MCLS). Also, a linear/curvilinear staining pattern was observed particularly with Claudin1. A diffuse staining pattern with EMA, Glut1 and Claudin1 was detected in a case with a microscopically distinct whorl structure, and in which spindle cells are separated from the superficial epithelioid melanocytes with an abrupt transition histologically. These findings of the case are compatible with previous reports of perineuromatous nevus. CONCLUSION Perineural differentiation is not uncommon and immunohistochemically observed in all nevi with a relatively large component of neurotization. To prevent misdiagnosing desmoplastic melanoma and overtreating patients, it is crucial to be aware of perineuromatous nevi.
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Affiliation(s)
- Cem Leblebici
- Department of Pathology, University of Health Science, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Beste Noyan Mod
- Department of Pathology, University of Health Science, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Merve Cin
- Department of Pathology, University of Health Science, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Burcu Özcan
- Department of Pathology, University of Health Science, Istanbul Training and Research Hospital, Istanbul, Turkey
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Plexiform Melanocytic Schwannoma: Report of a Second Case and Overview of a Rare Entity. Am J Dermatopathol 2022; 44:943-947. [DOI: 10.1097/dad.0000000000002311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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3
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Brown RA, Wang JY, Raghavan SS, Zhang J, Wan DC, Born D, Koo M, Hazard FK, Novoa RA, Rieger KE. ALK-positive compound Spitz nevus with extensive perineural and intraneural neurotropism. J Cutan Pathol 2020; 48:154-159. [PMID: 33034114 DOI: 10.1111/cup.13890] [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: 07/02/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 01/18/2023]
Abstract
Historically recognized by their characteristic histopathologic features, Spitz neoplasms are now known to be molecularly defined by mutually exclusive recurrent abnormalities that cause activation of the MAPK pathway. Spitz neoplasms with ALK rearrangements frequently demonstrate polypoid growth with a plexiform arrangement of nested, fusiform melanocytes in intersecting fascicles. Although neurotropism has been described in indolent Spitz neoplasms, this feature is not frequently mentioned in publications on histopathologic assessment of this group of melanocytic tumors. Here, we present an unusual case of a 3-year-old female with an ALK-positive compound Spitz nevus with extensive perineural and intraneural neurotropism occurring on the vermilion border of the lower lip.
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Affiliation(s)
- Ryanne A Brown
- Department of Pathology, Stanford Medicine, Stanford, California, USA.,Department of Dermatology, Stanford Medicine, Stanford, California, USA.,Department of Pathology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Jennifer Y Wang
- Department of Pathology, Stanford Medicine, Stanford, California, USA.,Department of Dermatology, Stanford Medicine, Stanford, California, USA
| | - Shyam S Raghavan
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Jingjing Zhang
- Department of Pathology, Stanford Medicine, Stanford, California, USA
| | - Derrick C Wan
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford Medicine, Stanford, California, USA
| | - Donald Born
- Department of Pathology, Stanford Medicine, Stanford, California, USA
| | - Matthew Koo
- Department of Pathology, Stanford Medicine, Stanford, California, USA
| | - Florette K Hazard
- Department of Pathology, Stanford Medicine, Stanford, California, USA
| | - Roberto A Novoa
- Department of Pathology, Stanford Medicine, Stanford, California, USA.,Department of Dermatology, Stanford Medicine, Stanford, California, USA
| | - Kerri E Rieger
- Department of Pathology, Stanford Medicine, Stanford, California, USA.,Department of Dermatology, Stanford Medicine, Stanford, California, USA
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4
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Spectrum of Melanocytic Proliferation/Differentiation in a Large Series of Cutaneous Neurofibromas: An Under-Recognized Histopathologic Phenomenon and Potential Clue for Neurofibromatosis Type 1. Am J Dermatopathol 2020; 42:165-172. [DOI: 10.1097/dad.0000000000001512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Chen SJT, Patel RM, Hans CP, Chan MP, Fullen DR. Superficial papular neuroma: Case series of a new entity. J Cutan Pathol 2017. [PMID: 28627021 DOI: 10.1111/cup.12981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dermal neural lesions arise in various circumstances and may be difficult to classify. METHODS We describe the clinical, histopathologic and immunophenotypic features of a series of terminally differentiated neural lesions not described previously, to our knowledge. RESULTS Four cases from men aged 58 to 66 years were included. Some lesions reportedly bled, but no inciting trauma or prior biopsies were reported. None recurred after biopsy, with follow-up ranging from 19 to 113 months. All lesions were papular, with vertically oriented S100-positive spindled cells and nerve fibers in the papillary dermis. Slight epidermal hyperplasia, dilated superficial thin-walled vessels and minimal to mild inflammation were seen in each. Fibers were uniformly fine in 3 cases, with slightly thicker central fibers in the fourth. Three had parakeratotic scale. None were associated with dermal fibrosis or adnexal proliferation. Neurofilament stained axons in each. EMA was negative in all cases. CD34, melan-A and HMB45 were negative when performed. CONCLUSIONS We report a small series of benign neural lesions and propose the name "superficial papular neuroma" for this distinct entity. Awareness is important to understand the clinical significance of these lesions and avoid misinterpretation that could lead to overtreatment, unnecessary work-up and increased cost.
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Affiliation(s)
| | - Rajiv M Patel
- Department of Pathology, University of Michigan, Ann Arbor, Michigan.,Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - Christine P Hans
- Department of Pathology, Methodist Health System, Omaha, Nebraska
| | - May P Chan
- 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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Fernandez-Flores A, Cassarino DS. Unusual Histopathological Patterns in Melanocytic Nevi With Some Previously Undescribed Patterns. Am J Dermatopathol 2016; 38:167-85. [PMID: 26894768 DOI: 10.1097/dad.0000000000000381] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Melanocytic nevi are one of the most common diagnoses in the daily practice of any dermatopathologist. Although in the vast majority of cases the final diagnosis is not difficult, there are certain rare and unusual morphologic variations that can elicit some diagnostic problems. Although some of these variations can be considered as mere morphologic oddities, others might lead to a differential diagnosis with melanoma, or with other tumors, including epithelial or neural tumors. In the current report, we review many of these morphologic variations and discuss the main differential diagnosis, when appropriate.
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Affiliation(s)
- Angel Fernandez-Flores
- *Consultant Histopathologist, Department of Cellular Pathology, Hospital El Bierzo, Ponferrada, Spain; and †Consultant Dermatopathologist, Department of Pathology, Southern California Kaiser Permanente, Los Angeles Medical Center (LAMC), Los Angeles, CA
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Novoa RA, Kovarik CL, Low DW, Argenyi Z. Cutaneous epithelioid melanocytic neurofibroma arising in a patient with neurofibromatosis-1. J Cutan Pathol 2014; 41:457-61. [DOI: 10.1111/cup.12297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/25/2014] [Accepted: 01/25/2014] [Indexed: 12/30/2022]
Affiliation(s)
- Roberto A. Novoa
- University of Pennsylvania; Department of Dermatology; Philadelphia PA USA
| | - Carrie L. Kovarik
- University of Pennsylvania; Department of Dermatology; Philadelphia PA USA
| | - David W. Low
- University of Pennsylvania; Division of Plastic Surgery; Philadelphia PA USA
| | - Zsolt Argenyi
- University of Washington; Department of Pathology; Seattle WA USA
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Su A, Dry SM, Binder SW, Said J, Shintaku P, Sarantopoulos GP. Malignant melanoma with neural differentiation: an exceptional case report and brief review of the pertinent literature. Am J Dermatopathol 2014; 36:e5-9. [PMID: 23782676 PMCID: PMC4079032 DOI: 10.1097/dad.0b013e31828cf90a] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
: The term neurotropic melanoma has been used to refer to malignant melanoma with associated infiltration of nerve or "neural differentiation"--that is, melanoma cells exhibiting cytological characteristics of nerve cells. Historically, neurotropic melanoma has generally been discussed within the context of desmoplastic melanoma. We report an exceptional case of melanoma notable for a very well-differentiated neural component that was contiguous with obvious overlying melanoma. After careful consideration of all pertinent histological features, the overall diagnostic impression was that of melanoma with associated "malignant neurotization." We have not encountered a previously reported case with such a well-differentiated neural component. The following article details our exceptional case of melanoma with "malignant neurotization" and presents a discussion of the differential diagnosis and brief review of the pertinent literature.
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Affiliation(s)
- Albert Su
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Yeh I, Argenyi Z, Vemula SS, Furmanczyk PS, Bouffard D, McCalmont TH. Plexiform melanocytic schwannoma: a mimic of melanoma. J Cutan Pathol 2012; 39:521-5. [DOI: 10.1111/j.1600-0560.2011.01856.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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10
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Ernfors P. Cellular origin and developmental mechanisms during the formation of skin melanocytes. Exp Cell Res 2010; 316:1397-407. [PMID: 20211169 DOI: 10.1016/j.yexcr.2010.02.042] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 02/28/2010] [Indexed: 11/20/2022]
Abstract
Melanocytes are derived from the neural crest (NC), which are transient multipotent cells arising by delamination from the developing dorsal neural tube. During recent years, signaling systems and molecular mechanisms of melanocyte development have been studied in detail, but the exact diversification of the NC into melanocytes and how they migrate, expand and disperse in the skin have not been fully understood. The recent finding that Schwann cell precursors (SCPs) of the growing nerve represents a stem cell niche from which various cell types, including Schwann cells, endoneural fibroblasts and melanocytes arise has exposed new knowledge on the cellular basis for melanocyte development. This opens for the identification of new factors and reinterpretation of old data on cell fate instructive, proliferative, survival and cell homing factors participating in melanocyte development.
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Affiliation(s)
- Patrik Ernfors
- Division of Molecular Neurobiology, Department of Medical Biochemistry and Biophysics, Karolinska Institute, 17177 Stockholm, Sweden.
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Adameyko I, Lallemend F, Aquino JB, Pereira JA, Topilko P, Müller T, Fritz N, Beljajeva A, Mochii M, Liste I, Usoskin D, Suter U, Birchmeier C, Ernfors P. Schwann Cell Precursors from Nerve Innervation Are a Cellular Origin of Melanocytes in Skin. Cell 2009; 139:366-79. [DOI: 10.1016/j.cell.2009.07.049] [Citation(s) in RCA: 315] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 04/03/2009] [Accepted: 07/22/2009] [Indexed: 02/02/2023]
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