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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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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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Periasamy N, Khullar G, Sharma S. Asymptomatic skin-colored papule on the upper eyelid in a young man. Int J Dermatol 2019; 58:1379-1381. [PMID: 31168792 DOI: 10.1111/ijd.14522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/28/2019] [Accepted: 05/13/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Nandhini Periasamy
- Department of Dermatology and Sexually Transmitted Diseases, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Geeti Khullar
- Department of Dermatology and Sexually Transmitted Diseases, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Shruti Sharma
- National Institute of Pathology, Indian Council of Medical Research, Safdarjung Hospital Campus, New Delhi, India
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Moisak GI, Matsko DE, Chernov SV, Dmitriev AB, Amelin ME, Zhelbunova EA, Chernov MF, Rzaev JA. What Tactics Should a Surgeon Choose to Treat a Black Extracerebral Tumor? A Case Report of Psammomatous Melanotic Schwannoma of the Meckel Cave and Literature Review. World Neurosurg 2018; 116:337-342. [PMID: 29715570 DOI: 10.1016/j.wneu.2018.04.153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neoplasms located in the Meckel cave account for 0.2%-0.5% of all intracranial tumors. This area is the site of many types of pathologic lesions, most often trigeminal nerve schwannomas and meningiomas. Melanin-containing tumors are rare in this area. These tumor types can be suspected if the magnetic resonance characteristics of a tumor has some differences in comparison with other types of central nervous system neoplasms. In fact, differential diagnosis of melanotic tumors is based mainly on the histopathologic criteria and immunohistochemical profile. This article presents a case report of melanotic schwannoma of the Meckel cave and a literature review of the problem. CASE DESCRIPTION A 23-year-old man underwent a 2-stage surgery for a dumbbell pigmented mass lesion located in the Meckel cave. No signs of recurrence were seen on follow-up magnetic resonance imaging (MRI) 3.5 years after the operation. CONCLUSIONS Melanin-containing tumor can be suspected in the presence of radiologic characteristics, such as a hyperintense MRI signal on T1-weighted images and a hypointense signal on T2-weighted images. If a black extracerebral tumor is detected, the main course of surgical treatment is maximal excision despite it possibly being a malignant melanoma and the temptation to perform partial resection because of an unfavorable prognosis. Chemotherapy can be justified in the presence of an aggressive melanotic schwannoma.
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Affiliation(s)
- Galina I Moisak
- Federal Center of Neurosurgery, Novosibirsk, Russia; Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia
| | - Dmitry E Matsko
- Chair of Oncology, Saint Petersburg State University, Saint Petersburg, Russia; Department of Pathomorphology and Histology, Diagnostic and Treatment Center of the International Institute of the Biological Systems named after Dr. S.M. Berezin, Saint Petersburg, Russia
| | | | | | | | - Elena A Zhelbunova
- Department of Pathomorphology and Histology, Diagnostic and Treatment Center of the International Institute of the Biological Systems named after Dr. S.M. Berezin, Saint Petersburg, Russia
| | - Mikhail F Chernov
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
| | - Jamil A Rzaev
- Federal Center of Neurosurgery, Novosibirsk, Russia; Department of Neuroscience, Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia.
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Cheng X, Liu J, Le J, Huang S, Chen H, You C. Invasive intramedullary melanotic schwannoma: case report and review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:303-308. [PMID: 28695275 DOI: 10.1007/s00586-017-5207-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/26/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE Melanotic schwannoma (MS) is rare, accounting for less than 1% of primary peripheral nerve sheath tumors, and most often occurs in the paraspinal nerve roots. Intramedullary MS is exceedingly rare, and to the best of our knowledge, only nine cases have been reported in literature. METHODS AND RESULTS We present a 47-year-old male, who underwent excision of thoracic intraspinal space-occupying lesion 6 years ago, as the 10th known case to date of intradural intramedullary MS that had a more invasive growth pattern than those reported before, and we review the diagnosis, clinicopathologic features, treatment and prognosis of intramedullary MS. CONCLUSIONS Intramedullary MS' behavior is unpredictable and can have an aggressive clinical course such as recurrence and metastasis.
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Affiliation(s)
- Xing Cheng
- Department of Neurosurgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.,Department of Neurosurgery, Chongqing Cancer Hospital, Chongqing, People's Republic of China
| | - Jiagang Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jun Le
- Department of Neurosurgery, Yingtan People's Hospital, Yingtan, Jiangxi, People's Republic of China
| | - Siqing Huang
- Department of Neurosurgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Haifeng Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.
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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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Luzar B, Tanaka M, Schneider J, Calonje E. Cutaneous microcystic/reticular schwannoma: a poorly recognized entity. J Cutan Pathol 2015; 43:93-100. [PMID: 26350054 DOI: 10.1111/cup.12624] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/19/2015] [Accepted: 08/02/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Microcystic/ reticular schwannoma is exceptionally rare yet distinctive morphological variant of schwannoma with predilection for visceral sites lacking association with neurofibromatosis. AIMS To further delineate clinicopathological features of cutaneous microcystic/reticular schwannoma and to discuss its differential diagnosis. RESULTS We analyzed three cutaneous microcystic/reticular schwannomas, occurring in two males and one female (mean age: 37.6 years). The tumors presented as a non-painful slightly raised papule (mean: 0.7 cm) on upper arm (n = 2) and back (n = 1). No recurrences were observed despite marginal excision (mean follow up: 42 months). Histopathologically, a multilobular proliferation was present in the dermis composed of bland tumor cells forming distinctive microcystic, reticular, lace-like or pseudoglandular structures, containing abundant myxoid/mucinous material. By immunohistochemistry, tumor cells lining microcystic structures corresponded to Schwann cells (diffuse S100 positive, variable GFAP positivity). A discontinuous EMA-positive perineurium was present at the periphery of some of the lobules. CONCLUSION Cutaneous microcystic/reticular schwannoma expands the spectrum of benign peripheral nerve sheath tumors with reticular morphology encountered in the skin. Other tumors in this group include reticular perineurioma and hybrid tumors with reticular morphology, e.g. reticular perineurioma/schwannoma and reticular perineurioma/neurofibroma.
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Affiliation(s)
- Boštjan Luzar
- Institute of Pathology, Medical Faculty University of Ljubljana, Ljubljana, Slovenia
| | - Maiko Tanaka
- Department of Dermatology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Johann Schneider
- Division of Anatomical Pathology at University of Stellenbosch, Cape Town, South Africa
| | - Eduardo Calonje
- Department of Dermatopathology, St John's Institute of Dermatology, St Thomas' Hospital, London, UK
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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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Faria MHG, Dória-Netto RH, Osugue GJ, Queiroz LDS, Chaddad-Neto FE. Melanotic schwannoma of the cervical spine progressing with pulmonary metastasis: case report. Neurol Med Chir (Tokyo) 2013; 53:712-6. [PMID: 24077273 PMCID: PMC4508740 DOI: 10.2176/nmc.cr2012-0203] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Melanotic schwannoma (MS) is an unusual variant of nerve sheath neoplasm. Only 10% of these tumors will undergo malignant degeneration, with exceedingly rare reported metastasis. We present a 32-year-old woman with a 6-month history of cervical pain and left arm progressive weakness. Neurological examination showed a left upper limb radicular pain, with pyramidal syndrome at C5 level. The magnetic resonance imaging (MRI) study highlighted an intradural extramedullary heterogeneous mass along the spinal cord at the C4-C5 level, slightly hyperintense with T1 and hypointense with T2-weighted sequences, invading the left neural foramen. The patient underwent C3-C5 laminectomy with total resection of a black tumor. In the postoperative period, a patent deficit of shoulder abduction ensued related to the nervous section. Microscopically, compactly fascicles of spindle-shaped cells with pleomorphic and hypercromatic nuclei, dark brown intracellular pigments, as well as some mitotic figures were seen. Immunohistochemical stains for S-100, Human Melanoma Black-45 (HMB-45), and vimentin were positive, with Ki-67 Labelling Index (LI) of 15% compatible with MS. Six months after radiotherapy she presents local recurrence and lung metastatic dissemination of the MS. She underwent left pulmonary segmentectomy, followed by chemotherapy and radiosurgery. The patient developed a febrile neutropenia and worsening of general status, and died after 3 months due to respiratory complications. MS are rare tumors with potential for local recurrence and distal metastasis. Complete surgical resection remains as the treatment of choice, once the uncommon cases with malignant progression shows low response to chemo and radiotherapy.
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Melanocytic Differentiation Is Present in a Significant Proportion of Nonpigmented Diffuse Neurofibromas. Am J Surg Pathol 2013; 37:1182-91. [DOI: 10.1097/pas.0b013e31828950a3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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