1
|
Katarzyna L, Kyriakos O, Linda V, Ingrid S, Petra W, Karin Ö. Evaluation of tubulin β-3 and 5 hydroxy-methyl cytosine as diagnostic and prognostic markers in malignant melanoma. Ann Diagn Pathol 2024; 72:152332. [PMID: 38776734 DOI: 10.1016/j.anndiagpath.2024.152332] [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: 04/02/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
Tubulin β-3 staining pattern and staining intensity of 5-hydroxymethyl cytosine (5-hmC) are potential diagnostic and prognostic markers in melanocytic lesions that need further evaluation. Melanocytic nevi and primary cutaneous melanomas were immunohistochemically stained for tubulin-β-3 and 5-hmC. Immunoreactivity and staining patterns were correlated with Breslow-thickness, clinical and pathological characteristics, and progression-free survival. Melanocytes showed positive tubulin β-3 staining. However, in most nevi, tubulin β-3 staining appeared as a gradient with intense cytoplasmic staining in cells of the superficial part of the lesion that faded to weak staining in the deep dermal part, while no gradient was found in deep penetrating nevi and melanomas. In 53 % of the melanomas, areas with loss of tubulin β-3 staining were found. 5-hmC staining intensity was significantly higher in melanocytic nevi compared to melanomas. Breslow thickness in combination with low 5-hmC score and loss of tubulin-β-3 staining was predictive for poor prognosis. As single markers, tubulin-β-3 and 5-hmC can be useful to distinguish between melanocytic nevi and melanoma, but staining variability limits the use of 5-hmC. In melanomas measuring >1.5 mm, combination of low 5-hmC score and loss of tubulin-β-3 staining may have prognostic value.
Collapse
Affiliation(s)
- Lundmark Katarzyna
- Department of Clinical Pathology, Department of Biomedical and Clinical Sciences, Linkoping University, Linkoping, Sweden
| | - Orfanidis Kyriakos
- Department of Dermatology and Venereology, Department of Biomedical and Clinical Sciences, Linkoping University, Sweden
| | - Vainikka Linda
- Experimental Pathology, Department of Biomedical and Clinical Sciences, Linkoping University, Linkoping, Sweden
| | - Synnerstad Ingrid
- Department of Dermatology and Venereology, Department of Biomedical and Clinical Sciences, Linkoping University, Sweden
| | - Wäster Petra
- Experimental Pathology, Department of Biomedical and Clinical Sciences, Linkoping University, Linkoping, Sweden
| | - Öllinger Karin
- Experimental Pathology, Department of Biomedical and Clinical Sciences, Linkoping University, Linkoping, Sweden.
| |
Collapse
|
2
|
Zhang Y, Ostrowski SM, Fisher DE. Nevi and Melanoma. Hematol Oncol Clin North Am 2024:S0889-8588(24)00054-6. [PMID: 38880666 DOI: 10.1016/j.hoc.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Cutaneous melanoma is an aggressive form of skin cancer derived from skin melanocytes and is associated with significant morbidity and mortality. A significant fraction of melanomas are associated with precursor lesions, benign clonal proliferations of melanocytes called nevi. Nevi can be either congenital or acquired later in life. Identical oncogenic driver mutations are found in benign nevi and melanoma. While much progress has been made in our understanding of nevus formation and the molecular steps required for transformation of nevi into melanoma, the clinical diagnosis of benign versus malignant lesions remains challenging.
Collapse
Affiliation(s)
- Yifan Zhang
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Stephen M Ostrowski
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - David E Fisher
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
| |
Collapse
|
3
|
Avram A, Scurtu LG, Costache M, Simionescu O. A Disguising Fast-Growing Metachronous Melanoma and COVID-19. Cureus 2023; 15:e36108. [PMID: 37065319 PMCID: PMC10101186 DOI: 10.7759/cureus.36108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/15/2023] Open
Abstract
An unusual case of a 52-year-old female with two metachronous melanomas is presented. An atypical fast-growing nodular melanoma appeared 18 months after the complete excision of an in situ melanoma and one month afterward a SARS-CoV-2 infection. Intra-nodal melanocytic proliferations were identified during lymph node assessment, raising important diagnostic and prognostic concerns. No melanoma susceptibility genes were found. This case report raises the question about the COVID-19 immunosuppression effect on the tumor microenvironment and the oncogenic potential of SARS-CoV-2. It also highlights the importance of clinical follow-up in melanoma patients, which was significantly delayed during the COVID-19 pandemic.
Collapse
|
4
|
Successful Repigmentation of Full-Thickness Wound Healing in Fraser’s Dolphins (Lagenodelphis hosei). Animals (Basel) 2022; 12:ani12121482. [PMID: 35739819 PMCID: PMC9219537 DOI: 10.3390/ani12121482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/03/2022] [Accepted: 06/05/2022] [Indexed: 11/16/2022] Open
Abstract
Fraser’s dolphins (Lagenodelphis hosei) exhibit the capability to restore nearly normal pigmentation after full-thickness wounding. However, the association among melanocytes, melanin and skin pigmentation during wound healing in cetaceans has yet to be addressed. Here, the number of melanocytes and the distribution of melanocytes and melanin in different-colored skin and different wound-healing stages in Fraser’s dolphins were analyzed by using Fontana–Masson staining, immunofluorescence staining and immunohistochemical staining. It was noticed that there was the highest number of melanocytes in dark skin and the lowest number of melanocytes in white skin. The appearance of functional melanocytes and full-melanized neoepidermis was observed in the early stage of wound healing in Fraser’s dolphins. Furthermore, the melanocyte number and skin pigmentation and pattern in healed wounds recovered to a similar condition of unwounded skin. This study provides fundamental knowledge of skin repigmentation in cetaceans for further research, and it will be warranted to elucidate the mechanisms of the replenishment of melanocytes and the regulation of melanocyte activity that contribute to the successful repigmentation in cetacean skin wounds.
Collapse
|
5
|
Ricci C, Dika E, Ambrosi F, Lambertini M, Veronesi G, Barbara C. Cutaneous Melanomas: A Single Center Experience on the Usage of Immunohistochemistry Applied for the Diagnosis. Int J Mol Sci 2022; 23:5911. [PMID: 35682589 PMCID: PMC9180684 DOI: 10.3390/ijms23115911] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 12/12/2022] Open
Abstract
Cutaneous melanoma (cM) is the deadliest of all primary skin cancers. Its prognosis is strongly influenced by the stage at diagnosis, with early stages having a good prognosis and being potentially treatable with surgery alone; advanced stages display a much worse prognosis, with a high rate of recurrence and metastasis. For this reason, the accurate and early diagnosis of cM is crucial-misdiagnosis may have extremely dangerous consequences for the patient and drastically reduce their chances of survival. Although the histological exam remains the "gold standard" for the diagnosis of cM, a continuously increasing number of immunohistochemical markers that could help in diagnosis, prognostic characterization, and appropriate therapeutical choices are identified every day, with some of them becoming part of routine practice. This review aims to discuss and summarize all the data related to the immunohistochemical analyses that are potentially useful for the diagnosis of cM, thus rendering it easier to appropriately applicate to routine practice. We will discuss these topics, as well as the role of these molecules in the biology of cM and potential impact on diagnosis and treatment, integrating the literature data with the experience of our surgical pathology department.
Collapse
Affiliation(s)
- Costantino Ricci
- Pathology Unit, Ospedale Maggiore, 40139 Bologna, Italy; (C.R.); (F.A.)
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40139 Bologna, Italy;
| | - Emi Dika
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40139 Bologna, Italy;
| | - Francesca Ambrosi
- Pathology Unit, Ospedale Maggiore, 40139 Bologna, Italy; (C.R.); (F.A.)
| | - Martina Lambertini
- Dermatology Unit, IRCCS Policlinico Sant’Orsola-Malpighi, University of Bologna, 40139 Bologna, Italy; (M.L.); (G.V.)
| | - Giulia Veronesi
- Dermatology Unit, IRCCS Policlinico Sant’Orsola-Malpighi, University of Bologna, 40139 Bologna, Italy; (M.L.); (G.V.)
| | - Corti Barbara
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, 40139 Bologna, Italy
| |
Collapse
|
6
|
Kim YJ, Jung CJ, Na H, Lee WJ, Chang SE, Lee MW, Park CS, Lim Y, Won CH. Cyclin D1 and PRAME expression in distinguishing melanoma in situ from benign melanocytic proliferation of the nail unit. Diagn Pathol 2022; 17:41. [PMID: 35484605 PMCID: PMC9047257 DOI: 10.1186/s13000-022-01218-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Distinguishing benign lesion from early malignancy in melanocytic lesions of the nail unit still remains a diagnostic challenge, both clinically and histopathologically. While several immunohistochemistry (IHC) stainings have been suggested to help discriminate benign subungual melanocytic proliferation (SMP) and subungual melanoma in situ (MIS), the diagnostic utility of IHC staining for cyclin D1 and PRAME has not been thoroughly investigated in melanocytic lesions of nail unit. METHODS This retrospective study included cases of benign SMP and subungual MIS confirmed by biopsy at Asan Medical Center from January 2016 to December 2020. Cases of melanocytic activation without proliferation and melanoma where dermal invasion was identified were excluded. Cyclin D1 and PRAME expression was assessed by counting proportion of melanocytes with nuclear positivity under 200x magnification. RESULTS A total of 14 patients with benign SMP and 13 patients with subungual MIS were included in this study. 11 patients with benign SMP (71.4%) and 5 patients with subungual MIS (38.5%) showed > 60% nuclear immunostaining for cyclin D1, respectively. While 13 patients with benign SMP (92.9%) showed totally negative staining for PRAME, 10 patients with subungual MIS (76.9%) exhibited > 50% nuclear immunostaining for PRAME. Using the cutoff of 10%, PRAME exhibited good overall discrimination between benign SMP and subungual MIS (AUC = 0.849, 95% CI = 0.659-0.957). CONCLUSIONS This study suggests that PRAME IHC staining as a reliable discriminator in distinguishing subungual MIS from benign SMP.
Collapse
Affiliation(s)
- Young Jae Kim
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic- ro 43 gil, Songpa-gu, Seoul, Korea
| | - Chang Jin Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic- ro 43 gil, Songpa-gu, Seoul, Korea
| | - Hyoungmin Na
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic- ro 43 gil, Songpa-gu, Seoul, Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic- ro 43 gil, Songpa-gu, Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic- ro 43 gil, Songpa-gu, Seoul, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic- ro 43 gil, Songpa-gu, Seoul, Korea
| | - Chan-Sik Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic- ro 43 gil, Songpa-gu, Seoul, Korea
| | - Youngkyoung Lim
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic- ro 43 gil, Songpa-gu, Seoul, Korea.
- Present address: Department of Dermatology, Seoul National University Hospital, 101, Daehak ro, Jongno gu, Seoul, Korea.
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic- ro 43 gil, Songpa-gu, Seoul, Korea.
| |
Collapse
|
7
|
Commentary on Systematic Review of Technical Variations for "Mohs Micrographic Surgery for Melanoma". Dermatol Surg 2021; 47:1545-1546. [PMID: 34818270 DOI: 10.1097/dss.0000000000003262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
8
|
Dass SE, Huizenga T, Farshchian M, Mehregan DR. Comparison of SOX-10, HMB-45, and Melan-A in Benign Melanocytic Lesions. Clin Cosmet Investig Dermatol 2021; 14:1419-1425. [PMID: 34675577 PMCID: PMC8502009 DOI: 10.2147/ccid.s333376] [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: 08/12/2021] [Accepted: 09/28/2021] [Indexed: 02/01/2023]
Abstract
Purpose Different immunohistochemical stains are used in dermatopathology to stain melanocytes and diagnose benign and malignant melanocytic lesions. Methods SOX-10, HMB-45, and Melan-A immunohistochemical stains were used to assess 32 biopsy specimens with a histologic diagnosis of lentigo. The total number of melanocytes stained with each immunohistochemical stain was counted and an average count was obtained from two readings. Results Analysis of the data revealed a significant difference in staining melanocytes between these three immunostains (p=0.0010, ANOVA). SOX-10 stained 0.195 more melanocytes than HMB-45 (p=0.0026). Similarly, Melan-A stained 0.195 more melanocytes than HMB-45 (p=0.0011). However, the difference between SOX-10 and Melan-A was not statistically significant (p=0.9810). Conclusion SOX-10 and Melan-A immunostaining stain more melanocytes than HMB-45. No significant difference was noted between Melan-A and SOX-10.
Collapse
Affiliation(s)
- Sabrina E Dass
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Taryn Huizenga
- Department of Dermatology, Wayne State University, Detroit, MI, USA
| | - Mehdi Farshchian
- Department of Dermatology, Wayne State University, Detroit, MI, USA
| | | |
Collapse
|
9
|
Hessler M, Jalilian E, Xu Q, Reddy S, Horton L, Elkin K, Manwar R, Tsoukas M, Mehregan D, Avanaki K. Melanoma Biomarkers and Their Potential Application for In Vivo Diagnostic Imaging Modalities. Int J Mol Sci 2020; 21:E9583. [PMID: 33339193 PMCID: PMC7765677 DOI: 10.3390/ijms21249583] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/09/2020] [Accepted: 12/12/2020] [Indexed: 12/16/2022] Open
Abstract
Melanoma is the deadliest form of skin cancer and remains a diagnostic challenge in the dermatology clinic. Several non-invasive imaging techniques have been developed to identify melanoma. The signal source in each of these modalities is based on the alteration of physical characteristics of the tissue from healthy/benign to melanoma. However, as these characteristics are not always sufficiently specific, the current imaging techniques are not adequate for use in the clinical setting. A more robust way of melanoma diagnosis is to "stain" or selectively target the suspect tissue with a melanoma biomarker attached to a contrast enhancer of one imaging modality. Here, we categorize and review known melanoma diagnostic biomarkers with the goal of guiding skin imaging experts to design an appropriate diagnostic tool for differentiating between melanoma and benign lesions with a high specificity and sensitivity.
Collapse
Affiliation(s)
- Monica Hessler
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48201, USA; (M.H.); (Q.X.); (S.R.); (L.H.); (K.E.); (R.M.)
- Department of Dermatology, School of Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA;
| | - Elmira Jalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60607, USA;
| | - Qiuyun Xu
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48201, USA; (M.H.); (Q.X.); (S.R.); (L.H.); (K.E.); (R.M.)
| | - Shriya Reddy
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48201, USA; (M.H.); (Q.X.); (S.R.); (L.H.); (K.E.); (R.M.)
| | - Luke Horton
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48201, USA; (M.H.); (Q.X.); (S.R.); (L.H.); (K.E.); (R.M.)
- Department of Dermatology, School of Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA;
| | - Kenneth Elkin
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48201, USA; (M.H.); (Q.X.); (S.R.); (L.H.); (K.E.); (R.M.)
- Department of Dermatology, School of Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA;
| | - Rayyan Manwar
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48201, USA; (M.H.); (Q.X.); (S.R.); (L.H.); (K.E.); (R.M.)
- Richard and Loan Hill Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Maria Tsoukas
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL 60607, USA;
| | - Darius Mehregan
- Department of Dermatology, School of Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA;
| | - Kamran Avanaki
- Richard and Loan Hill Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL 60607, USA;
| |
Collapse
|
10
|
See SHC, Finkelman BS, Yeldandi AV. The diagnostic utility of PRAME and p16 in distinguishing nodal nevi from nodal metastatic melanoma. Pathol Res Pract 2020; 216:153105. [PMID: 32825968 DOI: 10.1016/j.prp.2020.153105] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 01/12/2023]
Abstract
The status of the sentinel lymph node is the strongest predictor of recurrence in patients with malignant melanoma, making accurate distinction between nodal metastases and nodal nevi of paramount importance. We explored the utility of p16 and PRAME in differentiating nodal nevi from metastatic melanoma by immunohistochemistry. We searched our institutional database for cases of nodal nevi and nodal metastatic melanoma. p16 and PRAME expression were assessed with immunolabeling quantified by extent of nuclear positivity (0-25 %, >25 %-50 %, >50 %-75 % and >75 %). Sensitivities and specificities were calculated, and discrimination assessed using the area under the receiver operating characteristic curve (AUC). Forty-nine cases out of 51 nevi and 56/56 melanoma cases had lesional tissue present for p16, while 44/51 nevi and 54/56 melanoma cases had lesional tissue present for PRAME. 43 nodal nevi (88 %) had >50 % nuclear staining for p16, while none had >50 % staining for PRAME. More than half (55 %) of melanoma cases had complete loss of nuclear staining for p16, while majority (94 %) had >50 % nuclear staining for PRAME. Using a cut-off value of 50 %, higher PRAME expression had a sensitivity and specificity of 94 % and 100 %, respectively, while lower p16 expression had a sensitivity and specificity of 66 % and 88 %, respectively, for detecting metastatic melanoma. PRAME showed significantly better discrimination (AUC = 0.97, 95 % CI 0.94-1.00) than p16 (AUC = 0.77, 95 % CI 0.68-0.86) for differentiating nodal nevi from nodal melanoma (P < 0.001). Our findings suggest that PRAME is more accurate than p16 in discriminating between the two entities, with excellent sensitivity and specificity.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antigens, Neoplasm/metabolism
- Biomarkers, Tumor/analysis
- Cyclin-Dependent Kinase Inhibitor p16/metabolism
- Diagnosis, Differential
- Female
- Humans
- Lymphatic Metastasis/pathology
- Male
- Melanoma/diagnosis
- Melanoma/metabolism
- Melanoma/pathology
- Middle Aged
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/metabolism
- Neoplasm Recurrence, Local/pathology
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/pathology
- Nevus, Pigmented/diagnosis
- Nevus, Pigmented/pathology
- Sentinel Lymph Node Biopsy/methods
- Skin Neoplasms/diagnosis
- Skin Neoplasms/metabolism
- Skin Neoplasms/pathology
- Melanoma, Cutaneous Malignant
Collapse
Affiliation(s)
- Sharlene Helene C See
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Brian S Finkelman
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Anjana V Yeldandi
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
11
|
Observational Study Examining the Diagnostic Practice of Ki67 Staining for Melanocytic Lesions. Am J Dermatopathol 2019; 41:488-491. [DOI: 10.1097/dad.0000000000001379] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
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]
|
13
|
Koh SS, Cassarino DS. Immunohistochemical Expression of p16 in Melanocytic Lesions: An Updated Review and Meta-analysis. Arch Pathol Lab Med 2019; 142:815-828. [PMID: 29939777 DOI: 10.5858/arpa.2017-0435-ra] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Making an accurate diagnosis for melanocytic lesions has always been challenging for pathologists, especially when dealing with difficult-to-diagnose cases. Misdiagnosis of melanoma and melanocytic lesions in general has tremendous medical-legal implications, often leading to unnecessary and excessive use of adjunctive tests. Although molecular testing is of much interest and there is great support for its development, currently, for most melanocytic lesions, immunohistochemical studies remain the most practical method for assistance in the routine diagnosis of melanocytic lesions for the average pathologist. OBJECTIVES - To review the practical use of p16 immunohistochemistry for evaluating melanocytic lesions, particularly for differentiating benign from malignant tumors, and to perform a meta-analysis of primary studies evaluating p16 immunohistochemistry in melanocytic lesions. DATA SOURCES - A PubMed database search for literature reporting melanocytic lesions and p16 immunohistochemistry was performed. Essential information from each study (number of samples, antibody used, collection dates, overall p16 immunohistochemistry results, and general method of interpretation) was tabulated and analyzed. Examples of representative cases showing p16 immunostaining pattern are also illustrated. CONCLUSIONS - Incorporation of p16 immunohistochemistry for the diagnosis of melanocytic lesions is of limited use, especially for the purpose of differentiating benign from malignant lesions. Evaluation of multiple studies reveals a wide range of results. However, there appears to be some value for the use of p16 in distinguishing nodal nevi from metastatic melanoma within nodes. The method of interpretation (nuclear versus cytoplasmic staining) also appears to give differing results, as studies considering only nuclear staining appeared to show more consistent results from study to study.
Collapse
Affiliation(s)
| | - David S Cassarino
- From the Department of Pathology and Dermatopathology, Kaiser Permanente Anaheim Medical Center, Anaheim, California
| |
Collapse
|
14
|
Bang E, Lee EK, Noh S, Jung HJ, Moon KM, Park MH, Park YJ, Hyun MK, Lee AK, Kim SJ, Yang J, Park Y, Chun P, Moon HR, Chung HY. In vitro and in vivo evidence of tyrosinase inhibitory activity of a synthesized(Z)‐5‐(3‐hydroxy‐4‐methoxybenzylidene)‐2‐thioxothiazolidin‐4‐one (5‐HMT). Exp Dermatol 2019; 28:734-737. [DOI: 10.1111/exd.13863] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- EunJin Bang
- Molecular Inflammation Research Center for Aging Intervention (MRCA)College of PharmacyPusan National University Busan Korea
- College of PharmacyPusan National University Busan Korea
| | - Eun Kyeong Lee
- Molecular Inflammation Research Center for Aging Intervention (MRCA)College of PharmacyPusan National University Busan Korea
- Korea Institute of Toxicology Daejeon Korea
| | - Sang‐Gyun Noh
- Molecular Inflammation Research Center for Aging Intervention (MRCA)College of PharmacyPusan National University Busan Korea
| | - Hee Jin Jung
- Molecular Inflammation Research Center for Aging Intervention (MRCA)College of PharmacyPusan National University Busan Korea
| | - Kyoung Mi Moon
- Korean Medicine (KM)‐Application CenterKorea Institute of Oriental Medicine (KIOM) Daegu Korea
| | - Mi Hwa Park
- Pusan National University Hospital Biomedical Research Institute Busan Korea
| | - Yeo Jin Park
- College of PharmacyPusan National University Busan Korea
| | - Min Kyung Hyun
- College of PharmacyPusan National University Busan Korea
| | - A Kyoung Lee
- College of PharmacyPusan National University Busan Korea
| | - Su Jeong Kim
- Molecular Inflammation Research Center for Aging Intervention (MRCA)College of PharmacyPusan National University Busan Korea
| | - Jungho Yang
- Molecular Inflammation Research Center for Aging Intervention (MRCA)College of PharmacyPusan National University Busan Korea
| | - Yujin Park
- Molecular Inflammation Research Center for Aging Intervention (MRCA)College of PharmacyPusan National University Busan Korea
| | - Pusoon Chun
- College of Pharmacy and Inje Institute of Pharmaceutical Sciences and ResearchInje University Gimhae Gyeongnam Korea
| | - Hyung Ryong Moon
- Molecular Inflammation Research Center for Aging Intervention (MRCA)College of PharmacyPusan National University Busan Korea
- College of PharmacyPusan National University Busan Korea
| | - Hae Young Chung
- Molecular Inflammation Research Center for Aging Intervention (MRCA)College of PharmacyPusan National University Busan Korea
- College of PharmacyPusan National University Busan Korea
| |
Collapse
|
15
|
Sivaraju L, Ghosal N, Mahadevan A, Uday Krishna AS, Rao S, Hegde AS. Aggressive Primary Pediatric Intracranial Malignant Melanoma: Sphinx of the Tissue Diagnosis. Asian J Neurosurg 2019; 14:275-279. [PMID: 30937053 PMCID: PMC6417341 DOI: 10.4103/ajns.ajns_253_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
It is often intriguing to suspect and confirm the diagnosis of primary malignant melanoma (PMM) in the brain without any evidence of neurocutaneous melanosis. We report a 16-year-old male patient with malignant melanoma which intraoperatively was small sized, soft, fleshy, hemorrhagic in appearance resembling hematoma. Interestingly, the histopathology showed prominent papillary architecture with a differential diagnosis of papillary meningioma and ependymoma and perplexed the tissue diagnosis. This case is discussed in light of very uncommon occurrence of intracranial PMM in pediatric age group, enigmatic histological features, and aggressive nature of lesion with rapid progression despite complete excision following radiation therapy.
Collapse
Affiliation(s)
- Laxminadh Sivaraju
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Nandita Ghosal
- Department of Pathology and Transfusion Medicine, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - A S Uday Krishna
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Shilpa Rao
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Alangar S Hegde
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| |
Collapse
|
16
|
|
17
|
Murtas D, Pilloni L, Diana A, Casula L, Tomei S, Piras F, Ferreli C, Maxia C, Perra MT. Tyrosinase and nestin immunohistochemical expression in melanocytic nevi as a histopathologic pattern to trace melanocyte differentiation and nevogenesis. Histochem Cell Biol 2018; 151:175-185. [PMID: 30232588 DOI: 10.1007/s00418-018-1730-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
Abstract
While histological analysis represents a powerful tool for the classification of melanocytic lesions as benign or malignant, a clear-cut distinction between a nevus and a melanoma is sometimes a challenging step of the diagnostic process. The immunohistochemical detection of tyrosinase, cardinal melanogenic enzyme during melanocytic maturation, has often been helpful in formulating a differential diagnosis due to the peculiar staining pattern in nevocytes compared with melanoma cells. Tyrosinase distribution in nevi appears to overlap with the cytoarchitectural changes observable within these lesions, that result in epidermal or superficial dermal nevocytes being larger and strongly expressing melanocytic differentiation antigens, such as tyrosinase, compared with deeper dermal nevus cells. Our study aimed to evaluate the immunohistochemical expression pattern of tyrosinase in different histological types of acquired dysplastic melanocytic nevi, including junctional, compound, and intradermal nevi. Moreover, to estimate whether in nevocytes the expression of tyrosinase was associated with their differentiation state, we investigated the expression of two recognized markers of pluripotency, CD34 and nestin. In all examined nevi, our analysis revealed a remarkable immunoreactivity for tyrosinase in junctional and superficial dermal nevocytes and a decreasing gradient of staining in dermal nevocytes, up to become negative in deeper dermis. Meanwhile, junctional and dermal nevocytes were lacking in CD34 protein. Furthermore, nestin immunostaining showed an opposite distribution compared with tyrosinase, leading us to look into the tyrosinase/nestin expression pattern in melanocytic nevus as a tool to better understand the final stages of differentiation of melanocyte precursors toward their ultimate anatomical site into the epidermis.
Collapse
Affiliation(s)
- Daniela Murtas
- Section of Cytomorphology, Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, S.P. 8, Monserrato, 09042, Cagliari, Italy.
| | - Luca Pilloni
- Section of Pathology, Department of Surgical Sciences, University of Cagliari, Via Ospedale, 09124, Cagliari, Italy
| | - Andrea Diana
- Section of Cytomorphology, Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, S.P. 8, Monserrato, 09042, Cagliari, Italy.
| | - Laura Casula
- Department of Medical Sciences and Public Health, University of Cagliari, Via Ospedale, 09124, Cagliari, Italy
| | - Sara Tomei
- Omics Core and Biorepository, Sidra Medical and Research Center, Doha, Qatar
| | - Franca Piras
- Section of Cytomorphology, Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, S.P. 8, Monserrato, 09042, Cagliari, Italy
| | - Caterina Ferreli
- Department of Medical Sciences and Public Health, University of Cagliari, Via Ospedale, 09124, Cagliari, Italy
| | - Cristina Maxia
- Section of Cytomorphology, Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, S.P. 8, Monserrato, 09042, Cagliari, Italy
| | - Maria Teresa Perra
- Section of Cytomorphology, Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, S.P. 8, Monserrato, 09042, Cagliari, Italy
| |
Collapse
|
18
|
Xia Y, Mashouf LA, Maxwell R, Peng LC, Lipson EJ, Sharfman WH, Bettegowda C, Redmond KJ, Kleinberg LR, Lim M. Adjuvant radiotherapy and outcomes of presumed hemorrhagic melanoma brain metastases without malignant cells. Surg Neurol Int 2018; 9:146. [PMID: 30105140 PMCID: PMC6080145 DOI: 10.4103/sni.sni_140_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/14/2018] [Indexed: 12/28/2022] Open
Abstract
Background Patients with melanoma can present with a hemorrhagic intracranial lesion. Upon resection, pathology reports may not detect any malignant cells. However, the hemorrhage may obscure their presence and so physicians may still decide whether adjuvant radiotherapy should be applied. Here, we report on the outcomes of a series of patients with melanoma with hemorrhagic brain lesions that returned with no tumor cells. Methods All melanoma patients who had craniotomies from 2008 to 2017 at a single institution for hemorrhagic brain lesions were identified through retrospective chart review. Those who had pathology reports with no malignant cells were analyzed. Recurrence at the former site of hemorrhage and resection was the primary outcome. Results Ten patients met inclusion criteria, and the median follow-up time was 8.5 (1.8-27.3) months. At the time of craniotomy, the median number of brain lesions was 3 (1-25). Two patients had prior craniotomies, eight had prior radiation, and six had prior immunotherapy to the lesion of interest. After surgery, one patient received stereotactic radiosurgery (SRS) to the resection bed. Only one patient developed subsequent melanoma at the resection site; this patient developed the lesion recurrence once and had not received postoperative SRS. Conclusion Although small foci of metastatic disease as a source of bleeding for some patients cannot be excluded, melanoma patients with a suspected hemorrhagic brain metastasis that shows no tumor cells on pathology may benefit from close observation. The local recurrence risk in such cases appears to be low, even without adjuvant radiation.
Collapse
Affiliation(s)
- Yuanxuan Xia
- Department of Neurosurgery, Johns Hopkins Medical Institutes, Baltimore, Maryland, USA
| | - Leila A Mashouf
- Department of Neurosurgery, Johns Hopkins Medical Institutes, Baltimore, Maryland, USA
| | - Russell Maxwell
- Department of Neurosurgery, Johns Hopkins Medical Institutes, Baltimore, Maryland, USA.,Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medical Institutes, Baltimore, Maryland, USA
| | - Luke C Peng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medical Institutes, Baltimore, Maryland, USA
| | - Evan J Lipson
- Department of Oncology, Johns Hopkins Medical Institutes, Baltimore, Maryland, USA
| | - William H Sharfman
- Department of Oncology, Johns Hopkins Medical Institutes, Baltimore, Maryland, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins Medical Institutes, Baltimore, Maryland, USA
| | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medical Institutes, Baltimore, Maryland, USA
| | - Lawrence R Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medical Institutes, Baltimore, Maryland, USA
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins Medical Institutes, Baltimore, Maryland, USA.,Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medical Institutes, Baltimore, Maryland, USA.,Department of Oncology, Johns Hopkins Medical Institutes, Baltimore, Maryland, USA
| |
Collapse
|
19
|
Harvey NT, Wood BA. A Practical Approach to the Diagnosis of Melanocytic Lesions. Arch Pathol Lab Med 2018; 143:789-810. [PMID: 30059258 DOI: 10.5858/arpa.2017-0547-ra] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Melanocytic lesions are common in routine surgical pathology. Although the majority of these lesions can be confidently diagnosed using well-established morphologic criteria, there is a significant subset of lesions that can be diagnostically difficult. These can be a source of anxiety for patients, clinicians, and pathologists, and the potential consequences of a missed diagnosis of melanoma are serious. OBJECTIVE.— To provide a practical approach to the diagnosis of melanocytic lesions, including classic problem areas as well as suggestions for common challenges and appropriate incorporation of ancillary molecular techniques. DATA SOURCES.— Literature search using PubMed and Google Scholar, incorporating numerous search terms relevant to the particular section, combined with contemporaneous texts and lessons from personal experience. CONCLUSIONS.— Although a subset of melanocytic lesions can be diagnostically challenging, the combination of a methodical approach to histologic assessment, knowledge of potential diagnostic pitfalls, opinions from trusted colleagues, and judicious use of ancillary techniques can help the pathologist navigate this difficult area.
Collapse
Affiliation(s)
- Nathan T Harvey
- From the Dermatopathology Group, Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia; and the Division of Pathology and Laboratory Medicine, Medical School, University of Western Australia, Perth, Australia
| | - Benjamin A Wood
- From the Dermatopathology Group, Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia; and the Division of Pathology and Laboratory Medicine, Medical School, University of Western Australia, Perth, Australia
| |
Collapse
|
20
|
Filosa A, Filosa G. Melanoma Diagnosis: The Importance of Histopathological Report. Dermatopathology (Basel) 2018; 5:41-43. [PMID: 29719829 PMCID: PMC5920954 DOI: 10.1159/000486670] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/08/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Giorgio Filosa
- Dermatology Unit, AV2, Carlo Ubani Hospital, Jesi, Italy
| |
Collapse
|
21
|
Parra-Medina R, Morales SD. Diagnostic utility of epithelial and melanocitic markers with double sequential immunohistochemical staining in differentiating melanoma in situ from invasive melanoma. Ann Diagn Pathol 2017; 26:70-74. [PMID: 27594302 DOI: 10.1016/j.anndiagpath.2016.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 07/01/2016] [Indexed: 10/21/2022]
Abstract
Identification of melanoma in situ and its distinction from invasive melanoma is important because of its significant impact on morbidity and mortality. However, this interpretation can cause pitfalls in the diagnosis even with the use of immunohistochemistry. The aim of this study is to evaluate the diagnostic utility of epithelial makers (AE1/AE3, CK5/6, and p63) combined with melanocytic markers (HMB-45, S-100, or Melan-A) using dual-color immunohistochemical staining, performed on a single slide by sequentially applying the antibodies. In this study, we show 4 cases in which examination of routine hematoxylin and eosin slides did not allow for clear-cut distinction between in situ and invasive melanoma and highlight the utility of the double-staining method. Therefore, we recommend this double-staining method with melanocytic and epithelial markers as a helpful adjunct to the diagnosis of cases with a differential diagnosis between in situ and invasive melanoma.
Collapse
Affiliation(s)
- Rafael Parra-Medina
- Department of Pathology, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | - Samuel David Morales
- Department of Pathology, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia; Department of Pathology, National Institute of Cancer, Bogotá, Colombia.
| |
Collapse
|
22
|
Use of New Techniques in Addition to IHC Applied to the Diagnosis of Melanocytic Lesions, With Emphasis on CGH, FISH, and Mass Spectrometry. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:17-30. [DOI: 10.1016/j.ad.2016.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/03/2016] [Accepted: 05/09/2016] [Indexed: 02/08/2023] Open
|
23
|
Nagarajan P, Tetzlaff M, Curry J, Prieto V. Use of New Techniques in Addition to IHC Applied to the Diagnosis of Melanocytic Lesions, With Emphasis on CGH, FISH, and Mass Spectrometry. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2016.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
24
|
Generation of metastatic melanoma specific antibodies by affinity purification. Sci Rep 2016; 6:37253. [PMID: 27853253 PMCID: PMC5112778 DOI: 10.1038/srep37253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 10/26/2016] [Indexed: 12/03/2022] Open
Abstract
Melanoma is the most aggressive type of skin cancer and one of the most frequent tumours in young adults. Identification of primary tumours prone to develop metastasis is of paramount importance for further patient stratification. However, till today, no markers exist that are routinely used to predict melanoma progression. To ameliorate this problem, we generated antiserum directed against metastatic melanoma tissue lysate and applied a novel approach to purify the obtained serum via consecutive affinity chromatography steps. The established antibody, termed MHA-3, showed high reactivity against metastatic melanoma cell lines both in vitro and in vivo. We also tested MHA-3 on 227 melanoma patient samples and compared staining with the melanoma marker S100b. Importantly, MHA-3 was able to differentiate between metastatic and non-metastatic melanoma samples. By proteome analysis we identified 18 distinct antigens bound by MHA-3. Combined expression profiling of all identified proteins revealed a significant survival difference in melanoma patients. In conclusion, we developed a polyclonal antibody, which is able to detect metastatic melanoma on paraffin embedded sections. Hence, we propose that this antibody will represent a valuable additional tool for precise melanoma diagnosis.
Collapse
|
25
|
Al-Rohil RN, Curry JL, Torres-Cabala CA, Nagarajan P, Ivan D, Aung PP, Lyons GF, Bassett RL, Prieto VG, Tetzlaff MT. Proliferation indices correlate with diagnosis and metastasis in diagnostically challenging melanocytic tumors. Hum Pathol 2016; 53:73-81. [DOI: 10.1016/j.humpath.2016.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/11/2016] [Accepted: 02/17/2016] [Indexed: 10/22/2022]
|
26
|
Oral Congenital Melanocytic Nevus: A Rare Case Report and Review of the Literature. Head Neck Pathol 2015; 9:481-7. [PMID: 26142565 PMCID: PMC4651921 DOI: 10.1007/s12105-015-0639-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/29/2015] [Indexed: 10/23/2022]
Abstract
Melanocytic nevi are congenital or acquired benign proliferations of cells of melanocytic origin. Oral congenital melanocytic nevi are rare, and only a few cases have been reported in the literature. The purpose of this study is to present the clinical, histological and immunohistochemical features of an oral congenital melanocytic nevus in a 16-year-old female with an 11-year follow-up and to review the pertinent literature. The reported case is the fifth well-documented case report of oral congenital melanocytic nevus in the English literature and the first with a long period of follow-up, thereby making it an important contribution to the knowledge regarding this uncommon oral mucosa lesion.
Collapse
|
27
|
Abstract
CONTEXT Immunohistochemistry is not a diagnostic test but a highly valuable tool that requires interpretation within a context. OBJECTIVE To review the current status and limitations of immunohistochemistry in dermatopathology. DATA SOURCES English-language literature published between 1980 and 2014. CONCLUSIONS Although immunohistochemistry is rarely completely specific or sensitive, it is an important adjunctive technique in dermatopathology and can be helpful in a series of diagnostic dilemmas.
Collapse
Affiliation(s)
- Tammie Ferringer
- From the Departments of Dermatology and Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania
| |
Collapse
|
28
|
Brandão J, Blair R, Kelly A, Fowlkes N, Shiomitsu K, Espinheira Gomes F, Rich G, Tully TN. Amelanotic Melanoma in the Rabbit: A Case Report With an Overview of Immunohistochemical Characterization. J Exot Pet Med 2015. [DOI: 10.1053/j.jepm.2015.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
29
|
Forty-three-year-old woman with mediastinal PEComa treated with chemoradiation therapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2015. [DOI: 10.1017/s1460396913000526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThe rarity of PEComa tumours has precluded any clinical trials, but surgery remains the most commonly reported treatment modality with just a few reports on treatment plans involving chemoradiation. We describe a patient with a mediastinal PEComa who presented with symptoms concerning for superior vena cava syndrome. She was deemed inoperable and was thus treated exclusively with chemoradiation therapy. The use of chemoradiation in the treatment of PEComa tumours is reviewed.
Collapse
|
30
|
Tetzlaff MT, Torres-Cabala CA, Pattanaprichakul P, Rapini RP, Prieto VG, Curry JL. Emerging clinical applications of selected biomarkers in melanoma. Clin Cosmet Investig Dermatol 2015; 8:35-46. [PMID: 25674009 PMCID: PMC4321413 DOI: 10.2147/ccid.s49578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Melanoma is a lethal skin disease with a mostly predictable clinical course according to a known constellation of clinical and pathologic features. The distinction of melanoma from benign melanocytic nevus is typically unequivocol; however, there is a subset of tumors known for its diagnostic challenges, development of late metastases, and difficulties in treatment. Several melanocytic tissue biomarkers are available that can facilitate the histopathologic interpretation of melanoma as well as provide insight into the biologic potential and mutational status of this disease. This review describes the clinical application of some of these established and emerging tissue biomarkers available to assess melanocytic differentiation, vascular invasion, mitotic capacity, and mutation status. The selected tissue biomarkers in this review include MiTF, Sox10, D2-40, PHH3, H3KT (anti-H3K79me3T80ph), anti-BRAFV600E, and anti-BAP-1.
Collapse
Affiliation(s)
- Michael T Tetzlaff
- Department of Pathology, Section of Dermatopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos A Torres-Cabala
- Department of Pathology, Section of Dermatopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Penvadee Pattanaprichakul
- Department of Pathology, Section of Dermatopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ronald P Rapini
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Victor G Prieto
- Department of Pathology, Section of Dermatopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jonathan L Curry
- Department of Pathology, Section of Dermatopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
31
|
Cassarino DS, Lewine N, Cole D, Wade B, Gustavsen G. Budget impact analysis of a novel gene expression assay for the diagnosis of malignant melanoma. J Med Econ 2014; 17:782-91. [PMID: 25170544 DOI: 10.3111/13696998.2014.950421] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Traditional pathology techniques alone can be insufficient to reliably distinguish between malignant melanoma, dysplastic nevi, and benign nevi in biopsies of suspicious pigmented lesions. Numerous studies have shown high rates of ambiguity when assessing such samples. A novel gene expression assay has been developed to objectively differentiate malignant melanoma from benign nevi. OBJECTIVE The purpose of this study was to quantify the economic impact of the gene expression assay on a US commercial health plan. METHODS The clinical paradigm of care was modeled for a hypothetical cohort of patients with suspicious pigmented lesions that are difficult-to-diagnose. Costs were assigned to each unit of care provided based on 2013 Medicare fee-for-service rates. Patients were followed for 10 years and were modeled to progress according to the natural history of their disease. The total cost of care was calculated for two scenarios: a Reference Scenario, representing current clinical practice, and a Test Scenario, in which each lesion was tested with the gene expression assay and diagnosed. Total cost of care was compared between the two scenarios to determine overall budget impact. Sensitivity analyses were performed to test the robustness of the model. RESULTS The gene expression assay reduces costs by $1268 per patient tested over 10 years, a decrease of 8.3%, after accounting for the cost of the assay. For a health plan with 10 million members, this would translate to over $8 million in savings. The largest portion of this saving comes from reducing the number of missed melanomas, which would otherwise progress to advanced disease. In sensitivity analyses, no single model input changed within a reasonable range of values caused the model to show that the assay was not cost-saving. CONCLUSION In addition to improving the diagnosis of melanoma, this gene expression assay would likely reduce costs for health plans that choose to cover it.
Collapse
Affiliation(s)
- David S Cassarino
- Department of Pathology, Southern California Permanente Medical Group , Los Angeles, CA , USA
| | | | | | | | | |
Collapse
|
32
|
Desman G, Waintraub C, Zippin JH. Investigation of cAMP microdomains as a path to novel cancer diagnostics. Biochim Biophys Acta Mol Basis Dis 2014; 1842:2636-45. [PMID: 25205620 DOI: 10.1016/j.bbadis.2014.08.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/21/2014] [Accepted: 08/26/2014] [Indexed: 12/17/2022]
Abstract
Understanding of cAMP signaling has greatly improved over the past decade. The advent of live cell imaging techniques and more specific pharmacologic modulators has led to an improved understanding of the intricacies by which cAMP is able to modulate such a wide variety of cellular pathways. It is now appreciated that cAMP is able to activate multiple effector proteins at distinct areas in the cell leading to the activation of very different downstream targets. The investigation of signaling proteins in cancer is a common route to the development of diagnostic tools, prognostic tools, and/or therapeutic targets, and in this review we highlight how investigation of cAMP signaling microdomains driven by the soluble adenylyl cyclase in different cancers has led to the development of a novel cancer biomarker. Antibodies directed against the soluble adenylyl cyclase (sAC) are highly specific markers for melanoma especially for lentigo maligna melanoma and are being described as "second generation" cancer diagnostics, which are diagnostics that determine the 'state' of a cell and not just identify the cell type. Due to the wide presence of cAMP signaling pathways in cancer, we predict that further investigation of both sAC and other cAMP microdomains will lead to additional cancer biomarkers. This article is part of a Special Issue entitled: The role of soluble adenylyl cyclase in health and disease.
Collapse
Affiliation(s)
- Garrett Desman
- Department of Pathology, Joan and Sanford I. Weill Medical College of Cornell University, 1300 York Avenue, New York, NY 10021, USA
| | - Caren Waintraub
- Albert Einstein College of Medicine at Yeshiva University, 1300 Morris Park Avenue, Bronx, NY 10461, USA; Department of Dermatology, Joan and Sanford I. Weill Medical College of Cornell University, 1300 York Avenue, New York, NY 10021, USA
| | - Jonathan H Zippin
- Department of Dermatology, Joan and Sanford I. Weill Medical College of Cornell University, 1300 York Avenue, New York, NY 10021, USA.
| |
Collapse
|
33
|
Kuźbicki Ł, Urban J, Chwirot BW. Different detectability of cyclooxygenase-2 (COX-2) protein in standard paraffin sections and tissue microarrays of human melanomas and naevi – Comparative study. Pathol Res Pract 2014; 210:591-5. [DOI: 10.1016/j.prp.2014.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 03/31/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
|
34
|
Trevisan F, Pinto JCCL, de Moraes Alves CAX, Pinto CAL, de Macedo MP, Costa FD, Neto JPD. Clear cell sarcoma: a case report from clinic to cytogenetic studies. Int J Dermatol 2014; 54:e126-31. [DOI: 10.1111/ijd.12147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Flavia Trevisan
- Department of Dermatology; Medicine Faculty of Jundai; Jundiaí Brasil
| | | | | | - Clóvis Antonio Lopes Pinto
- Department of Pathology; Medicine Faculty of Jundai; Jundiaí Brasil
- Department of Pathology and Center of Skin Cancer; A. C. Camarco Hospital; São Paulo Brasil
| | | | - Felipe D'Almeida Costa
- Department of Pathology and Center of Skin Cancer; A. C. Camarco Hospital; São Paulo Brasil
| | | |
Collapse
|
35
|
Seleit I, Bakry OA, Abdou AG, Dawoud NM. Immunohistochemical evaluation of vitiliginous hair follicle melanocyte reservoir: is it retained? J Eur Acad Dermatol Venereol 2014; 29:444-51. [PMID: 24909913 DOI: 10.1111/jdv.12573] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 04/29/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vitiligo is an acquired depigmentaion of skin and hair. The presence of white hair within vitiligo lesions is considered a bad prognostic sign since these lesions are difficult to repigment. Melanocyte reservoir was not extensively studied in vitiliginous white hair. OBJECTIVE To evaluate pigment cell reservoir in vitiliginous black and white hair. METHOD Using immunohistochemical technique, skin biopsies from 30 vitiligo patients (including either black or white hair) and 10 age- and gender-matched healthy subjects were examined. Human Melanoma Black-45 (HMB-45) was used for detecting active melanocytes and Tyrosinase Related Protein 2 (TRP2) for detecting the whole melanocyte lineage including melanocyte stem cells (MelSC). RESULTS About 61.1% of black hair was positive for HMB-45 and 83.3% was positive for TRP2. About 25% of white hair was positive for HMB-45 and 75% retained TRP2 positivity. Follicular HMB-45 expression and TRP2 expression percentage were significantly lower in white than black hair (P = 0.05, 0.04 respectively). Epidermal HMB-45 and TRP2 expression percentages were significantly higher in lesions containing black rather than white hair (P < 0.001, P = 0.05 respectively). Black hair was significantly associated with histologically pigmented hair follicles (P = 0.049), and with residual interfollicular melanin pigment (P = 0.007). CONCLUSION Melanocytes, either active (melanotic) or inactive (amelanotic which may include MelSC), are not totally absent from vitiliginous white hair. However, intact melanocyte reservoir was observed more in black than white hair. This may add avenues for future research about the possibility of white vitiliginous hair to repigment.
Collapse
Affiliation(s)
- I Seleit
- Faculty of Medicine, Department of Dermatology, Andrology and STDs, Menoufiya University, Shebein Elkom, Egypt
| | | | | | | |
Collapse
|
36
|
Euscher E, Malpica A. Use of immunohistochemistry in the diagnosis of miscellaneous and metastatic tumors of the uterine corpus and cervix. Semin Diagn Pathol 2014; 31:233-57. [PMID: 24863030 DOI: 10.1053/j.semdp.2014.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Uncommon tumors in the uterus present diagnostic challenges. In some cases, the tumor subtype is usually seen outside the gynecologic tract and the possibility of a uterine primary is not considered. In other cases, histologic overlap with more common uterine tumors leads to potential misdiagnosis. Finally, metastatic carcinoma may involve the uterus and cervix. Rarely, symptoms related to the uterine metastasis may precede diagnosis of an extrauterine primary. Without the proper clinical context, the possibility of a missed diagnosis is increased. One must first be aware of these possibilities, but immunoperoxidase studies are often necessary to confirm the diagnosis. In this review, unusual and metastatic tumors involving the uterine corpus and cervix and immunoperoxidase studies used to diagnosis such tumors are discussed.
Collapse
Affiliation(s)
- Elizabeth Euscher
- The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 85, Houston, Texas 77030.
| | - Anais Malpica
- The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 85, Houston, Texas 77030
| |
Collapse
|
37
|
Ordóñez NG. Value of melanocytic-associated immunohistochemical markers in the diagnosis of malignant melanoma: a review and update. Hum Pathol 2014; 45:191-205. [PMID: 23648379 DOI: 10.1016/j.humpath.2013.02.007] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 02/12/2013] [Accepted: 02/15/2013] [Indexed: 11/21/2022]
Abstract
Since the identification of S100 protein as an immunohistochemical marker that could be useful in the diagnosis of melanoma in the early 1980s, a large number of other melanocytic-associated markers that could potentially be used to assist in the differential diagnosis of these tumors have also been investigated. A great variation exists, however, among these markers, not only in their expression in some subtypes of melanoma, particularly desmoplastic melanoma, but also in their specificity because some of them can also be expressed in nonmelanocytic neoplasms, including various types of soft tissue tumors and carcinomas. This article reviews the information that is currently available on the practical value of some of the markers that have more often been recommended for assisting in the diagnosis of melanomas, including those that have only recently become available.
Collapse
Affiliation(s)
- Nelson G Ordóñez
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030.
| |
Collapse
|
38
|
Seleit I, Bakry OA, Abdou AG, Dawoud NM. Immunohistochemical study of melanocyte-melanocyte stem cell lineage in vitiligo; a clue to interfollicular melanocyte stem cell reservoir. Ultrastruct Pathol 2014; 38:186-98. [PMID: 24460782 DOI: 10.3109/01913123.2013.870274] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There has been a long lasting controversy over whether melanocytes (MCs) in vitiligo are actually lost or still present but functionally inactive. We aimed to evaluate the MC cell lineage in follicular and interfollicular vitiliginous epidermis through immunohistochemical localization of Human Melanoma Black-45 (HMB-45) and Tyrosinase Related Protein 2 (TRP2) and to correlate it with clinicopathologic parameters. Using immunohistochemical techniques, skin biopsies from 50 vitiligo patients and 20 age- and gender-matched healthy subjects were examined. Differentiated active MCs were detected in 44% of interfollicular epidermis (IFE) and 46.7% of follicular epidermis (FE) in lesional skin. Melanocyte precursors/stem cells were detected in 54% of IFE and 63.3% of FE in lesional skin. Melanocyte precursors/stem cells of IFE were significantly associated with residual melanin pigment (p = 0.007) and with absence of angiogenesis (p = 0.05). HMB-45 percentage of expression in IFE was positively correlated with MC precursors/stem cells percentage in FE (r = +0.65, p < 0.001) and IFE (r = +0.33, p = 0.01). Melanocyte precursors/stem cells positivity (p < 0.001) was progressively decreasing with advanced histopathologic grading. There was no significant association between interfollicular or follicular expression of HMB-45, TRP2 or MC precursors/stem cells and the clinical type of vitiligo or its duration. In conclusion, functioning MCs may exist in vitiligo. The presence of MC precursors/stem cells in IFE may provide an additional reservoir needed for repigmentation.
Collapse
Affiliation(s)
- Iman Seleit
- Department of Dermatology, Andrology and STDs and
| | | | | | | |
Collapse
|
39
|
Ambiguous melanocytic tumors in a tertiary referral center: the contribution of fluorescence in situ hybridization (FISH) to conventional histopathologic and immunophenotypic analyses. Am J Surg Pathol 2013; 37:1783-96. [PMID: 24061523 DOI: 10.1097/pas.0b013e31829d20f5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The diagnosis of benign versus malignant melanocytic proliferations remains an important challenge. The current diagnostic algorithm typically involves an assessment of histopathologic and immunohistochemical parameters by light microscopy. Recently, fluorescence in situ hybridization (FISH) was reported as a useful ancillary diagnostic tool in melanocytic lesions, but the utility of FISH in melanocytic tumors that are difficult to diagnose with standard morphologic analysis remains controversial. To address this issue, we collected 34 ambiguous melanocytic tumors for FISH testing (NeoGenomics). Before FISH testing, cases were designated as "favor benign" (n=24) or "favor malignant" (n=10) by a consensus group (up to 7 dermatopathologists) on the basis of clinical, histopathologic, and immunophenotypic parameters. FISH was positive in 3/24 "favor benign" lesions and in 5/10 "favor malignant" lesions. The histopathologic, immunophenotypic, and FISH parameters informing our diagnostic impression were correlated with the final consensus diagnosis and clinical follow-up; in all cases, the initial diagnosis remained unchanged. In this series, the sensitivity of FISH for the histopathologic diagnosis of melanoma was 50%, the specificity was 87.5%, the positive predictive value was 62.5%, and the negative predictive value was 80.7%. Follow-up information was available for 25 patients (17 benign and 8 malignant diagnoses). Among benign lesions, the mean follow-up was 16.8 months (range, 8 to 25 mo); no metastases have been reported to date. Among the malignant lesions, the mean follow-up was 14.6 months (range, 7 to 23 mo); a single lymph node metastasis was identified in a 4-year-old girl with a histopathologic diagnosis of melanoma, which was negative on FISH. In our experience, in the setting of a lesion with predominantly benign findings, a negative FISH test-given its high specificity-is a reassuring finding that supports a benign diagnosis. In contrast, a positive FISH test should be carefully interrogated in the context of the complete histopathologic findings.
Collapse
|
40
|
Viray H, Bradley WR, Schalper KA, Rimm DL, Gould Rothberg BE. Marginal and joint distributions of S100, HMB-45, and Melan-A across a large series of cutaneous melanomas. Arch Pathol Lab Med 2013; 137:1063-73. [PMID: 23899062 DOI: 10.5858/arpa.2012-0284-oa] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The distribution of the standard melanoma antibodies S100, HMB-45, and Melan-A has been extensively studied. Yet, the overlap in their expression is less well characterized. OBJECTIVES To determine the joint distributions of the classic melanoma markers and to determine if classification according to joint antigen expression has prognostic relevance. DESIGN S100, HMB-45, and Melan-A were assayed by immunofluorescence-based immunohistochemistry on a large tissue microarray of 212 cutaneous melanoma primary tumors and 341 metastases. Positive expression for each antigen required display of immunoreactivity for at least 25% of melanoma cells. Marginal and joint distributions were determined across all markers. Bivariate associations with established clinicopathologic covariates and melanoma-specific survival analyses were conducted. RESULTS Of 322 assayable melanomas, 295 (91.6%), 203 (63.0%), and 236 (73.3%) stained with S100, HMB-45, and Melan-A, respectively. Twenty-seven melanomas, representing a diverse set of histopathologic profiles, were S100 negative. Coexpression of all 3 antibodies was observed in 160 melanomas (49.7%). Intensity of endogenous melanin pigment did not confound immunolabeling. Among primary tumors, associations with clinicopathologic parameters revealed a significant relationship only between HMB-45 and microsatellitosis (P = .02). No significant differences among clinicopathologic criteria were observed across the HMB-45/Melan-A joint distribution categories. Neither marginal HMB-45 (P = .56) nor Melan-A (P = .81), or their joint distributions (P = .88), was associated with melanoma-specific survival. CONCLUSIONS Comprehensive characterization of the marginal and joint distributions for S100, HMB-45, and Melan-A across a large series of cutaneous melanomas revealed diversity of expression across this group of antigens. However, these immunohistochemically defined subclasses of melanomas do not significantly differ according to clinicopathologic correlates or outcome.
Collapse
Affiliation(s)
- Hollis Viray
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut 06520, USA
| | | | | | | | | |
Collapse
|
41
|
Magro CM, Yang SE, Zippin JH, Zembowicz A. Expression of soluble adenylyl cyclase in lentigo maligna: use of immunohistochemistry with anti-soluble adenylyl cyclase antibody (R21) in diagnosis of lentigo maligna and assessment of margins. Arch Pathol Lab Med 2013. [PMID: 23194049 DOI: 10.5858/arpa.2011-0617-oa] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Soluble adenylyl cyclase (sAC) is an enzyme that generates cyclic adenosine monophosphate, a signaling molecule involved in regulating melanocyte functions. R21, a mouse monoclonal antibody against sAC, shows a striking pan-nuclear staining in lentigo maligna, indicating possible utility for diagnosis and margin assessment. OBJECTIVE To evaluate R21 in the diagnosis and evaluation of margins in lentigo maligna. DESIGN Thirty one re-excision specimens for lentigo maligna were evaluated for R21 expression using previously published protocol. In addition, 153 cases including 41 lentigo malignas, 30 non-lentigo maligna-type melanomas, 38 lentigos, and 44 nevi were evaluated using a modified stringent protocol to eliminate all nonmelanocyte staining. RESULTS The sensitivity of nuclear staining with R21 in lentigo maligna was 87.8%. Nuclear expression of sAC was observed in 40% of other melanomas and 2.3% of benign nevi. R21 did not stain nuclei of resting melanocytes but was observed in 28.9% of melanocytic hyperplasias. These cases were easily distinguished from lentigo maligna in routine sections. R21 staining facilitated extent of the lesion in resection margins. In cases examined under the less stringent conditions, interpretation was facilitated by comparing R21 and Mart1/Melan A staining. Greater than 9 pan-nuclear staining melanocytes within one high-power field along with a pan-nuclear sAC/Melan A ratio greater than 0.5 was consistent with a positive margin whereas 5 or less pan-nuclear staining melanocytes along with a sAC/Melan A ratio of less than 0.3 constituted a negative margin. CONCLUSION R21 is a useful diagnostic adjunct in the diagnosis and evaluation of margins in re-excision specimens in lentigo maligna.
Collapse
Affiliation(s)
- Cynthia M Magro
- Department of Pathology, Weill Medical College of Cornell University, New York, New York, USA
| | | | | | | |
Collapse
|
42
|
Libon F, Arrese JE, Rorive A, Nikkels AF. Ipilimumab induces simultaneous regression of melanocytic naevi and melanoma metastases. Clin Exp Dermatol 2012; 38:276-9. [PMID: 23020081 DOI: 10.1111/j.1365-2230.2012.04452.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ipilimumab blocks cytotoxic T-lymphocyte-associated antigen (CTLA)-4, potentiating the antimelanoma T-cell host response. Ipilimumab has been shown to improve overall survival in patients with previously treated metastatic melanoma. CTLA-4 antibodies generate immune responses to the melanoma-associated antigens Melan-A, NY-ESO-1 and glycoprotein (gp)100 in metastatic melanoma. Digital epiluminescence microscopy (DELM) is a noninvasive method permitting the monitoring of the morphology of melanocytic lesions over time. A 50-year-old man with metastatic melanoma received four ipilimumab injections after failure of dacarbazine chemotherapy. Positron emission tomography revealed regression of pulmonary metastases, and simultaneously, DELM showed regression of several melanocytic naevi. On histological examination of the regressing naevi, prominent CD8+, CD4+ and CD45R0 lichenoid lymphohistiocytic infiltrates were seen, whereas nonregressing naevi were almost free of inflammatory infiltrate. Expression of melanoma-associated antigens in benign melanocytic naevi may explain the induction of naevus regression by ipilimumab. DELM could represent a valuable noninvasive method to monitor ipilimumab efficacy.
Collapse
Affiliation(s)
- F Libon
- Department of Dermatology, Chu Du Sart Tilman, University Medical Center, Liege, Belgium
| | | | | | | |
Collapse
|
43
|
|
44
|
Abstract
This article is an up-to-date overview of the potential uses and limitations of immunohistochemistry (IHC) in melanocytic lesions. The information is intended to assist dermatopathologists and dermatologists who read slides to appropriately use IHC in this setting. In addition, dermatologists who do not review microscopic slides will better understand the rationale of the pathologist when reading and interpreting the pathology report.
Collapse
Affiliation(s)
- Tammie Ferringer
- Department of Dermatology, Geisinger Medical Center, Danville, PA 17822, USA.
| |
Collapse
|
45
|
Abstract
Of all pathology fields, the analysis of melanocytic lesions has one of the highest rates of review for legal reasons, particularly regarding the distinction between nevus and melanoma. Among the most frequently involved are desmoplastic melanoma, nevoid melanoma, and Spitz nevus versus spitzoid melanoma. Therefore, it follows that pathologists and dermatopathologists should pay special attention when dealing with such type of lesions. This review article will emphasize a number of clinical, histologic, and immunohistochemical features we believe are essential when evaluating lesions whose differential diagnosis includes melanoma/nevus. Furthermore, we want to stress the importance of examining the entire slide within the context of all available information in order to not miss the invisible gorilla in the slide. Regarding this apparently bizarre choice to illustrate these problems (to not miss an invisible gorilla), we request the reader to continue reading this article to find out why.
Collapse
|
46
|
|