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Presented by Pedram Argani, M.D. and prepared by Dengfeng Cao, M.D. Ph.D.
Case 3: 79 year-old female with an enlarged axillary lymph node.
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1. Question
Week 203: Case 3
79 year-old female with an enlarged axillary lymph node.images/Cao_121304_case3a.jpg
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images/Cao_121304_case3e.jpgCorrect
Answer: Metastatic malignant melanoma
Histology: The lymph node is effaced by monotonous small cells with somewhat angulated nuclei. Occasional cells feature intranuclear inclusions, and the nuclear chromatin is diffuse throughout. Tumor cells were nonreactive for all epithelial and lymphoid immunohistochemical markers attempted. In contrast, they showed diffuse nuclear labeling for MiTF and labeled for HMB45 and Melan-A.
Discussion: Based on morphology, most pathologists who saw this case favored a hematopoietic tumor or neuroendocrine carcinoma. The correct diagnosis was established by the convincing immunohistochemistry as well as a knowledge of the many faces that melanoma can have. The current lesion is an example of a small cell melanoma which simulated malignant lymphoma and a small cell neuroendocrine carcinoma.
Incorrect
Answer: Metastatic malignant melanoma
Histology: The lymph node is effaced by monotonous small cells with somewhat angulated nuclei. Occasional cells feature intranuclear inclusions, and the nuclear chromatin is diffuse throughout. Tumor cells were nonreactive for all epithelial and lymphoid immunohistochemical markers attempted. In contrast, they showed diffuse nuclear labeling for MiTF and labeled for HMB45 and Melan-A.
Discussion: Based on morphology, most pathologists who saw this case favored a hematopoietic tumor or neuroendocrine carcinoma. The correct diagnosis was established by the convincing immunohistochemistry as well as a knowledge of the many faces that melanoma can have. The current lesion is an example of a small cell melanoma which simulated malignant lymphoma and a small cell neuroendocrine carcinoma.
