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Presented by Dr. Pedram Argani and prepared by Dr. Kevan Salimian
This is a 62 year old male with a mediastinal adenopathy and a history of melanoma.
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1. Question
This is a 62 year old male with mediastinal adenopathy and a history of melanoma. Choose the correct diagnosis.
Correct
Answer: C. Metastatic melanoma and melanophages
Histologic Description: The majority of this lymph node is occupied by macrophages containing abundant melanin pigment (melanophages). These cells generally have small nuclei with thin nuclear membranes, and prominent cytoplasmic pigment. The prominent cytoplasmic pigment makes evaluation of cytoplasmic immunohistochemical markers for melanoma problematic. However, in addition to these cells, there are small clusters of neoplastic cells with prominent nucleoli and irregular, thick nuclear membranes, morphologically suggestive of melanoma. Immunohistochemistry for the nuclear marker SOX10 highlights these cells, confirming the diagnosis of metastatic melanoma in addition to melanophages.
Differential Diagnosis: The differential diagnosis of melanoma and melanophages is highlighted above. It is important recognize that some markers like HMB45 may actually stain melanophages due to phagocytosis of melanosomes (Modern Pathology 2002; 15: 1288-1293). Dermatopathic lymphadenopathy would be characterized by dendritic macrophages harboring melanin pigment in the paracortical zone of a lymph node typically draining inflamed skin.
Incorrect
Answer: C. Metastatic melanoma and melanophages
Histologic Description: The majority of this lymph node is occupied by macrophages containing abundant melanin pigment (melanophages). These cells generally have small nuclei with thin nuclear membranes, and prominent cytoplasmic pigment. The prominent cytoplasmic pigment makes evaluation of cytoplasmic immunohistochemical markers for melanoma problematic. However, in addition to these cells, there are small clusters of neoplastic cells with prominent nucleoli and irregular, thick nuclear membranes, morphologically suggestive of melanoma. Immunohistochemistry for the nuclear marker SOX10 highlights these cells, confirming the diagnosis of metastatic melanoma in addition to melanophages.
Differential Diagnosis: The differential diagnosis of melanoma and melanophages is highlighted above. It is important recognize that some markers like HMB45 may actually stain melanophages due to phagocytosis of melanosomes (Modern Pathology 2002; 15: 1288-1293). Dermatopathic lymphadenopathy would be characterized by dendritic macrophages harboring melanin pigment in the paracortical zone of a lymph node typically draining inflamed skin.
