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Presented by Dr. Argani and prepared by Daniel Miller
54 year old male with an adrenal mass.
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1. Question
This is a 54 year old male with an adrenal mass.
Choose the correct diagnosis.
Correct
Answer: B. Metastatic melanoma
Histology: This is a high grade malignant neoplasm that features cells that are epithelioid and spindled within the adrenal gland. In some areas, the nuclei mold in the pattern of small cell carcinoma, and there are numerous mitotic figures that would support a high grade lesion. However, this patient had a history of malignant melanoma. The lesional cells were negative for cytokeratin but diffusely immunoreactive for S100 and SOX10, supporting the diagnosis of metastatic melanoma.
Discussion: The immunoprofile of diffuse S100 and SOX10 immunoreactivity in the face of negative cytokeratins, along with the clinical history, supports melanoma over small cell carcinoma. Pheochromocytoma would feature more amphophilic cytoplasm, and would be lower grade. Neuroblastomas usually occur in younger patients, and generally feature smaller, more round nuclei with a background of neuropil.
This case illustrates the ability of malignant melanoma to mimic a variety of lesions, including small cell carcinoma.Incorrect
Answer: B. Metastatic melanoma
Histology: This is a high grade malignant neoplasm that features cells that are epithelioid and spindled within the adrenal gland. In some areas, the nuclei mold in the pattern of small cell carcinoma, and there are numerous mitotic figures that would support a high grade lesion. However, this patient had a history of malignant melanoma. The lesional cells were negative for cytokeratin but diffusely immunoreactive for S100 and SOX10, supporting the diagnosis of metastatic melanoma.
Discussion: The immunoprofile of diffuse S100 and SOX10 immunoreactivity in the face of negative cytokeratins, along with the clinical history, supports melanoma over small cell carcinoma. Pheochromocytoma would feature more amphophilic cytoplasm, and would be lower grade. Neuroblastomas usually occur in younger patients, and generally feature smaller, more round nuclei with a background of neuropil.
This case illustrates the ability of malignant melanoma to mimic a variety of lesions, including small cell carcinoma.
