Fortuitous discovery of melanomas in the ENT Department - a histopathological and immunohistochemical study

Abstract

The melanoma, having its origin in the melanocyte cells, is one of the most aggressive forms of skin cancer in the world with one of the highest rates of brain metastasis. The incidence of cutaneous melanoma in the Mediterranean countries varies from three to five cases∕100 000 people∕year. Its prognosis is based on an early diagnosis. Sinonasal mucosal melanoma (SNMM) is an extremely rare tumor, accounting for 0.3-2% of all melanomas. The non-specific symptomatology is often delaying the presentation of the patient at the hospital and therefore the diagnosis. The SNMM is a highly aggressive tumor, and the presence of metastasis at the diagnosis usually implies a poor prognosis. The management of the melanomas requires a precise pre-therapeutic assessment and a multidisciplinary approach for the diagnosis, with surgical treatment or radiotherapy required in order to ensure a better a quality of life. In this paper, we retrospectively analyzed two cases of mucosal melanoma and one case of cutaneous melanoma of the nose.

Figure 1

Tumor cell at dermo–epidermal junction and organized in nests in the superficial dermis. The tumor is not ulcerated. Cutaneous superficial spreading melanoma. HE staining, ×400. HE: Hematoxylin–Eosin

Figure 2

Tumoral melanocytes rise in the epidermis among the cell of the granular layer. Epithelioid melanocytes with rich intracytoplasmic melanin pigment, condensed chromatin on the nuclear membrane that gives the nucleus a vesicular appearance and eosinophilic macronucleoli. Epidermal invasion. HE staining, ×400

Figure 3

In the dermis are nests of epithelioid and fusiform melanocytes, inflammatory cells consisting of lymphocytes and melanophages arranged in spots, around and in between the tumor cells islands. Superficial spreading melanoma, nests in dermis. HE staining, ×400

Figure 4

Along the sheath of the hair follicle, the tumor cells expand lentiginous; in the surrounding dermis are lymphocytes and melanophages. Lentiginous growth along the hair follicle. HE staining, ×400

Figure 5

Epithelioid cells with eosinophilic cytoplasm, highly pleomorphic vesicular nuclei and eosinophilic macronucleolus; some of the cells are binucleated or multinucleated. Mucosal melanoma with epithelioid cells. HE staining, ×400

Figure 6

Nests of epithelioid tumor cells with clear cytoplasm and minimal amount of brown pigment located near small blood vessels, inflammatory cell such as lymphocytes, plasma cell and macrophages with brown pigment. Mucosal melanoma. HE staining, ×400

Figure 7

Intensely positive HMB45 on tumor cell, cytoplasmic immunoreaction. Anti-HMB45 antibody immunomarking, ×400. HMB45: Human melanoma black 45

Figure 8

Diffuse intense S100 positivity in tumor cell, cytoplasmic immunoreaction. Anti-S100 antibody immunomarking, ×400

Figure 9

Intensely positive Melan A cytoplasmic immunoreaction. Anti-Melan A antibody immunomarking, ×400

Figure 10

A few tumor cells with Ki67 positive nuclear immunoreaction. Anti-Ki67 antibody immunomarking, ×400

Figure 11

Large tumor cell with reduced eosinophilic cytoplasm, vesicular nuclei with unevenly distributed chromatin pattern, multiple eosinophilic macronucleoli and numerous atypical mitoses. Mucosal amelanotic melanoma. HE staining, ×400

Figure 12

Dyscohesive tumor cell, atypical mitoses and red blood cells extravasation among tumor cell. Mucosal amelanotic melanoma. HE staining, ×400

Figure 13

Intense Melan A positivity in tumor cells of cytoplasmic immunoreaction. Anti-Melan A antibody immunomarking, ×400

Figure 14

Cytoplasmic and nuclear immunoreaction in some tumor cell for S100 protein. Anti-S100 antibody immunomarking, ×400

Figure 15

Intensely and homogenous positive nuclear immunoreaction on tumor cell for BAP-1. Anti-BAP-1 antibody immunomarking, ×400. BAP-1: Breast cancer-associated protein-1

Figure 16

Cytoplasmic immunoreaction in a few tumor cells for HMB45. Anti-HMB45 antibody immunomarking, ×400