Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Cutan Pathol. 2020 Dec;47(12):1196-1199. doi: 10.1111/cup.13829. Epub 2020 Sep 6.
We report a case of tumor-to-tumor metastasis of a cutaneous malignant melanoma to a synchronous thyroid Hurthle cell carcinoma. A 42-year-old male underwent a biopsy of right inguinal lymphadenopathy which showed metastatic melanoma. The primary lesion was identified on his right posterior leg, and staging workup discovered a synchronous left thyroid lobe nodule concerning for a follicular neoplasm. He underwent excision of the primary melanoma, right inguinal lymphadenectomy, and total thyroidectomy. The resected thyroid contained a 6.6-cm, well-encapsulated left-sided nodule, red-brown in color and homogenous in consistency, with areas of focal hemorrhage and no grossly identifiable calcification. Microscopically, large tumor cells with distinct cell borders were present, with deeply eosinophilic and granular cytoplasm, large nuclei with prominent nucleoli, and loss of polarity consistent with oncocytes. A microscopic single focus of vascular invasion was identified, and a diagnosis of angioinvasive Hurthle cell carcinoma was made. Within the Hurthle cell carcinoma, multiple deposits of metastatic melanoma were seen. These findings were indicative of tumor-to-tumor metastasis of the cutaneous melanoma to the angioinvasive Hurthle cell carcinoma. Our findings show the ability of melanoma to metastasize to a pre-existing neoplasm.
我们报告了一例皮肤恶性黑色素瘤向同步甲状腺 Hurthle 细胞癌的肿瘤对肿瘤转移。一名 42 岁男性因右侧腹股沟淋巴结病接受了活检，活检显示转移性黑色素瘤。原发性病变位于他的右后腿上，分期检查发现左侧甲状腺叶结节同步存在，考虑为滤泡性肿瘤。他接受了原发性黑色素瘤切除术、右侧腹股沟淋巴结清扫术和全甲状腺切除术。切除的甲状腺包含一个 6.6 厘米、包膜完整的左侧结节，颜色为红棕色，质地均匀，有局灶性出血区域，无明显可识别的钙化。显微镜下，存在边界清晰的大肿瘤细胞，具有深嗜酸性和颗粒状细胞质、大核仁明显的大核，以及与癌瘤细胞一致的极性丧失。显微镜下发现一处微小的血管侵犯焦点，诊断为血管侵袭性 Hurthle 细胞癌。在 Hurthle 细胞癌中，可见多个转移性黑色素瘤的沉积。这些发现表明皮肤黑色素瘤向血管侵袭性 Hurthle 细胞癌的肿瘤对肿瘤转移。我们的发现表明黑色素瘤有向先前存在的肿瘤转移的能力。
