伴有血管肉瘤样转分化的转移性结节性黑色素瘤——1例报告并文献复习

Metastatic Nodular Melanoma with Angiosarcomatous Transdifferentiation-A Case Report and Review of the Literature.

作者信息

Dumitru Adrian Vasile, Țăpoi Dana Antonia, Costache Mariana, Ciongariu Ana Maria, Ionescu Andreea Iuliana, Liscu Horia Dan, Alius Catalin, Tampa Mircea, Marin Andrei, Furtunescu Andreea Roxana

机构信息

Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania.

Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania.

出版信息

Diagnostics (Basel). 2024 Jun 21;14(13):1323. doi: 10.3390/diagnostics14131323.

Abstract

Diagnosing cutaneous melanomas relies mainly on histopathological analysis, which, in selected cases, can be aided by immunohistochemical evaluation of conventional melanocytic markers. Nevertheless, these malignancies, particularly in metastatic settings, may display divergent differentiation with unusual histological and immunohistochemical features. In this context, we present the case of a 65-year-old male diagnosed with typical superficial spreading melanoma who developed recurrence and metastatic lesions featuring angiosarcomatous differentiation. The diagnosis of the initial tumour and the subsequently dedifferentiated lesions was confirmed by ample immunohistochemical analysis, which included several melanocytic markers, as well as mesenchymal and vascular markers. The recurrent tumour and lymph nodes metastases were completely negative for Melan-A and PRAME, and focally positive for SOX10. Additionally, they also displayed diffuse, intense positivity for CD10 and WT1 and focal positivity for CD99, ERB, and CD31. Thus, the diagnosis of primary cutaneous melanoma with recurrent and metastatic divergent angiosarcomatous differentiation was established. This occurrence is particularly rare and can pose important diagnostic challenges. Therefore, in addition to presenting this highly unusual case, we also performed a comprehensive review of the literature on divergent differentiation in melanomas.

摘要

皮肤黑色素瘤的诊断主要依赖组织病理学分析,在某些特定情况下,可通过对传统黑素细胞标志物进行免疫组化评估来辅助诊断。然而,这些恶性肿瘤,尤其是在转移的情况下,可能会表现出具有不寻常组织学和免疫组化特征的分化异常。在此背景下,我们报告一例65岁男性患者,该患者被诊断为典型的浅表扩散性黑色素瘤,其复发和转移病灶具有血管肉瘤样分化特征。通过充分的免疫组化分析证实了初始肿瘤及随后去分化病灶的诊断,免疫组化分析包括多种黑素细胞标志物以及间充质和血管标志物。复发性肿瘤及淋巴结转移灶Melan-A和PRAME完全阴性,SOX10局灶阳性。此外,它们还显示CD10和WT1弥漫性强阳性,CD99、ERB和CD31局灶阳性。因此,确诊为原发性皮肤黑色素瘤伴复发和转移的分化异常血管肉瘤样改变。这种情况极为罕见,会带来重要的诊断挑战。因此,除了呈现这一极其罕见的病例外,我们还对黑色素瘤分化异常的文献进行了全面综述。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7096/11240390/d397476f9812/diagnostics-14-01323-g001.jpg

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