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Primary malignant melanoma of the duodenum without visible melanin pigment: a mimicker of lymphoma or carcinoma.

Li H, Fan Q, Wang Z, Xu H, Li X, Zhang W, Zhang Z - Diagn Pathol (2012)

Bottom Line: Definite diagnosis depends on both careful histologic examination and the use of proper immunohistochemical stains.Moreover, detailed history and thorough investigation should be made to exclude the preexistence or coexistence of a primary lesion elsewhere.The patient had achieved disease-free survival for more than 46 months without any evidence of recurrence after surgery.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, PR China.

ABSTRACT
Primary malignant melanoma of the duodenum is an unusual oncologic entity. Patients usually present the similar clinical symptoms like other common tumors in this site. And there are no specific radiological features either. The cases with only little melanin pigment or without notable melanin pigment are very misleading, especially in small biopsies or frozen sections. Definite diagnosis depends on both careful histologic examination and the use of proper immunohistochemical stains. Moreover, detailed history and thorough investigation should be made to exclude the preexistence or coexistence of a primary lesion elsewhere. Herein we report the case of a 60-year-old male patient with primary malignant melanoma of the duodenum, which was misdiagnosed as lymphoma or undifferentiated carcinoma in frozen consultation. The patient had achieved disease-free survival for more than 46 months without any evidence of recurrence after surgery.

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Histological examination (hematoxylin-eosin). (A) The lesion located under the enteric mucosa with diffusely infiltrative tumor cells without obvious mucosal destruction (Objective × 4); (B) The tumor cells showed markedly cytologic atypia with large eosinophilic nucleoli, abundant mitotic figures and moderate cytoplasm, however, without visible melanin pigment (Objective × 40).
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Figure 2: Histological examination (hematoxylin-eosin). (A) The lesion located under the enteric mucosa with diffusely infiltrative tumor cells without obvious mucosal destruction (Objective × 4); (B) The tumor cells showed markedly cytologic atypia with large eosinophilic nucleoli, abundant mitotic figures and moderate cytoplasm, however, without visible melanin pigment (Objective × 40).

Mentions: Intraoperative consultation showed a tumor measuring 2.5 cm × 1.5 cm × 1 cm, mesentery lymph node and peripancreatic lymph node measuring 3 cm, 2 cm in diameter respectively. The cut surfaces of the specimens were both pliable and gray red without pigment. Frozen sections were applied. Histologically, the lesion located under the enteric mucosa with diffusely infiltrative tumor cells, however, without obvious mucosal destruction (Figure 2A). The tumor cells were round, oval or polygonal epithelioid, showing markedly cytologic atypia with large eosinophilic nucleoli, abundant mitotic figures and moderate cytoplasm. But there was no obviously visible melanin pigment in cytoplasm (Figure 2B). Mesentery lymph node was positive for tumor cells (1/1), whereas peripancreatic lymph node was negative (0/1). According to above-mentioned features, pathologists consulted malignant tumor, prone to lymphoma or undifferentiated carcinoma. And the surgeons thought it might be lymphoma so only local tumor was resected.


Primary malignant melanoma of the duodenum without visible melanin pigment: a mimicker of lymphoma or carcinoma.

Li H, Fan Q, Wang Z, Xu H, Li X, Zhang W, Zhang Z - Diagn Pathol (2012)

Histological examination (hematoxylin-eosin). (A) The lesion located under the enteric mucosa with diffusely infiltrative tumor cells without obvious mucosal destruction (Objective × 4); (B) The tumor cells showed markedly cytologic atypia with large eosinophilic nucleoli, abundant mitotic figures and moderate cytoplasm, however, without visible melanin pigment (Objective × 40).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3472194&req=5

Figure 2: Histological examination (hematoxylin-eosin). (A) The lesion located under the enteric mucosa with diffusely infiltrative tumor cells without obvious mucosal destruction (Objective × 4); (B) The tumor cells showed markedly cytologic atypia with large eosinophilic nucleoli, abundant mitotic figures and moderate cytoplasm, however, without visible melanin pigment (Objective × 40).
Mentions: Intraoperative consultation showed a tumor measuring 2.5 cm × 1.5 cm × 1 cm, mesentery lymph node and peripancreatic lymph node measuring 3 cm, 2 cm in diameter respectively. The cut surfaces of the specimens were both pliable and gray red without pigment. Frozen sections were applied. Histologically, the lesion located under the enteric mucosa with diffusely infiltrative tumor cells, however, without obvious mucosal destruction (Figure 2A). The tumor cells were round, oval or polygonal epithelioid, showing markedly cytologic atypia with large eosinophilic nucleoli, abundant mitotic figures and moderate cytoplasm. But there was no obviously visible melanin pigment in cytoplasm (Figure 2B). Mesentery lymph node was positive for tumor cells (1/1), whereas peripancreatic lymph node was negative (0/1). According to above-mentioned features, pathologists consulted malignant tumor, prone to lymphoma or undifferentiated carcinoma. And the surgeons thought it might be lymphoma so only local tumor was resected.

Bottom Line: Definite diagnosis depends on both careful histologic examination and the use of proper immunohistochemical stains.Moreover, detailed history and thorough investigation should be made to exclude the preexistence or coexistence of a primary lesion elsewhere.The patient had achieved disease-free survival for more than 46 months without any evidence of recurrence after surgery.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, PR China.

ABSTRACT
Primary malignant melanoma of the duodenum is an unusual oncologic entity. Patients usually present the similar clinical symptoms like other common tumors in this site. And there are no specific radiological features either. The cases with only little melanin pigment or without notable melanin pigment are very misleading, especially in small biopsies or frozen sections. Definite diagnosis depends on both careful histologic examination and the use of proper immunohistochemical stains. Moreover, detailed history and thorough investigation should be made to exclude the preexistence or coexistence of a primary lesion elsewhere. Herein we report the case of a 60-year-old male patient with primary malignant melanoma of the duodenum, which was misdiagnosed as lymphoma or undifferentiated carcinoma in frozen consultation. The patient had achieved disease-free survival for more than 46 months without any evidence of recurrence after surgery.

Show MeSH
Related in: MedlinePlus