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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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Immunohistochemical stains (Envision, Objective × 40). (A) The tumor cells were positive for HMB45 in cytoplasm; (B) The tumor cells were positive for Melan-A in cytoplasm; (C) The tumor cells were positive for protein S-100 protein in both nucleus and cytoplasm; (D) Ki-67 immunostaining showed a proliferative index of 60%.
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Figure 3: Immunohistochemical stains (Envision, Objective × 40). (A) The tumor cells were positive for HMB45 in cytoplasm; (B) The tumor cells were positive for Melan-A in cytoplasm; (C) The tumor cells were positive for protein S-100 protein in both nucleus and cytoplasm; (D) Ki-67 immunostaining showed a proliferative index of 60%.

Mentions: Subsequently, routine hematoxylin-eosin sections (formalin-fixed and paraffin-embedded) and immunostains were done. But the results of immunohistochemical stains didn’t support the diagnoses of lymphoma and undifferentiated carcinoma. The tumor cells were strongly positive for melanoma marker (HMB45), Melan-A, S-100 protein (Figure 3A-C) and vimentin, whereas CD20, CD45RO, CD3, CD79α, myeloperoxidase, terminal deoxynucleotidyl transferase, pan cytokeratin (AE1/AE3), keratin 5/6, keratin 7, synaptophysin, chromogranin A, and sarcoma markers such as smooth muscle actin, desmin, CD117, CD34 were all negative. A proliferative index of 60% was noted with Ki-67 immunostaining (Figure 3D). So the diagnosis of malignant melanoma was confirmed.


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)

Immunohistochemical stains (Envision, Objective × 40). (A) The tumor cells were positive for HMB45 in cytoplasm; (B) The tumor cells were positive for Melan-A in cytoplasm; (C) The tumor cells were positive for protein S-100 protein in both nucleus and cytoplasm; (D) Ki-67 immunostaining showed a proliferative index of 60%.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Immunohistochemical stains (Envision, Objective × 40). (A) The tumor cells were positive for HMB45 in cytoplasm; (B) The tumor cells were positive for Melan-A in cytoplasm; (C) The tumor cells were positive for protein S-100 protein in both nucleus and cytoplasm; (D) Ki-67 immunostaining showed a proliferative index of 60%.
Mentions: Subsequently, routine hematoxylin-eosin sections (formalin-fixed and paraffin-embedded) and immunostains were done. But the results of immunohistochemical stains didn’t support the diagnoses of lymphoma and undifferentiated carcinoma. The tumor cells were strongly positive for melanoma marker (HMB45), Melan-A, S-100 protein (Figure 3A-C) and vimentin, whereas CD20, CD45RO, CD3, CD79α, myeloperoxidase, terminal deoxynucleotidyl transferase, pan cytokeratin (AE1/AE3), keratin 5/6, keratin 7, synaptophysin, chromogranin A, and sarcoma markers such as smooth muscle actin, desmin, CD117, CD34 were all negative. A proliferative index of 60% was noted with Ki-67 immunostaining (Figure 3D). So the diagnosis of malignant melanoma was confirmed.

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