Uncommon case of the acral melanoma with chondro-osseous metaplasia

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Abstract

Aim. This study aimed to improve the diagnostics of acral melanoma and investigate tumor morphological features of the chondroid and osseous matrix.

Materials and methods. The article presents a clinical case of metastatic acral melanoma with chondroid and osseous metaplasia in a 60-year-old patient. Cytological, histologic, immunohistochemical, and molecular genetic studies were performed.

Results. A conglomerate of lymph nodes was noted in the inguinal region of the patient. Oxyphilic chondroid masses and tumor cells with morphological features of sarcoma were revealed using thin-needle aspiration biopsy. On physical examination, pink-colored subcutaneous neoplasm was discovered in the skin of the heel. Histological examination of the primary neoplasm and inguinal lymph node was performed. Melanoma with chondro-osseous metaplasia was diagnosed. Immunohistochemical examination of the tumor revealed some pronounced diffuse expressions of S-100 protein, HMB-45, and focal expression of Melan A in tumor cells. The sample was tested to detect BRAF mutation, and no mutations were found.

Conclusion. Morphological diagnostics of acral melanoma with chondro-osseous metaplasia is characterized by a high risk of diagnostic error. Therefore, additional immunohistological, molecular, and genetic studies should be used in the diagnostics of acral melanoma with chondro-osseous metaplasia.

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About the authors

E. Yu. Bychkova

Biysk Oncological Dispensary

Email: cytolakod@rambler.ru
Russian Federation, Biysk, Altai Krai, 659325

Olga G. Grigoruk

Biysk Oncological Dispensary; Altai Regional Oncological Dispensary; The Altai State Medical University, Ministry of Health of Russia

Author for correspondence.
Email: cytolakod@rambler.ru

заведующий цитологической лабораторией, доктор биологических наук, доцент кафедры биологической химии, клинической лабораторной диагностики

Russian Federation, Biysk, Altai Krai, 659325; Barnaul, 656045; Barnaul, 656038

D. O. Kuratov

Biysk Oncological Dispensary

Email: cytolakod@rambler.ru
Russian Federation, Biysk, Altai Krai, 659325

E. A. Afanasieva

Biysk Oncological Dispensary

Email: cytolakod@rambler.ru
Russian Federation, Biysk, Altai Krai, 659325

L. M. Bazulina

Altai Regional Oncological Dispensary

Email: cytolakod@rambler.ru
Russian Federation, Barnaul, 656045

N. A. Bykova

Biysk Oncological Dispensary

Email: cytolakod@rambler.ru
Russian Federation, Biysk, Altai Krai, 659325

References

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  3. Magro CM, Crowson AN, Mihm MC. Unusual variants of malignant melanoma. Mod Pathol. 2006;19 Suppl 2:S41-70. doi: 10.1038/modpathol.3800516
  4. Joana Devesa P, Labareda JM, Bartolo EA, et al. Cartilaginous melanoma: case report and review of the literature. An Bras Dermatol. 2013;88(3):403-407. doi: 10.1590/abd1806-4841.20131595
  5. Ali AM, Wang WL, Lazar AJ. Primary chondro-osseous melanoma (chondrosarcomatous and osteosarcomatous melanoma). J Cutan Pathol. 2018;45(2):146-150. doi: 10.1111/cup.13067
  6. Berro J, Abdul Halim N, Khaled C, Assi HI. Malignant melanoma with metaplastic cartilaginous transdifferentiation: A case report. J Cutan Pathol. 2019;46(12):935-941. doi: 10.1111/cup.13539
  7. Hioki M, Asai J, Ohshita A, et al. Acral malignant melanoma exhibiting cartilaginous differentiation in a metastatic lymph node. J Dermatol. 2020;47(2):e39-e41. doi: 10.1111/1346-8138.15188
  8. Crowson AN, Magro C, Mihm MC, Jr. Unusual histologic and clinical variants of melanoma: implications for therapy. Curr Treat Options Oncol. 2006;7(3):169-180. doi: 10.1007/s11864-006-0010-0

Supplementary files

Supplementary Files
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1. Fig. 1. Inguinal lymphatic node. Mesenchymal tumor cells, having the appearance of sarcomatous, among oxyphilic chondroid masses. Pappenheim staining, × 400

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2. Fig. 2. Inguinal lymphatic node. Oxyphilic chondroid masses, sarcomatoid tumor cells with significant anaplasia. Pappenheim staining, × 1000

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3. Fig. 3. Calcaneal skin tumor. Epithelioid-cell pigmented melanoma with surface ulceration. Hematoxylin-eosin staining, × 200

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4. Fig. 4. Melanoma metastasis in inguinal lymph node. Focal chondroid metaplasia and osteoid loci. Staining with hematoxylin and eosin, × 200

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5. Fig. 5. Positive immunohistochemical staining for S-100 in tumor tissue, × 200

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6. Fig. 6. Positive immunohistochemical staining for HMB-45 in tumor tissue, × 200

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7. Fig. 7. Positive immunohistochemical staining for Melan A in tumor tissue, × 200

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