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Anaplastic large cell lymphoma: a potential pitfall in the differential diagnosis of melanoma.

黑色素瘤鉴别诊断中的潜在陷阱:间变性大细胞淋巴瘤。

Pulitzer M,Brady MS,Blochin E,Amin B,Teruya-Feldstein J

Abstract

The diagnosis of metastatic melanoma can be complicated by absent characteristic cytology, melanin, or antigen expression in a suspect tumor, putting the pathologist at risk for incorrectly diagnosing recurrent melanoma while missing a second malignancy. We report a 69-year-old man with a history of acral melanoma, metastatic to inguinal nodes, presenting with an ipsilateral thigh nodule. Histology showed a proliferation of pleomorphic cells in the dermis and subcutis, suspicious for melanoma. S100, Melan-A, and HMB-45 immunohistochemistry were negative. However, microphthalmia-associated transcription factor and CD117 labeled the neoplasm, prompting consideration of a late metastatic melanoma with loss of antigen expression. Subsequent immunolabeling for CD4, CD43, and CD30 and clonal T-cell gene rearrangements enabled the correct diagnosis of cutaneous anaplastic large cell lymphoma. This case illustrates a pitfall in evaluating tumors in patients with known metastatic melanoma, and emphasizes the need for broad-spectrum immunohistochemistry in cases that are not clear-cut.

摘要

因为缺乏典型细胞学特征、黑色素或抗原表达,在可疑肿瘤中诊断转移性黑色素瘤可能很复杂,会使病理学医师出现误诊为黑色素瘤复发而没有诊断出第二个恶性肿瘤。我们报告一例69岁的男性,有肢端黑色素瘤病史,转移至腹股沟淋巴结,现在出现一个同侧的股部结节。组织学显示在皮肤和皮下组织内多形性细胞增生,可疑为黑色素瘤。S100、Melan-A和HMB45免疫组织化学标记均阴性。然而小眼畸形相关转录因子和CD117标记肿瘤提示考虑为抗原丢失的晚期转移性黑色素瘤。随后免疫标记CD4、CD43、CD30,克隆性T细胞基因重排确诊为皮肤间变性大细胞淋巴瘤。这一病例说明在诊断有转移性恶黑病史患者再发肿瘤时存在陷阱,强调在不能明确诊断的病例中要拓宽免疫组化标记的范围。

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