Melanoma Mimicking Malignant Peripheral Nerve Sheath Tumor with Spread to the Cerebellopontine Angle: Utility of Next-Generation Sequencing in Diagnosis

Nerve Sheath Tumor in a Cynomolgus Macaque (Macaca fascicularis) and Diagnostic Differentiation from Amelanotic Melanoma

There are few reports describing spontaneous neoplasms in cynomolgus macaques, despite the frequent use of this species in laboratory research. This report describes cytologic, histologic, and immunohistochemical findings of a cutaneous to subcutaneous nerve sheath tumor located within the haired skin of the abdomen of a 2.5-y-old, intact, female, captive Mauritius cynomolgus macaque. The nerve sheath tumor was well demarcated, partially encapsulated, densely cellular, and extended from the subcutis to the most superficial dermis, abutting the epidermis. Neoplastic cells formed intersecting streams and had a high mitotic count (18 per 2.37 mm2). Due to the substantial morphologic overlap of this neoplasm with amelanotic melanoma, particularly the close association with the epidermis, immunohistochemistry was required for definitive diagnosis. Neoplastic cells were immunoreactive to vimentin, S-100, SOX10, laminin, collagen IV, and CD56, and negative for melan-A, tyrosinase, MITF, and HMB45. This immunohistochemical profile is diagnostic for nerve sheath tumor based on human and canine criteria and rules out amelanotic melanoma. Despite incomplete excision, the nerve sheath tumor had not grossly recurred after 1 mo, at which point the animal was euthanized for unrelated reasons. This report underscores the importance of using an immunohistochemical panel in cases of cutaneous and subcutaneous spindle cell neoplasms, as there is substantial morphologic and immunohistochemical overlap between nerve sheath tumors and melanocytic neoplasms due to their shared neuroectodermal origin. To our knowledge, this is the first report of a nerve sheath tumor in a cynomolgus macaque, and one of the few reports of spontaneous neoplasia in this species.

Is Primary Poorly Differentiated Sarcomatoid Malignancy of the Parotid Gland Sarcomatoid Undifferentiated/Dedifferentiated Melanoma? Report of Three Unusual Cases Diagnosed by Fine-Needle Aspiration Combined with Histological, Immunohistochemical, and Molecular Analyses

INTRODUCTION

Poorly differentiated primary sarcomatoid parotid malignancies are extremely rare. These tumors have not been consistently studied by morphology, immunohistochemistry, or molecular techniques.

CASE PRESENTATION

We report three unusual cases of parotid gland poorly-differentiated sarcomatoid malignancy investigated by fine-needle aspiration and studied histologically, by immunohistochemistry and molecular investigations. Aspirates showed poorly specific polymorphous sarcomatoid malignancy in all cases. Histologically, all cases were polymorphous high-grade malignancies, and additionally, one case showed epithelial structures and was finally classified as salivary carcinosarcoma. Immunohistochemistry showed classical melanocytic markers negativity but positivity for PRAME, CD10, and WT1 in all three tumors and for CD56 in two tumors, which can potentially be supportive of melanocytic origin. Although not entirely specific, molecular characterization also suggested the melanocytic lineage of these tumors.

CONCLUSION

Although rare, primary malignant melanoma of salivary gland was already described, but undifferentiated/dedifferentiated amelanotic forms are unknown in this localization up today. Further case reports of similar presentations are required to confirm the unequivocal primary origin of these obscure neoplasms in the parotid gland.

Top 10 Differential Diagnoses for Desmoplastic Melanoma

BACKGROUND

Desmoplastic melanoma is a rare subtype of melanoma mainly appearing on sun-exposed skin. Clinically, it is many times non-pigmented and therefore the diagnosis is often not suspected.

METHODS

Review article.

RESULTS

In this paper we review the main histopathological, immunohistochemical, and molecular features of desmoplastic melanoma, as well as the top 10 morphologic differential diagnoses which should be considered in most cases. The histopathological pattern can be many times deceptive, mimicking a scar, a fibrous reaction, a fibrohistiocytic tumor such as a dermatofibroma, a vascular tumor such as angiosarcoma, a smooth muscle tumor such as leiomyosarcoma, or a neural tumor. Although an overlying atypical junctional melanocytic proliferation may be seen in most cases, it is absent in a significant percentage (up to 30%) of cases, making the diagnosis even more difficult in those instances. The range of diagnostic pitfalls is wide, which may present disastrous prognostic consequences.

CONCLUSION

Desmoplastic melanoma is often a difficult diagnosis to make, as it frequently shows nonspecific clinical findings and overlapping histologic features with many other tumors. However, the potential clinical and prognostic consequences of misdiagnosis as another entity are great. Therefore, this diagnosis must always be kept in mind when encountering spindle cell tumors affecting the head and neck area.

Soft tissue pathology for the radiologist: a tumor board primer with 2020 WHO classification update

Radiologists serve an important role in the diagnosis and staging of soft tissue tumors, often through participation in multidisciplinary tumor board teams. While an important function of the radiologist is to review pertinent imaging and assist in the differential diagnosis, a critical role is to ensure that there is concordance between the imaging and the pathologic diagnosis. This requires a basic understanding of the pathology of soft tissue tumors, particularly in the case of diagnostic dilemmas or incongruent imaging and histologic features. This work is intended to provide an overview of soft tissue pathology for the radiologist to optimize participation in multidisciplinary orthopedic oncology tumor boards, allowing for contribution to management decisions with expertise beyond image interpretation.

Giant Malignant Peripheral Nerve Sheath Tumor of the Scalp: Case Report and Review of the Literature

BACKGROUND

Malignant peripheral nerve sheath tumors (MPNSTs) are rare nervous system tumors that rarely appear on the scalp. About half of the scalp MPNSTs described in the literature have reached giant dimensions at the time of diagnosis. The surgical treatment is the gold standard for this type of tumor. Some authors suggest adjuvant radiotherapy for local tumor control, although there is uncertainty about its advantages and its use is not without risks.

CASE DESCRIPTION

We present the case of a 31-year-old man who presented with a large necrotic scalp tumor of the left frontoparietal convexity. magnetic resonance imaging showed a large extra-axial tumor, measuring 17 x 17 x 8 cm, centered on the soft tissues, with skull erosion and signs of dural invasion, although with no intradural component. The tumor was surgically removed and the osteocutaneous defect was reconstructed with a latissimus dorsi muscle free flap. The anatomopathologic diagnosis was MPNST. The patient then underwent adjuvant radiotherapy. After 7 months he developed a progressive right hemiparesis and magnetic resonance imaging showed results compatible with cerebral radiation necrosis. This motor deficit improved with corticotherapy. After 9 months the patient went back to his home country and was subsequently lost to follow-up.

CONCLUSIONS

Giant MPNSTs of the scalp are highly aggressive lesions that should primarily be treated in a surgical fashion. Although adjuvant radiotherapy has been used routinely for local tumor control, there is uncertainty about its advantages.