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Anorectal malignant melanoma
Author(s) -
BenIzhak Ofer,
Levy Rivka,
Weill Shoshana,
Groisman Gabriel,
Cohen Hector,
Stajerman Selina,
Misselevich Ines,
Nitecky Sami,
Eidelman Shmuel,
Kerner Hedviga
Publication year - 1997
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19970101)79:1<18::aid-cncr4>3.0.co;2-i
Subject(s) - medicine , carcinoembryonic antigen , pathology , immunohistochemistry , melanoma , abdominoperineal resection , staining , vimentin , cytokeratin , monoclonal , monoclonal antibody , cancer , antibody , colorectal cancer , cancer research , immunology
BACKGROUND Anorectal malignant melanoma is a rare tumor with an extremely poor prognosis. DNA flow cytometric study as well as detailed immunohistochemical study have not been reported previously. METHODS Eighteen cases of anorectal melanoma were studied, including immunohistology for melanoma markers and epithelial markers and DNA flow cytometric study of paraffin blocks. RESULTS Most patients were Ashkenazi Jews, compared with Sephardi Jews and Arabs. Of the 17 patients followed, 14 died of disease at 4‐39 months from presentation. Three patients were alive with disease at 12, 53, and 72 months of follow‐up. Tumor thickness ranged from 3‐35 mm (mean, 12.8 mm). The 2 long term survivors had tumor thickness ≤ 7 mm. No correlation was found between the mode of primary surgical treatment (8 patients: abdominoperineal resection; 10 patients: local excision) and outcome. Vimentin, HMB‐45, and S‐100 protein stainings were positive in 18, 17, and 15 tumors, respectively. Polyclonal carcinoembryonic antigen (CEA), broad‐spectrum cytokeratin, epithelial membrane antigen, monoclonal CEA, and TAG‐72 (B72.3) stainings were positive in 13, 3 (only focal and rare staining), 2, 0, and 0 tumors, respectively. Thirteen tumors had adequate material for DNA analysis, and all were DNA aneuploid. S‐phase fraction could be assessed in 11 tumors and ranged from 7.7‐24% (mean, 14%). An S‐phase fraction of < 10% was observed in the 2 long term survivors. CONCLUSIONS Anorectal melanoma in this study carried a grave prognosis. The frequent staining for polyclonal CEA (with negative monoclonal CEA staining) was probably due to nonspecific cross‐reacting antigens. The occasional staining for epithelial markers warrants a comprehensive immunohistochemical study to ensure a correct diagnosis, especially in small biopsies of amelanotic undifferentiated tumors that lack junctional changes. The aneuploidy of all tested tumors reflected their highly malignant behavior. A trend toward longer survival was observed in patients with thin tumors and an S‐phase fraction of < 10%. However, due to the small number of survivors, the latter observation should be further tested in a larger scale series. Cancer 1997; 79:18‐25. © 1997 American Cancer Society.