Open AccessCytodiagnosis of epithelioid malignant melanoma (amelanotic) and diagnostic dilemmas
Author(s) -
Santosh Kumar Mondal,
Palash Mondal,
Sujit Dutta
Publication year - 2014
Publication title -
journal of cytology/journal of cytology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.267
H-Index - 19
eISSN - 0974-5165
pISSN - 0970-9371
DOI - 10.4103/0970-9371.151134
Subject(s) - amelanotic melanoma , medicine , epithelioid cell , pathology , giant cell , melanoma , biopsy , immunohistochemistry , differential diagnosis , fine needle aspiration , cytopathology , cytology , cancer research
Melanoma is an aggressive neoplasm, and early diagnosis can reduce mortality in such patients. Diagnosis may be delayed in amelanotic tumors. We present one such case, a 35-year-old lady with a rapidly growing mass over the right angle of mandible. Fine-needle aspiration cytology was done, and smears showed discretely arranged large epithelioid cells with high N:C ratio, prominent single to multiple nucleoli. Occasional binucleated and multinucleated tumor giant cells were also noted. Poorly differentiated carcinoma, high-grade non-Hodgkin lymphoma, amelanotic melanoma, and pleomorphic sarcoma were included as differential diagnoses. Immunocytochemistry (ICC) revealed Melan-A/MART-1 positivity in some cells and S-100 positivity in most tumor cells. Desmin, pancytokeratin, and leukocyte common antigen were negative. Based on cytomorphological features and ICC findings, a diagnosis of epithelioid variant of amelanotic melanoma was rendered. Later on, true cut biopsy and histologic examination of excised specimen and adjunct immunohistochemistry with positive Melan-A and S-100 confirmed the diagnosis.