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. 2018 Jul;16(1):580-584.
doi: 10.3892/ol.2018.8662. Epub 2018 May 8.

Undifferentiated sinonasal malignant melanoma: A case report

Jun Du  1 , Liang-Liang Huang  1 , Ao Xu  1 , An-Li Zhang  1 , Xue Kong  1 , Min Ding  1 , Wen Hu  1 , Zhen-Li Guo  1 , Wen Zhong  1 , Si-Bai Sun  1 , Heng Li  1 , Jie Chen  1 , Qian Shen  1 , Lu-Lu Xu  1 , Hai-Bo Wu  1
Affiliations

Undifferentiated sinonasal malignant melanoma: A case report

Jun Du et al. Oncol Lett. 2018 Jul.

Abstract

Undifferentiated sinonasal malignant melanoma (MM) is a rare type of tumor, which can be easily misdiagnosed. The present study reports a 41-year-old male patient who presented with a 4-day history of epistaxis. Clinical examination and radiological imaging lead to the detection of a mass in the right sinonasal region. Histopathological examination revealed that the mass was composed of malignant epithelioid cells arranged in nests and sheets. These cells displayed a hemangiopericytoma-like pattern with antler-like branching vessels. Immunohistochemical staining revealed that the tumor cells exhibited negative expression of melanocytic markers. This increased the difficulty of distinguishing undifferentiated MM from other malignant tumors located in the sinonasal area, particularly undifferentiated nasopharyngeal carcinoma. The diagnosis of undifferentiated MM was determined by ultrastructures, including the mature melanosomes and premelanosomes, in tumor cells by transmission electron microscopy. The present study suggests that the analysis of cancer stem cell marker and vasculogenic mimicry may be an important auxiliary tool for the diagnosis of MM.

Keywords: diagnosis; melanoma; pathology; undifferentiated.

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Figures

Figure 1.
Figure 1.
Preoperative magnetic resonance imaging. (A) Sagittal view and (B) axial view, demonstrating a mass occupying the right side of the nasal cavity, extending forward toward the right ethmoid sinus with erosion of adjacent bone tissues.
Figure 2.
Figure 2.
Histopathological analysis of the tumor tissue. (A) H&E staining revealed that the tumor exhibited a nests and sheets arrangement, and displayed a hemangiopericytoma-like pattern with antler-like branching vessels (magnification, ×100). (B) Higher magnification (×400) revealed that the tumor was composed of uniform epithelioid cells, with hyperchromatic, rounded or ovoid nuclei with prominent nucleoli and high mitotic activity. H&E, hematoxylin and eosin.
Figure 3.
Figure 3.
Immunohistochemical analysis of undifferentiated malignant melanoma. (A) The tumor cells did not express human melanoma black-45. (B) The tumor cells were positive for vimentin expression. (C) The tumor cells were positive for epithelial membrane antigen expression. (D) The tumor cells were positive for friend leukemia integration 1 transcription factor nucleic expression. (E) The tumor cells exhibited scattered expression of pan-cytokeratin. (F) Ki-67 expression was positive in the nuclei of 80% tumor cells. Magnification, ×200.
Figure 4.
Figure 4.
The ultrastructure of the undifferentiated malignant melanoma. Transmission electron microscopy detected a small number of mature melanosomes, indicated by black arrows, and premelanosomes, indicated by black arrowheads, within the tumor cells (scale bar: 1 µm).
Figure 5.
Figure 5.
Cancer stem cells markers and vasculogenic mimicry detection in undifferentiated malignant melanoma. (A) The tumor cells were positive for CD133 expression (magnification, ×200). (B) The tumor cells exhibited scattered expression of sex determining region Y-box 2 (magnification, ×200). (C) The tumor cells did not express Nestin, but did exhibit vascular mural cells (magnification, ×200). (D) CD34/PAS double staining revealed vasculogenic mimicry positive for PAS staining (purple-red) and negative for CD34 (black arrow). The microvessels were positive for both CD34 and PAS staining (magnification, ×400). CD133, cluster of differentiation 133; CD34, cluster of differentiation 34; PAS, periodic acid-Schiff.
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