Summary:
The authors presented the case of an 82-year-old man with primary nodular melanoma of the skin
on the back (Breslow 3 mm) which repeatedly metastasized five times to the cervical lymph nodes.
Metastases were excised. The aim of this report was to demonstrate changes in the phenotype and
immunophenotype during tumour progression. Originally round and oval melanoblasts had a
characteristic immunophenotype. They were S100 protein, HMB45, Malan A, MITF positive. From
the second biopsy the immunophenotype began to change, and the amount of positive cells
declined. In the succeeding biopsies the morphology was also changed. There were spindle cells
which formed mutually intermingled bundles in places with large multinucleate cells. The
histological pattern assembled malignant mesenchymal tumour - type malignant fibrous
histiocytoma. The immunophenotype was also changed. The second to fifth metastases in the
cervical region were only S100 protein positive. The other above-mentioned melanoma markers
were negative. Differential diagnosis includes neurotropic-desmoplastic malignant melanoma,
Bednář tumour (pigmented dermatofibrosarcoma protuberans; storiform neurofibroma),
malignant peripheral nerve sheath tumour (neurogenic sarcoma) and malignant fibrous
histiocytoma.
Key words:
melanoma – malignant fibrous histiocytoma – immunohistochemistry - phenotype
|