Capsular nevus in melanoma sentinel lymph node: a difficult diagnosis with prognostic implication
Abstract: The finding of melanoma metastasis in sentinel lymph node is an ominous prognostic sign and a strong predictor of overall survival. Current data have shown that patients with nevus cells in sentinel lymph nodes do not require additional therapy as their prognosis has been sh...
Guardado en:
| Autores principales: | , , , |
|---|---|
| Formato: | Artículo revista |
| Publicado: |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2021
|
| Materias: | |
| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/34921 |
| Aporte de: |
| id |
I10-R327-article-34921 |
|---|---|
| record_format |
ojs |
| institution |
Universidad Nacional de Córdoba |
| institution_str |
I-10 |
| repository_str |
R-327 |
| container_title_str |
Revista de la Facultad de Ciencias Médicas de Córdoba |
| format |
Artículo revista |
| topic |
melanoma capsular nevus sentinel node Melanoma nevo capsular ganglio centinela . |
| spellingShingle |
melanoma capsular nevus sentinel node Melanoma nevo capsular ganglio centinela . Dionisio de Cabalier , ME Mazzotta , MM Alfaro Diaz , R Guidi , A Capsular nevus in melanoma sentinel lymph node: a difficult diagnosis with prognostic implication |
| topic_facet |
melanoma capsular nevus sentinel node Melanoma nevo capsular ganglio centinela . |
| author |
Dionisio de Cabalier , ME Mazzotta , MM Alfaro Diaz , R Guidi , A |
| author_facet |
Dionisio de Cabalier , ME Mazzotta , MM Alfaro Diaz , R Guidi , A |
| author_sort |
Dionisio de Cabalier , ME |
| title |
Capsular nevus in melanoma sentinel lymph node: a difficult diagnosis with prognostic implication |
| title_short |
Capsular nevus in melanoma sentinel lymph node: a difficult diagnosis with prognostic implication |
| title_full |
Capsular nevus in melanoma sentinel lymph node: a difficult diagnosis with prognostic implication |
| title_fullStr |
Capsular nevus in melanoma sentinel lymph node: a difficult diagnosis with prognostic implication |
| title_full_unstemmed |
Capsular nevus in melanoma sentinel lymph node: a difficult diagnosis with prognostic implication |
| title_sort |
capsular nevus in melanoma sentinel lymph node: a difficult diagnosis with prognostic implication |
| description |
Abstract:
The finding of melanoma metastasis in sentinel lymph node is an ominous prognostic sign and a strong predictor of overall survival. Current data have shown that patients with nevus cells in sentinel lymph nodes do not require additional therapy as their prognosis has been shown to be similar to that of patients with negative lymph nodes. Distinguishing between benign capsular nevi and metastatic melanoma is problematic from a diagnostic point of view. The use of an immunohistochemical panel for melanocytic lesions is usually of limited value in differentiating with metastatic melanoma and the diagnosis is usually based mainly on histomorphological findings.
53-year-old man, diagnosed with nodular variant of melanoma with BRAF V600E mutation in exon 15, located on the back and excised in November 2020; with surgical margin extension in February 2021 due to compromised surgical limit and with sentinel lymph node removal. Right and left axillary nodes were removed, the first measured 1.5 x 1 x 0.6 cm and the left ones were two: the largest measured 2 x 1.5 x 1 cm and the smallest 1 x 0.5 x 0.5 cm.
Microscopy: reactive lymphoid hyperplasia and abundant black tattoo ink at sinus location were observed in the left nodes, while in the right one a proliferation of nevus-like cells arranged in nests was observed, at intracapsular location, and immunohistochemistry was Melan-A and HMB-45 positive, with a cell proliferation index (% Ki-67) of 1 - 5%. Consultation with local dermatopathologists was made and the diagnosis was intracapsular melanocytic nevus.
The lack of standardized criteria to distinguish between nevus cells and melanoma poses a diagnostic problem. To avoid misdiagnosis and unnecessary therapy, obtaining a second opinion from additional histopathologists would be beneficial. The use of tissue morphology in conjunction with immunohistochemical staining may be the best way to make the most accurate diagnosis. The use of molecular tests to determine characteristic somatic mutations of melanoma will probably help in the near future to facilitate the distinction between capsular nevi and metastatic melanoma.
|
| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2021 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/34921 |
| work_keys_str_mv |
AT dionisiodecabalierme capsularnevusinmelanomasentinellymphnodeadifficultdiagnosiswithprognosticimplication AT mazzottamm capsularnevusinmelanomasentinellymphnodeadifficultdiagnosiswithprognosticimplication AT alfarodiazr capsularnevusinmelanomasentinellymphnodeadifficultdiagnosiswithprognosticimplication AT guidia capsularnevusinmelanomasentinellymphnodeadifficultdiagnosiswithprognosticimplication AT dionisiodecabalierme nevocapsularengangliocentinelademelanomaundiagnosticodificultosoyconimplicanciapronostica AT mazzottamm nevocapsularengangliocentinelademelanomaundiagnosticodificultosoyconimplicanciapronostica AT alfarodiazr nevocapsularengangliocentinelademelanomaundiagnosticodificultosoyconimplicanciapronostica AT guidia nevocapsularengangliocentinelademelanomaundiagnosticodificultosoyconimplicanciapronostica AT dionisiodecabalierme a AT mazzottamm a AT alfarodiazr a AT guidia a |
| first_indexed |
2024-09-03T21:02:47Z |
| last_indexed |
2024-09-03T21:02:47Z |
| _version_ |
1809210269552869376 |
| spelling |
I10-R327-article-349212024-04-15T16:19:09Z Capsular nevus in melanoma sentinel lymph node: a difficult diagnosis with prognostic implication Nevo capsular en ganglio centinela de melanoma: un diagnóstico dificultoso y con implicancia pronóstica A Dionisio de Cabalier , ME Mazzotta , MM Alfaro Diaz , R Guidi , A melanoma capsular nevus sentinel node Melanoma nevo capsular ganglio centinela . Abstract: The finding of melanoma metastasis in sentinel lymph node is an ominous prognostic sign and a strong predictor of overall survival. Current data have shown that patients with nevus cells in sentinel lymph nodes do not require additional therapy as their prognosis has been shown to be similar to that of patients with negative lymph nodes. Distinguishing between benign capsular nevi and metastatic melanoma is problematic from a diagnostic point of view. The use of an immunohistochemical panel for melanocytic lesions is usually of limited value in differentiating with metastatic melanoma and the diagnosis is usually based mainly on histomorphological findings. 53-year-old man, diagnosed with nodular variant of melanoma with BRAF V600E mutation in exon 15, located on the back and excised in November 2020; with surgical margin extension in February 2021 due to compromised surgical limit and with sentinel lymph node removal. Right and left axillary nodes were removed, the first measured 1.5 x 1 x 0.6 cm and the left ones were two: the largest measured 2 x 1.5 x 1 cm and the smallest 1 x 0.5 x 0.5 cm. Microscopy: reactive lymphoid hyperplasia and abundant black tattoo ink at sinus location were observed in the left nodes, while in the right one a proliferation of nevus-like cells arranged in nests was observed, at intracapsular location, and immunohistochemistry was Melan-A and HMB-45 positive, with a cell proliferation index (% Ki-67) of 1 - 5%. Consultation with local dermatopathologists was made and the diagnosis was intracapsular melanocytic nevus. The lack of standardized criteria to distinguish between nevus cells and melanoma poses a diagnostic problem. To avoid misdiagnosis and unnecessary therapy, obtaining a second opinion from additional histopathologists would be beneficial. The use of tissue morphology in conjunction with immunohistochemical staining may be the best way to make the most accurate diagnosis. The use of molecular tests to determine characteristic somatic mutations of melanoma will probably help in the near future to facilitate the distinction between capsular nevi and metastatic melanoma. Resumen: El hallazgo de metástasis de melanoma en un ganglio linfático centinela es un signo de pronóstico ominoso y un fuerte predictor de supervivencia general. los datos actuales han demostrado que los pacientes con células névicas en ganglio centinela no requieren terapia adicional, ya que se ha demostrado que su pronóstico es similar al de los pacientes con ganglios linfáticos negativos. Distinguir entre nevos capsulares benignos y melanoma metastásico, resulta problemático desde el punto de vista diagnóstico. La utilización de un panel de inmunohistoquímica para lesiones melanocíticas suele ser de valor limitado en la diferenciación con melanoma metastásico y el diagnóstico suele basarse principalmente en los hallazgos histomorfológicos. Hombre de 53 años, con diagnóstico de melanoma variante nodular, BRAF mutado V600E en exón 15, localizado en espalda y extirpado en noviembre 2020; en febrero 2021 ampliación por límite quirúrgico comprometido y extirpación de ganglio centinela. Se realiza extirpación de ganglios axilares derecho e izquierdo, el primero de 1,5 x 1 x 0,6 cm y el izquierdo: 2 ganglios, el mayor de 2 x 1,5 x 1 cm y el menor de 1 x 0,5 x 0,5 cm. Microscopía: en ganglio izquierdo se observó hiperplasia linfoide reactiva y abundante tinta negra de tatuaje a nivel sinusal, mientras que en ganglio derecho se observó una proliferación de células de aspecto névico dispuestas en nidos, a nivel intracapsular, cuya inmunohistoquímica resultó Melan-A y HMB-4 positiva, con un índice de proliferación celular (%Ki-67)1- 5%. Se realizó interconsulta con dermatopatólogos locales y el diagnóstico fue de nevo melanocítico intracapsular. La falta de criterios estandarizados para distinguir entre células névicas y melanoma plantea un problema diagnóstico. Para evitar un diagnóstico erróneo y realizar una terapia innecesaria, sería beneficioso obtener una segunda opinión de histopatólogos adicionales. El uso de la morfología de los tejidos junto con la tinción inmunohistoquímica puede ser la mejor manera de hacer el diagnóstico más preciso. El empleo de test moleculares para determinación de mutaciones somáticas propias del melanoma, probablemente ayudarán en un futuro cercano a facilitar la distinción entre nevo capsular y melanoma metastásico. . Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2021-10-12 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion texto texto texto https://revistas.unc.edu.ar/index.php/med/article/view/34921 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 78 No. Suplemento (2021): Suplemento JIC XXII Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 78 Núm. Suplemento (2021): Suplemento JIC XXII Revista da Faculdade de Ciências Médicas de Córdoba; v. 78 n. Suplemento (2021): Suplemento JIC XXII 1853-0605 0014-6722 http://creativecommons.org/licenses/by-nc/4.0 |