Case Report:
CASE REPORTSURGICAL PATHOLOGY REPORT Case: SJH20-00715 Authorizing Provider: Mark B Faries, MD: Collected on: 01/30/2020 Ordering Location: PROVIDENCE-SAINT JOHN’S Health Center. Received: 01/30/2020 1300 hrs. Clinical Information are as follows:
51 year-old male with a history of metastatic melanoma. He has a metastasis on his left lower abdomen (and others in multiple areas of his body) this particular mass is markedly inflamed and is tender.
FINAL DIAGNOSIS:
SKIN AND SUBCUTANEOUS TISSUES FROM LEFT LOWER ABDOMEN, MASS, EXCISION:
MALIGNANT EPITHELIOID S0X10 POSITIVE NEOPLASM, CONSISTENT WITH METASTATIC MELANOMA, 7.0 X 6.5 X 6.4 CM, INVOLVING DEEP SUBCUTIS AND ADHERENT FASCIAL TISSUE, WITH EXTENSIVE NECROSIS (APPROXIMATELY 75%), APPROXIMATELY 10 MITOSES/MM2, AND FOCALLY BRISK TUMOR INFILTRATING LYMPHOCYTES, NARROWLY EXCISED WITH A CLEARANCE OF LESS THAN 1 MM FROM THE INKED SURGICAL MARGIN.
MICROSCOPIC DESCRIPTION:
Sheets of cytologically malignant cells have an epithelioid morphology with abundant pink cytoplasm and contain large, round to irregular nuclei with conspicuous nucleoli. Several mitotic figures are seen. There is extensive necrosis and focally brisk tumor infiltrating lymphocytes are seen. Melanin pigment is not present. By immunohistochemistry, the tumor cells are positive for SOX10, and are negative for MART-1 and HMB45.
The morphologic findings, in conjunction with these immunohistochemical results, are consistent with metastatic melanoma. The melanoma is narrowly free of the inked surgical margins in these planes of section.
AP SPECIAL STUDIES-
IMMUNOHISTOCHEMICAL STAINS:
Block: A1
MART-1- Negative
HMB-45- Negative
SOX10- Strongly and diffusely positive
Interpretation: While HMB45 and MART-1 are more specific markers of melanocytic differentiation, the presence of SOX10 positivity, in conjunction with the morphology of this tumor, supports the diagnosis of metastatic melanoma.
Positive controls demonstrate appropriate reactivity…
GROSS DESCRIPTION:
A. Labeled “left lower abdominal mass”: The specimen consists of a 13.2 x 4.7 cm pink-red erythematous ellipse of skin without orientation and excised to a depth up to 7.5 cm. The skin is stretched over a bulging palpable 7.0 x 6.5 x 6.4 cm encapsulated mass. The specimen is inked as follows: Superficial radial margins–blue; deep–red. Sectioning reveals the mass to have a predominantly pink-yellow necrotic friable cut surface comprising approximately three fourths of the specimen. Only a few red fleshy more viable appearing foci are noted at the periphery. Representative sections including the more viable appearing foci are submitted in A1-6. MK/SK.mk
Microscopic H&E stained sections are prepared and interpreted.
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