24 January 2008 Case of the Week #109

 

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ARUP Laboratories First Annual Winter Update in Clinical and Laboratory Medicine is scheduled for March 3-7, 2008 at The Canyons, in Park City, Utah.

 

This 22.5 hour review and update in the areas of clinical chemistry, immunology, microbiology, and molecular medicine is intended to improve knowledge about the pathogenesis and clinical manifestations of a wide variety of metabolic infectious, immunologic, and genetic disorders along with the selection, performance, and interpretation of clinical laboratory tests. 

 

This course will provide a forum for the exchange of ideas among clinicians, clinical and anatomic pathologists, and laboratory scientists on new developments diagnosing these disorders.  Ample discussion time will be provided to address controversial issues.

 

For more information, please click here.

 

 

We added a new chapter, Chronic Myeloid Neoplasms, to our free online textbook. It incorporates the WHO 2008 classification to be published in a few months, and includes updated text and extensive images and references for Myelodysplasia, Myeloproliferative Neoplasms, MDS/MPN and Mast Cell Disease. We are currently updating the Thyroid Gland chapter.

 

Visit the Management Page (on the Home Page under Clinical Pathology Outlines) to read the new article "Pathology Practice Management Issues for 2008", by Mick Raich of Vachette Pathology. Click on our new Home Page Contribute button to learn how you can help improve our website by contributing images, videos or comments.

 

We thank Drs. Angela Bohlke and Matthew Stark, Tulane University School of Medicine, Louisiana (USA), for contributing this case. This case was reviewed in May 2020 by Dr. Jennifer Bennett, University of Chicago and Dr. Carlos Parra-Herran, University of Toronto.

 

Case of the Week #109

 

Clinical History

 

A 58 year old Asian female presented with a 6 month history of post-menopausal bleeding. She denied any other complaints and was not on any medications. Physical exam was unremarkable. Ultrasound demonstrated a grossly abnormal uterus with an area of centrally increased echogenicity suspicious for endometrial cancer. She had an endometrial biopsy.

 

Micro images: #1; #2; #3

 

What is your diagnosis?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Diagnosis:

 

Undifferentiated malignant neoplasm suggestive of melanoma

 

Discussion

 

The specimen shows markedly pleomorphic cells with abundant eosinophilic cytoplasm and frequent large eosinophilic nucleoli. There is a high mitotic rate and multiple areas of necrosis. No residual endometrial or cervical tissue is identified.

 

Immunohistochemistry confirmed the diagnosis of melanoma. The tumor cells were immunoreactive for MART1 and HMB45. There was moderate staining for S100. The tumor cells were essentially negative for keratins CAM5.2, CK7 and CK20, with only rare focal staining.

 

Melanoma of the uterus is very rare, either as a primary or metastatic tumor. Uterine metastases have been described from known primaries in the skin (Gynecol Oncol 2004;93:252), uvea (Pathol Oncol Res 2006;12:184) and hard palate (Can J Surg 2002;45:461). Melanoma has even been reported to metastasize to uterine polyps, including adenomyomas (Int J Surg Pathol 2005;13:223).

 

Some uterine melanomas may originate in the cervix, where they are also rare (see Cervix chapter). At both sites, prognosis is poor, whether the tumor is primary or secondary. Primary tumors may arise from lentigo or blue nevus, which have been reported at these sites (Diagn Gynecol Obstet 1981;3:269).

 

 

 

Nat Pernick, M.D., President
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