Diagnostic challenges of metastatic spindle cell melanoma on fine-needle aspiration specimens

Piao, Yingchao; Guo, Ming; Gong, Yun

doi:10.1002/cncr.23345

Cited by 38 publications

(53 citation statements)

References 26 publications

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“…27 These findings collectively suggest that the terminological imprecision of spindle cell melanoma may explain the variable incidence of 1-14% reported in the literature. 28 The Prevalence of Spindle Cell and Desmoplastic Melanoma Maybe Higher Than Previously Assumed…”

Section: The Terminology Remains Confusingmentioning

confidence: 95%

A diagnostic algorithm to distinguish desmoplastic from spindle cell melanoma

et al. 2014

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Spindle cell melanoma and desmoplastic melanoma differ clinically in prognosis and therapeutic implications; however, because of partially overlapping histopathological features, diagnostic distinction of spindle cell from desmoplastic melanoma is not always straightforward. A direct comparison of diagnostic and therapeutic biomarkers has not been performed. Meta-review of the literature discloses key clinicopathological differences between spindle cell and desmoplastic melanoma, including immunophenotypes. Using 50 biomarkers available in routine diagnostics, we examined 38 archival cases (n ¼ 16 spindle, 18 desmoplastic, 4 mixed spindle/desmoplastic melanoma). S100 remains as the most reliable routine marker to reach the diagnosis of melanoma in spindle cell and desmoplastic melanoma. We identified nine distinctly labeling markers with spindle cell melanoma showing positivity for laminin, p75, HMB45, c-kit, and MelanA, and desmoplastic melanoma preferentially labeling with collagen IV, trichrome, CD68, and MDM2. On the basis of comparisons of test performance measures, MelanA and trichrome were used to devise a 94% sensitive diagnostic algorithm for the distinction of desmoplastic from spindle cell melanoma. Gene amplification and expression status was assessed for a set of potentially drugable targets (HER2, EGFR, MET, MDM2, TP53, ALK, MYC, FLI-1, and KIT). Fluorescent in situ hybridizations did not reveal a significant number of gene aberrations/rearrangements; however, protein overexpression for at least one of these markers was identified in 35 of 38 cases (92%). In addition, we found BRAF mutations in 31% of spindle cell and 5% of desmoplastic melanoma, with an overall mutation frequency of 16% (n ¼ 6/38). We present the first comprehensive screening study of diagnostic and therapeutic biomarkers in spindle cell and desmoplastic melanoma. The devised algorithm allows diagnostic distinction of desmoplastic from spindle cell melanoma when routine histology is not decisive.

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Section: The Terminology Remains Confusingmentioning

confidence: 95%

A diagnostic algorithm to distinguish desmoplastic from spindle cell melanoma

et al. 2014

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“…Fine-needle aspiration (FNA) cytology with or without image guidance serves as an excellent tool for accurate diagnosis, and hence early recognition of metastatic and recurrent cases is possible. Morphologically, melanoma is known to mimic epithelial neoplasms, sarcomas and lymphomas on histopathology as well as on cytological smears [3,4,5,6]. Earlier studies have described variable cytomorphological features of melanomas in FNA smears [4,5,6].…”

Section: Introductionmentioning

confidence: 99%

“…Morphologically, melanoma is known to mimic epithelial neoplasms, sarcomas and lymphomas on histopathology as well as on cytological smears [3,4,5,6]. Earlier studies have described variable cytomorphological features of melanomas in FNA smears [4,5,6]. The spindle cell type is a rare variant with an incidence of 3-14% in different series [6,7].…”

Section: Introductionmentioning

confidence: 99%

Spindle Cell Melanoma: A Comparison of the Cytomorphological Features with the Epithelioid Variant

et al. 2013

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Objectives: Fine-needle aspiration cytology serves as a rapid and cost-effective tool for the diagnosis of melanoma, especially in the recurrent and metastatic cases. The diagnosis poses a challenge due to the varied morphological patterns. Spindle cell melanoma mimics other sarcomas and carcinomas on morphology. This study highlights the cytomorphological features of spindle cell melanoma and compares them with the conventional epithelioid type. Study Design: Cytology smears of 55 aspirates from 45 diagnosed cases of melanoma from various sites were reviewed. Histopathology correlation was done in spindle and mixed cell tumors. Results: Melanomas with a pure or mixed spindle cell component occurred in 31% of the cases and in a slightly higher age group. These demonstrated prominent cellular cohesion (p < 0.0001), mild to moderate nuclear atypia and inconspicuous to small nucleoli as compared to the epithelioid variant. The presence of melanin pigment was a useful clue to the diagnosis. Most of the cases correlated well with the histomorphology. Conclusion: Spindle cell melanoma is a morphological variant which can be readily misinterpreted due to a lack of classical cytological features of melanoma. Hence, these are vulnerable to be misinterpreted as other neoplasms. An awareness of clinical and cytological features is important to reach the correct diagnosis.

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“…Interestingly, the spindle cells also tended to lose immunoexpression of melanoma markers. In such cases, familiarity with cytologic features combined with clinical and immunoperoxidase findings are required to avoid misinterpretation (Piao et al, 2008). Prominent inclusion-like nucleoli are highly characteristic of melanomas; however, we have seen rare cases of pure spindle cell melanoma metastasizing to inguinal nodes that almost completely lacked nucleoli.…”

Section: Spindle Cell Melanomamentioning

confidence: 89%

“…Piao et al (2008) studied a large series (67 patients) of metastatic spindle cell melanomas on FNAC (all primaries were histologically proven). The smears were cellular and comprised predominantly of spindle cells that frequently formed cohesive fascicles, or whorls intermingled with scattered epithelioid tumor cells.…”

Section: Spindle Cell Melanomamentioning

confidence: 99%

Clinical Cytology in the Diagnosis and Management of Melanoma

Siddaraju¹

2011

Current Management of Malignant Melanoma

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Diagnostic challenges of metastatic spindle cell melanoma on fine-needle aspiration specimens

Cited by 38 publications

References 26 publications

A diagnostic algorithm to distinguish desmoplastic from spindle cell melanoma

A diagnostic algorithm to distinguish desmoplastic from spindle cell melanoma

Spindle Cell Melanoma: A Comparison of the Cytomorphological Features with the Epithelioid Variant

Clinical Cytology in the Diagnosis and Management of Melanoma

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