Metastatic melanoma with balloon/histiocytoid cytomorphology after treatment with immunotherapy: A histologic mimic and diagnostic pitfall

Farah, Maya; Nagarajan, Priyadharsini; Torres‐Cabala, Carlos A.; Curry, Jonathan L.; Amaria, Rodabe N.; Wargo, Jennifer A.; Tawbi, Hussein A.; Ivan, Doina; Prieto, Víctor G.; Tetzlaff, Michael T.; Aung, Phyu P.

doi:10.1111/cup.13263

Cited by 7 publications

(4 citation statements)

References 34 publications

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“…Morphologic plasticity and heterogeneity of melanomas after treatment with targeted therapy and immunotherapy has been documented in a few case studies, including a report in which a primary melanoma that had exhibited classic epithelioid and spindled features subsequently showed metastatic lesions with a balloon cell/histiocytoid morphology after treatment with nivolumab 26,27 . Similarly, in our Cases 1 and 2, it is notable that the heterogenous morphologies and aberrant immunophenotypes were only seen after treatment with targeted and/or immunotherapy.…”

Section: Discussionsupporting

confidence: 67%

BRAF V600E immunohistochemistry as a useful tool in the diagnosis of melanomas with ambiguous morphologies and immunophenotypes

et al. 2022

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We report three melanoma cases in which BRAF V600E immunohistochemistry (IHC) was valuable for diagnosis. Patient 1: In a patient with a history of primary melanoma on the chest and metastatic melanoma to right breast after undergoing multiple local and systemic therapies, a lung metastasis exhibited chondroid differentiation, aberrant myofibroblastic marker expression, and rare pancytokeratin positivity, without melanocytic marker expression. Patient 2: After targeted and immunotherapy for primary melanoma on the scalp as well as regional and distant metastatic melanoma, an omental metastasis showed CDX2‐positive glandular structures that were negative for melanocytic markers. It was initially misdiagnosed as primary gastrointestinal adenocarcinoma. Patient 3: A patient with history of melanoma showing epithelioid morphology on the right thigh presented with multiple soft tissue nodules on skin, lymph nodes and internal organs after being lost to follow‐up for 4 years. A biopsy specimen from the right thigh showed spindled cells with scattered pancytokeratin cocktail positivity and ambiguous staining for melanocytic markers. For melanomas with ambiguous morphologies and/or immunophenotypes in each of the three patients, BRAF V600E expression by IHC was maintained in both primary and metastatic melanoma specimens examined. These cases highlight the utility of BRAF V600E IHC in the diagnosis of melanoma.

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Section: Discussionsupporting

confidence: 67%

BRAF V600E immunohistochemistry as a useful tool in the diagnosis of melanomas with ambiguous morphologies and immunophenotypes

et al. 2022

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“…TNBC is characterized by negative expression of estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2, and is considered an independent clinicopathological type of cancer that is characterized by strong invasiveness (3–5). Metastasis is a critical biological hallmark of malignant tumors and is the leading cause of mortality among patients with TNBC (6–8); however, the specific process and underlying mechanism remains unclear. Therefore, further study of the mechanism underlying TNBC metastasis and exploration of its effective prevention are of great significance in terms of improving the survival rate and quality of life for patients.…”

Section: Introductionmentioning

confidence: 99%

Inhibition of miR‑214 attenuates the migration and invasion of triple‑negative breast cancer cells

Zhang

Zhao

et al. 2019

Mol Med Report

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Triple-negative breast cancer (TNBC) is a subtype of breast cancer. MicroRNA (miR)-214 is closely associated with controlling the development of tumor cells; therefore, in the present study, the target gene and effects of miR-214 on TNBC cells were explored. Luciferase activity was examined by luciferase reporter assay. The viability, invasion and migration of MDA-MB-231 TNBC cells were measured using Cell Counting kit-8, Transwell and wound-healing assays, respectively. The expression levels of various factors were determined using reverse transcription-quantitative polymerase chain reaction and western blotting. The results demonstrated that the expression levels of miR-214 were higher and the levels of α1-antitrypsin (α1-AT) were lower in TNBC tissues compared with in normal tissues. Subsequently, α1-AT was revealed to be a target of miR-214. Furthermore, inhibition of miR-214 decreased cell viability, invasion and migration, enhanced the expression of E-cadherin and tissue inhibitor of metalloproteinases-2, and reduced the expression of metastatic tumour antigen 1 and matrix metalloproteinase-2. Inhibition of miR-214 also significantly downregulated the phosphorylation of protein kinase B (Akt) and mammalian target of rapamycin (mTOR), and markedly downregulated that of phosphoinositide 3-kinase (PI3K); however, the expression levels of total PI3K, Akt and mTOR remained stable in all groups. Taken together, these findings indicated that α1-AT may be a target of miR-214. Downregulation of miR-214 markedly suppressed the viability, migration and invasion of MDA-MB-231 cells, and inhibited the PI3K/Akt/mTOR pathway. These findings suggested that miR-214 targeting α1-AT may be a potential mechanism underlying TNBC development.

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“…Although BRAF V600E mutation were continuously observed in the rapidly expanded brain metastasis, BRAF/MEK inhibitors were ineffective. Interestingly, a patient developing lymph node metastatic melanoma with balloon change following nivolumab treatment has been documented (10). Thus, BRAF/MEK or immune checkpoint inhibitors may induce the phenotypical changes in melanoma.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Effectiveness of Immunoradiotherapy on Brain-metastatic BRAF/MEK Inhibitor-resistant Melanoma with Balloon Cell Change

Goto¹,

Shimauchi²,

Fukuchi³

et al. 2019

Acta Derm Venerol

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Wet wrap therapy, based on skin application of a double layer of tubular bandages or gauze with a moist first inner layer and a dry second outer layer, is utilized to treat various pruritic conditions, in particular severe and refractory atopic dermatitis. This review, by literature search, evaluates current knowledge about wet wrap therapy. Wet wrap therapy superimposed topical corticosteroids appears more efficient than emollients only, at least for short-time treatments. Despite higher efficacy, there is a tendency towards more frequent infections when topical corticosteroids are covered with wet wrap bandages compared to emollients only. While temporary suppression of hypothalamic-pituitary-adrenocortical-axis was seen due to systemic bioactivity of corticosteroids, no long-term observation studies on putative adverse effects were identified. One hypothesis suggests that wet wrap therapy may trigger increased lamellar body secretion resulting in recovery of the damaged intercellular lipid laminar structure. Otherwise, little investigation on mechanisms exists.

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Metastatic melanoma with balloon/histiocytoid cytomorphology after treatment with immunotherapy: A histologic mimic and diagnostic pitfall

Cited by 7 publications

References 34 publications

BRAF V600E immunohistochemistry as a useful tool in the diagnosis of melanomas with ambiguous morphologies and immunophenotypes

BRAF V600E immunohistochemistry as a useful tool in the diagnosis of melanomas with ambiguous morphologies and immunophenotypes

Inhibition of miR‑214 attenuates the migration and invasion of triple‑negative breast cancer cells

Therapeutic Effectiveness of Immunoradiotherapy on Brain-metastatic BRAF/MEK Inhibitor-resistant Melanoma with Balloon Cell Change

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