Sinonasal amelanotic melanoma with neuroendocrine differentiation: a diagnostic conundrum.

Mucosal malignant melanoma of the head and neck (HN) is a rare and aggressive neoplasm which constitutes only 1% of all melanomas. Neuroendocrine differentiation is an extremely unusual phenomenon in mucosal melanomas, of which five cases have been reported. We report a rare case of a 63-year-old female who developed sinonasal amelanotic melanoma with immunohistochemical expression of neuroendocrine markers, presenting a diagnostic dilemma. Ultrastructural evidence of melanosomes and neurosecretory granules aided in arriving at the diagnosis. Aberrant immunoexpression of neuroendocrine markers, particularly in an amelanotic melanoma, has critical diagnostic implications, as various malignancies with undifferentiated histomorphology occur at this site, many of which stain positively with neuroendocrine markers. We discuss the differential diagnoses and recommend a high index of suspicion so as not to miss the diagnosis of mucosal melanoma at this location.

Establishment and characterization of a transplantable tumor line (RMM) and cell line (RMM-C) from a malignant amelanotic melanoma in the F344 rat, with particular reference to galectin-3 expression in vivo and in vitro.

To investigate characteristics of malignant melanomas with various pathobiological features, a homotransplantable tumor line (RMM) was established from a spontaneous amelanotic melanoma found in the pinna of an aged F344 rat. RMM tumors were transplanted in syngeneic rats by serial subcutaneous implantation with 100% intake. The original and RMM tumors consisted of spindle-shaped cells arranged mainly in interlacing bundles. Immunohistochemically, the neoplastic cells were positive to PNL-2 (melanocytes), nestin (neuroectodermal stem cells), S-100 (neurogenic cells) and vimentin (mesenchymal cells). Electron microscopically, tumor cells possessed single membrane-bound pre-melanosomes. Further, a cell line (RMM-C) was induced from an RMM tumor. RMM-C cells and the induced tumors in syngeneic rats showed immunohistochemical reactions similar to the original and RMM tumors. Interestingly, serum level of galectin-3 expression was increased with growing RMM tumors, and the expression was influenced by TNF-α (increase) or TGF-ß1 (decrease), indicating a possible biomarker of amelanotic melanomas. The RMM tumors and RMM-C cell line could become useful tools for studies on the pathobiology, including tumor immunity, and development of therapeutic strategies against this malignancy. These tools are the first tumor lines of amelanotic melanomas in the rat.

Amelanotic melanoma in a New Zealand White Rabbit (Oryctolagus cuniculus).

A 3.5-year-old intact male double-transgenic New Zealand white rabbit (Oryctolagus cuniculus), apoA-I and LCAT (apolipoprotein and lecithin:cholesterol acyltransferase), was presented with a discrete, raised facial mass (0.5 x 1.0 x 1.0 cm). The mass was surgically excised, with reoccurrence to the same site 88 days later. A second surgical excision was performed, and the rabbit died 3 weeks later from respiratory distress. At necropsy, multiple varying-sized masses were observed in the ventral mandibular region and throughout the lungs, pleura, and diaphragm. On histopathology, the masses were composed of moderately anisocytotic and anisokaryotic polygonal to spindloid cells with moderate finely granular, lightly eosinophilic cytoplasm, having round to oval nuclei with one to several nucleoli and finely stippled chromatin. Mitotic figures were frequent. Lymphatic and venous invasion were noted with neoplastic cells metastasized to the submandibular lymph nodes, lungs, liver, and adventitial surface of the aorta. Fontana-Masson stain was negative for melanin, thereby necessitating immunohistochemistry and transmission electron microscopy. Positive staining with MART-1 (a melanocyte protein marker) combined with transmission electron microscopy revealing type II melanosomes confirmed the diagnosis of an amelanotic melanoma.

Malignant amelanotic melanoma behind the left eye in a female Crj:CD(SD)IGS rat: a case report.

A tumor behind the left eye in a female Crj:CD(SD)IGS rat was investigated histopathologically, immunohistopathologically, and electron microscopically. The tumor invaded and destroyed orbital tissues and bones. It consisted of various tumor cells; namely, spindle-shaped, epithelioid, anaplastic melanoma cells, and had prominent eosinophilic cytoplasm and nuclei with a greater variation in size. Immunohistochemically, almost all of the tumor cells were positive for antimelanoma, PNL2 antibody. Ultrastructurally, the tumor cells were rich in small vesicles containing fine granules and filamentous structures. This is the first report describing an amelanotic melanoma in the head of an albino rat.

Regulation of tyrosinase processing and trafficking by organellar pH and by proteasome activity.

Pigmentation of the hair, skin, and eyes of mammals results from a number of melanocyte-specific proteins that are required for the biosynthesis of melanin. Those proteins comprise the structural and enzymatic components of melanosomes, the membrane-bound organelles in which melanin is synthesized and deposited. Tyrosinase (TYR) is absolutely required for melanogenesis, but other melanosomal proteins, such as TYRP1, DCT, and gp100, also play important roles in regulating mammalian pigmentation. However, pigmentation does not always correlate with the expression of TYR mRNA/protein, and thus its function is also regulated at the post-translational level. Thus, TYR does not necessarily exist in a catalytically active state, and its post-translational activation could be an important control point for regulating melanin synthesis. In this study, we used a multidisciplinary approach to examine the processing and sorting of TYR through the endoplasmic reticulum (ER), Golgi apparatus, coated vesicles, endosomes and early melanosomes because those organelles hold the key to understanding the trafficking of TYR to melanosomes and thus the regulation of melanogenesis. In pigmented cells, TYR is trafficked through those organelles rapidly, but in amelanotic cells, TYR is retained within the ER and is eventually degraded by proteasomes. We now show that TYR can be released from the ER in the presence of protonophore or proton pump inhibitors which increase the pH of intracellular organelles, after which TYR is transported correctly to the Golgi, and then to melanosomes via the endosomal sorting system. The expression of TYRP1, which facilitates TYR processing in the ER, is down-regulated in the amelanotic cells; this is analogous to a hypopigmentary disease known as oculocutaneous albinism type 3 and further impairs melanin production. The sum of these results shows that organellar pH, proteasome activity, and down-regulation of TYRP1 expression all contribute to the lack of pigmentation in TYR-positive amelanotic melanoma cells.

Plasmodium coatneyi-infected erythrocytes bind to C32 amelanotic melanoma cells under static and flow conditions.

The ability of Plasmodium coatneyi-infected red blood cells (IRBCs) to bind to C32 amelanotic melanoma cells was examined under static and physiologic flow conditions in vitro. Six blood samples obtained from P. coatneyi-infected Japanese macaques (Macaca fuscata) with severe manifestations of disease were used in the static adhesion assay. All blood samples constantly exhibited binding of IRBCs to C32 cells under static conditions. Immunofluorescence staining with anti-CD36 mAb revealed a positive reaction at the surface of C32 cells with the infected erythrocytes, while the reaction with C32 cells without IRBCs was negative. To further examine the specificity of the interaction between P. coatneyi-infected erythrocytes and C32 cells, we carried out the binding assay under physiological flow conditions. In flow adhesion assay, three blood samples were used. Adhesion and rolling of IRBCs on C32 cells were detected at several rates of shear stress under flow conditions. At a shear stress of 1.0 dyne/cm(2), the number of IRBCs adherent to C32 cell averaged 5 to 6, and the number of IRBCs rolling on C32 cells averaged 6 to 11. The anti-CD36 mAb OKM5 inhibited 75-100% of IRBC adhesion and rolling, while the inhibitory effect of anti-ICAM-1 mAb 84H10 varied between 20-40%. The combination of anti-CD36 and anti-ICAM-1 mAb resulted in 83-100% inhibition of rolling and 100% inhibition of adhesion. These findings suggest that CD36 is one of the principal adhesion receptors of P. coatneyi-infected erythrocytes.

Cerebriform nodular amelanotic metastases of malignant melanoma: a challenge in differential diagnosis of a rare variant.

High variability of the clinical appearance of malignant melanoma (MM) and its metastases render the differential diagnosis of solid amelanotic tumours difficult. We report a 71-year-old woman with several unusual cutaneous tumours of cerebriform morphology, suggesting skin metastases from occult internal cancer. Histopathological findings and thorough investigations, however, revealed a late-stage metastatic MM. We discuss the differential diagnosis of skin metastases of various origin and underline the difficulties for early detection of MM.

Cutaneous malignant melanomas in 57 cats: identification of (amelanotic) signet-ring and balloon cell types and verification of their origin by immunohistochemistry, electron microscopy, and in situ hybridization.

Cutaneous malignant melanomas in cats, both melanotic and amelanotic, were diagnosed in 57 of 1.530 skin tumors during the period 1991-1995. All melanomas occurred in domestic shorthaircats of ages 3-19 years (mean = 11.5 years). Postmortem examination was performed on 16 cats. All had metastases in the regional lymph node and several organ systems. The average time of survival after surgical removal of the tumor was 4.5 months. Histologically, five types of melanomas could be distinguished: epithelioid, spindle, mixed, signet-ring, and balloon cell. Whereas all epithelioid, spindle, and mixed epithelioid/spindle cell types showed pigmentation, signet-ring and balloon cell types were often amelanotic. Immunohistochemical examination of the melanomas revealed a positive staining for S-100, vimentin, and neuron-specific enolase. The melanomas were negative for muscle cell markers, except in some of the signet-ring cell melanomas; 13 of 21 tumors showed a weak positive staining for polyclonal desmin. Electron microscopic examination of signet-ring cell melanomas revealed an abundance of intermediate filaments, whereas in some of these tumors a few cells with melanosomes were found. Nonisotopic in situ hybridization for mRNA encoding for tyrosinase verified the melanocytic origin of the amelanotic signet-ring and balloon cell melanomas.

Ultrastructural localization of CD36 in human hepatic sinusoidal lining cells, hepatocytes, human hepatoma (HepG2-A16) cells, and C32 amelanotic melanoma cells.

Ultrastructural localization of CD36 in human hepatic sinusoidal lining cells, hepatocytes, human hepatoma (HepG2-A16) cells, and C32 amelanotic melanoma cells. Experimental Parasitology 79, 383-390. CD36 is expressed in the endothelial cells of some human organs, but the ultrastructural localization of this molecule in the sinusoidal lining cells of human liver is not well established. We report the ultrastructural localization of CD36 in the liver using a novel murine monoclonal antibody against CD36, namely MO30, as a primary antibody. Immunocytochemistry by the postembedding method showed that CD36 was localized in endothelial cells of sinusoids and in hepatocyte microvilli protruding into the space of Disse. Moreover, in cultured human hepatoma (HepG2-A16) cells and C32 amelanotic melanoma cells, MO30 reacted with microvilli. Hence, CD36 expressed on these cells may be involved in recognition and/or entry of these cells by malaria sporozoites.

Electron microscopic examination of cutaneous lesions by the quick re-embedding method from paraffin-embedded blocks.

We attempted to evaluate whether Widéhn's quick re-embedding method from paraffin blocks is useful for dermatopathological diagnosis. Regarding fine preservation of nuclei, tono-fibrils and desmosomes of keratinocytes in normal skin, we could recognize no difference between the quick re-embedding method and traditional re-embedding methods. However, preservation of mitochondria and Birbeck granules in Langerhans cells was poor regardless of the method used. Furthermore, we studied the ultrastructural features of some viral skin diseases including molluscum contagiosum, herpes simplex, varicella-zoster and verruca vulgaris, and some skin tumors, including angioleiomyoma, angiosarcoma, Merkel cell carcinoma and amelanotic melanoma using the quick re-embedding method. We determined that all viral structures were sufficiently preserved by the quick method to observe the virions and development of the virus. Myofilaments and dense bodies of angioleiomyoma, Weibel-Palade bodies of angiosarcoma, neurosecretory granules of Merkel cell carcinoma and melanosomes of amelanotic melanoma were recognized by the quick method. From these results, we concluded that the quick re-embedding method is useful for the diagnosis of skin diseases, especially viral skin diseases and some skin tumors.

Analyses of mixed melanogenesis in tyrosinase cDNA-transfected human amelanotic melanoma cells.

In the pigment cell the synthesis of tyrosinase and the formation of premelanosomes are independent, yet coordinated, processes. However, the interrelationship between the two processes has not been elucidated previously. In this study, an expression plasmid for human tyrosinase cDNA was constructed and transfected into a human amelanotic melanoma cell line, G-361. Stable transfected cells (G-CMHT-3) were obtained with high tyrosinase activity and distinct melanization occurred. As for the type of melanin, both pheo- and eumelanin contents increased in G-CMHT-3 cells. Interestingly, catalase activity as one of the other melanogenic enzymes was decreased in G-CMHT-3 cells. The decrease of catalase activity was considered to play a role in melanin-polymer formation, resulting in the increase of both pheo- and eumelanin contents. Under electron microscopic observation, dopa-oxidase-positive Golgi-associated endoplasmic reticulum of lysosome, coated vesicles, and premelanosomes were observed in pigmented G-CMHT-3 cells, and the expressed tyrosinase was considered to be well translocated to these organelles. In addition, the number of premelanosomes (stages I-III) as well as melanosomes (stage IV) increased in G-CMHT-3 cells compared to those in G-361 cells. It is also noted that G-CMHT-3 cells showed more normal phenotype premelanosomes with occasional transitional premelanosomes exhibiting partial melanin polymer formation within their concentric whorl-like internal membranes. Furthermore, the number of eumelanosomes in G-CMHT-3 cells was much larger than that in G-361 cells. These results suggest that the tyrosinase introduced by its cDNA transfection induced active and structurally non-aberrant premelanosome formation resulting in the upregulated pheo- and eumelanogenesis.

Amelanotic malignant melanoma presenting as malignant schwannoma.

A 78-year-old woman presented with a 14-month history of a nodule on the sole of her left foot. It had been increasing in size, and had become ulcerated. Histological, immunochemical and ultrastructural studies of the primary tumour revealed melanocytic and Schwannian characteristics, and posed diagnostic difficulties. The final diagnosis of a malignant melanoma with Schwannian differentiation was established on the basis of the clinical course, with the development of metastases in the subcutis, lymph nodes, liver and brain, as well as a shift in differentiation of the metastases towards cells containing giant melanosomes, typical of melanoma.

Amelanotic acral melanoma masquerading as fibrous histiocytic tumours. Three case reports.

We report 3 cases of amelanotic melanoma developing on the finger, whose histology disclosed dermal invasion of histiocyte-like tumour cells. One of the 3 cases was subungual melanoma and the other 2 were on the volar surface of the finger tip. Because of the characteristic dense infiltration of large histiocyte-like tumour cells, including many multinucleated giant cells, we initially considered histiocytic tumours. However, there were some histiocyte-like cells that displayed inclusion-like intranuclear invagination of cytoplasm, and almost all tumour cells, including the giant cells, were positive for S-100 protein. In addition, ultrastructural demonstration of premelanosomes within the cytoplasm of the tumour cells established the diagnosis of amelanotic melanoma. These features were distinct histologically from other variants of vertical growth phase amelanotic malignant melanoma, including desmoplastic or neurotropic melanoma. Because we encountered cases 2 and 3 within just a year after the first case, we think that the misdiagnosis of amelanotic "histiocytic" melanoma can be avoided through enhanced clinical awareness and subsequent appropriate histopathologic studies.

The melanocyte-stimulating hormone (MSH) receptor in M2R mouse melanoma tumours: solubilization and properties of the receptor-MSH complex and its covalently crosslinked conjugate.

Several properties of the MSH receptor in solid melanotic and amelanotic mouse M2R tumour isografts were studied in C57BL mice. Using cell membrane fractions prepared from such tumours and the superpotent [Nle4,D-Phe7]alpha MSH analogue, the affinity and receptor contents of the two tumour variants were found to be similar. When occupied by MSH, the receptor-MSH complex (R.MSH) was readily soluble in cholate. In the solubilized form, R.MSH was extremely stable and dissociated to an extent of only 30% within 12 days at 4 degrees C. While this high stability can be maintained in the pH range of 7.0-8.5, the solubilized R.MSH complex becomes increasingly unstable below pH 7.0 and totally dissociates at a pH < 6.0. In the membrane-bound form, the R.MSH complex shows a parallel pH stability profile which is shifted down by approximately two pH units. In addition to low pH, the R.MSH complex becomes unstable and totally dissociates in the presence of 10 mM EGTA, suggesting that the calcium-sensitive function of the receptor is still associated with the receptor in the detergent-soluble state. The R.MSH complexes in the soluble and membrane-bound forms are also totally resistant to proteolytic digestion by V8 protease, but were slowly digested by trypsin. Treatment of R.MSH with 1-ethyl-3-(3-dimethylamino-propyl)carbodiimide hydrochloride or bis (sulphosuccinimidyl) suberate led to covalent crosslinking of MSH to the receptor molecule. The electrophoretic mobility on SDS-PAGE of the 43/46 kD doublet of the receptor-MSH conjugate (R*MSH) was identical to the photoaffinity labelled MSH receptor product described earlier in cultured M2R cells. However, the efficiency of production of the crosslinked product was approximately 30%, much higher than that achieved previously by photoaffinity labelling. Using rabbit polyclonal anti-alpha MSH antibodies, the R*MSH conjugate was identifiable on Western immunoblots. These results provide a basis for further development of procedures for purification of the MSH receptor molecule and studying its protein structure.