Malignant melanoma diagnosed by fine-needle aspiration in cases presenting with parotid mass.

BACKGROUND: One of the most common malignancies that metastasize to the parotid glands and associated lymph nodes is cutaneous melanoma. Although fine-needle aspiration (FNA) is well established for diagnosing primary salivary gland tumours, there is limited literature on its role in diagnosing metastatic lesions. AIMS AND OBJECTIVES: This study aims to investigate the cytomorphological features of malignant melanoma diagnosed by FNA in cases presenting with a parotid mass. MATERIALS AND METHODS: We present the clinical and cytomorphological findings of four cases. Conventional FNA biopsy smears and cell blocks were performed using standard techniques and for the differential diagnosis, a panel of immunohistochemical markers was used. RESULTS: The patients included three females and one male, aged 54 to 77. FNA biopsies revealed atypical cells with large, hyperchromatic, pleomorphic nuclei, some of which exhibited prominent nucleoli. Plasmacytoid and oncocytic morphologies were also observed. Numerous mitotic figures were noted. Immunohistochemical staining showed HMB-45, S100 positivity in all cases. SOX10, MART-1 and MITF positivity were also observed. Three of the four patients had no history or suspected lesions of melanoma at the time of FNA diagnosis. The absence of melanin pigment complicated the diagnosis, but immunostains confirmed malignant melanoma. CONCLUSION: Diagnosing malignant melanoma by FNA can be challenging, especially when the melanoma is in an unusual site, cytological findings are ambiguous, and there is no history of cutaneous melanoma. Accurate diagnosis requires a high level of suspicion and the use of appropriate immunohistochemistry.

The role of R21 expression in differential diagnosis of melanocytic lesions.

Background: Cyclic adenosine monophosphate (cAMP) is an intracellular signal transmitter involved in the regulation of melanocyte growth, proliferation, and melanogenesis. R21 is a monoclonal antibody against the soluble adenylyl cyclase (sAC) protein. Various nuclear and cytoplasmic R21 expression patterns in melanocytic lesions have been previously reported. Pan-nuclear staining was defined as specific for melanoma and was found supportive in the assessment of surgical margins. Aims: The aim of this study is to evaluate the different expression patterns of R21 immunostain and investigate its effectiveness in the differential diagnosis of cutaneous malignant and benign melanocytic lesions. Settings and Design: Fifty invasive cutaneous melanoma and 50 benign melanocytic proliferation were included in the study. Materials and Methods: Paraffin blocks that best reflected tumor morphology were studied via immunohistochemical staining for R21. For all patterns, the cases showing staining in 25% or more tumor cells were considered as positive. Statistical Analysis used: Yates' Chi-square, Pearson Chi-square exact test, Spearman correlation were used. Results and Conclusions: Dot-like Golgi staining was characteristic for nevi (12/50) and seen only in one melanoma. Pan-nuclear staining was striking for melanoma (36/50). This pattern was observed in 2 dysplastic and 3 common melanocytic nevi too. None of the Spitz nevi expressed R21 in pan-nuclear pattern. For the diagnosis of melanoma, sensitivity and specificity of the pan-nuclear expression were 72% and 90%, respectively. Positive and negative predictive values were found as 87% and 76%. R21, a second-generation immunohistochemical marker, can be used in the differential diagnosis of benign and malignant melanocytic lesions.

Cervical Chondrocutaneous Branchial Remnants: A Rare Congenital Anomaly of the Neck. A Case Series, Literature Review, and Associated Anomalies.

Cervical chondrocutaneous branchial remnants (CCBRs) are rare anomalies found in the neck. These remnants can be easily misdiagnosed due to their low incidence, and they are often associated with other anomalies. Previous studies have reported an association with other anomalies in up to 76% of cases. In this article, the authors present a case series of two patients with bilateral CCBRs and investigate the associated anomalies through a literature review. Patients diagnosed with CCBRs who presented with cervical masses were included. Records were reviewed to investigate factors such as sex, location of the CCBRs, associated anomalies, timing of operations, and cartilage pathology. A surgical excision technique was employed, and the study also included a literature review focusing on reports related to CCBRs and associated anomalies. Two patients, a 3-year-old boy and a 17-year-old adolescent girl, with bilateral CCBRs underwent surgical excision. Patient demographics, prevalence, and characteristics of associated anomalies in CCBR cases were documented in the literature review. This case series presented two successful surgical excisions of CCBRs without complications or recurrence at 1 year of follow-up. The study emphasized the importance of thorough evaluation and assessment for associated anomalies in various body systems due to the potential co-occurrence of CCBRs with other anomalies.

Nephrogenic adenoma of the urinary tract: A 6-year single center experience.

BACKGROUND: Nephrogenic adenoma is an uncommon benign lesion that occurs at several sites in urinary tract, from the renal pelvis to urethra, with the highest frequency in urinary bladder. Nephrogenic adenoma displays a broad spectrum of architectural and cytological features. Hence, recognition of its characteristic histopathological features is needed to distinguish this lesion from its mimickers. MATERIALS AND METHODS: A retrospective series of 21 cases of nephrogenic adenoma in 18 patients, which were diagnosed in our department between 2010 and 2016, were analyzed. All histological slides were reviewed by two pathologists and the diagnosis of each case was confirmed. Immunohistochemistry was performed for PAX-8 in all cases. CK7, PAX-2, PSA, p53, p63, GATA-3 and α-methylacyl-CoA racemase (AMACR) were applied in problematic cases. RESULTS: The most common location of the lesion was urinary bladder (14 patients) followed by renal pelvis (2 patients), ureter (1 patient) and urethra (1 patient). A history of urothelial carcinoma and repeated TUR procedures were observed in 12 patients. There were 2 pediatric patients aged 3 years. Both of them had undergone previous urosurgery because of megaureter in one and bladder exstrophy in the other. Other clinical antecedents included bladder diverticulum (1 patient), cystitis (1 patient) and nephrolithiasis (1 patient). Recurrence of lesion was seen in two patients (once in one case and twice in the other one). The median time to disease recurrence in these patients was 11 months (range, 2-20 months). Histologically, the lesions exhibited various morphological findings, with mixed (15 cases, 71.4%), pure tubular (3 cases, 14.3%), pure papillary (2 cases, 9.5%) and pure flat (1 case, 4.8%) growth patterns. Of the 15 cases with mixed patterns, 8 cases were tubulocystic and flat, 3 cases were tubular and flat, 2 cases were tubular, papillary and flat, 1 case was tubulocystic, papillary and flat, and 1 case was tubular and papillary. Flat pattern was observed in 15 cases (71.4%). It was seen in association with other patterns in 14 cases (mixed morphology) and purely in 1 case. Our findings suggested that the flat pattern is a frequent finding in nephrogenic adenomas. Notably one case in this series showed superficial extension into bladder muscularis propria. CONCLUSIONS: Histologically nephrogenic adenoma may simulate a variety of malignancies. Awareness of characteristic morphologic features of nephrogenic adenoma is needed to diagnose this lesion correctly.