Tumor board melanoma 28082018
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This document summarizes the findings of a tumor board discussion for a 55-year-old male patient with a soft tissue swelling in his right thigh. The initial biopsy showed a poorly differentiated malignant tumor possibly melanoma or sarcoma. A later wide local excision found a high grade malignant melanoma (nodular variant) infiltrating the deep resection margin with lymphovascular invasion. Given the patient's history of a previous tumor resection and recurrence, an accurate staging could not be determined.
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Tumor board melanoma 28082018
- 2. Patient details • Age/Sex : 55/M • Hospital OP/ IP No: A18037692 • Biopsy No: 1666/18 • Date of Receiving Specimen : 5/7/2018 • Date of Report : 7/7/2018 • Clinical Diagnosis : Soft tissue sarcoma • Nature of Specimen : Trucut biopsy from right thigh swelling .
- 3. Gross Examination Biopsy no: 1666/18 Container labelled trucut biopsy right thigh: Received multiple (nine) grey white to grey brown soft tissue bits, largest linear bit measuring 1 cm in length smallest linear bit measuring 0.3cm in length. All embedded in one block.
- 4. Microscopy Section studied shows tumor tissue fragments with sheets of highly pleomorphic cells with moderate cytoplasm with intracytoplasmic vacuoles and hyperchromatic irregular nucleus. 10x 40x
- 5. Microscopy Round to spindle shaped pleomorphic tumor cells containing pigments 40x10x
- 6. Microscopy Another bit shows dense extracellular pigment deposition. 40x 10x
- 7. Microscopy Occasional tumor giant cells are seen. 40x 40x
- 8. Impression Trucut biopsy from thigh shows •Features suggestive of poorly differentiated malignant tumor. •Possibility of poorly differentiated melanoma/sarcoma has to be ruled out. •Advised immunohistochemical markers for further evaluation.
- 9. Patient details • Age/Sex : 55/M • Hospital OP/ IP No: A18037692 • Biopsy No: 1715/18 • Date of Receiving Specimen : 10/7/2018 • Date of Report : 16/7/2018 • Clinical Diagnosis : Soft tissue sarcoma • Nature of Specimen : Wide local excision of right thigh swelling
- 10. Gross Examination Biopsy no: 1715/18 Container labelled soft tissue sarcoma • Received skin covered elliptical soft tissue mass measuring 19 x 10 cm. • Attached skin measures 15 cm in length. • External surface shows two nodular areas.
- 11. Gross Examination Biopsy no: 1715/18 Cut section shows • Two gray brown to gray black soft tissue masses largest measuring 7x5cm, smallest measuring 3x3cm with areas of necrosis and hemorrhage. • A satellite nodule lies in close proximity to the smallest. nodule, measures 0.5x0.5cm.
- 12. Gross Examination Biopsy no: 1715/18 Cut section shows • Tumour appears to be arising close to the skin. • Tumour is 2cm away from inferior margin. 1.5cm away from superior margin. 1cm away from deep resected margin. 0.8cm away from lateral margin.
- 13. Microscopy Tissue with underlying tumor composed of nests, lobules, trabeculae with diffuse sheets of tumour cells. 4x4x
- 14. Microscopy Individual tumor cells are polygonal to spindle shaped cells with moderate eosinophilic cytoplasm, intracytoplasmic melanin pigmentation and dense extracellular pigments with irregular pleomorphic nucleus and prominent nucleoli. 40x40x
- 15. Microscopy Many tumor giant cells and increased atypical mitosis seen. 40x40x
- 16. Microscopy Section shows areas of necrosis and focal areas of lobules separated by fibrous septa with dense lymphoplasmacytic infiltration
- 17. Microscopy Section shows lymphovascular invasion by tumor 40x10x
- 18. Microscopy Section shows lymphovascular invasion by tumor 40x10x
- 19. Microscopy Section shows deep resected margin infiltrated by tumor cells 40x 40x 10x
- 20. Microscopy Section shows tumor cells showing diffuse positivity for S100 40x10x
- 21. Final Impression Biopsy nos: 1715/18 • Specimen : Wide local excision of right thigh swelling. • Histologic Type : Malignant melanoma (Nodular variant). • Histologic Grade : High grade. • Extranodal Extension : Cannot be determined. • Margins : Deep resected margin is infiltrated by tumor. • Lymphovascular Invasion : Identified/present, not brisk. • Perineural Invasion : Nil. • Regional Lymph Nodes : No lymph nodes identified/sent. • Pathologic Stage Classification :Considering previous history of tumor resected outside and recurrence, staging could not be given.
Editor's Notes
- TLE1, an antibody derived from gene expression profiling studies, is emerging as a highly sensitive (nuclear) marker for synovial sarcoma of all morphologic types.
- TLE1, an antibody derived from gene expression profiling studies, is emerging as a highly sensitive (nuclear) marker for synovial sarcoma of all morphologic types.