Nodal melanocytic nevus with balloon-cell change (nodal balloon-cell nevus)

Dermatopathology Section, Pigmented Skin Lesions, S. M. Annunziata Hospital, Florence, Italy.
Journal of Cutaneous Pathology (Impact Factor: 1.58). 08/2008; 35(7):672-6. DOI: 10.1111/j.1600-0560.2007.00860.x
Source: PubMed


Most nodal nevi are intracapsular and present the morphology of conventional nevi; less frequently, they show the appearance of common and cellular blue nevi. We report a case of an nodal capsular, trabecular and intraparenchymal melanocytic nevus with balloon-cell change in a patient with a malignant melanoma which arose in a pre-existing cutaneous giant congenital nevus, showing balloon-cell degeneration.

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    • "Since the original description by Stewart and Copeland in 1931 [1], melanocytic inclusions in lymph nodes, also called node nevi (NN), have been reported episodically [2–21] and their histological variants have been further elucidated [22] [23] [24] [25] [26] [27] [28]. "
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    ABSTRACT: Lymph node nevi (NN) have been occasionally described, yet little is currently known on their origin. According to a theoretical model of nevogenesis, the dissemination of nevus progenitor cells through lymphatic routes is responsible for the development of both nodal and skin nevi. The true incidence of NN is largely unknown but it has been reported to vary from 0.017% to as high as 22%. The frequency of NN nevi has increased since the introduction of sentinel lymph node mapping as a routine prognostic procedure in breast cancer and melanoma. The aim of this study was to analyze the frequency and morphological findings of NN, to discuss possible pathogenetic pathways in their evolution, and to verify the consistency of p16 immunostaining in the critical differential approach between NN and melanoma metastases. We therefore morphologically and immunohistochemically evaluated a series of 60 NN from 58 patients. In 21 patients, the lymph nodes had been removed during the staging for a skin melanoma; in all these patients NN immunostaining with p16 was strongly positive and p16 proved to be a reliable marker for the crucial differential diagnosis between NN and melanoma metastasis, strongly reacting in NN and lacking in melanoma deposits. A deeper knowledge on NN could help to clarify some important topics such as lymph node metastatic melanoma with unknown primary and the current debate on the lymph node involvement from atypical spitzoid tumors. Copyright © 2015 Elsevier GmbH. All rights reserved.
    Pathology - Research and Practice 01/2015; 211(5). DOI:10.1016/j.prp.2015.01.003 · 1.40 Impact Factor
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    • "There is one previous case report of a BCMM coinciding with a dermal nevus showing balloon cell changes [9]. In another reported case a superficial spreading melanoma (level 4 Breslow thickness 1.75 mm), arising in a giant congenital nevus which had balloon cell changes, was associated with a nodal capsular, trabecular and intraparenchymal balloon cell nevus [10]. "
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    ABSTRACT: A case of balloon cell melanoma encountered in a primary care skin cancer practice in Melbourne, Australia is presented. The presenting lesion was 6 mm in diameter, ulcerated, non-pigmented and without any algorithmic clues to melanoma. However the presence of terminal hairs caused the clinician to suspect that it was melanocytic. The lesion was reported as a balloon cell melanoma, Clark level 4, Breslow thickness 2 mm with a mitotic index of 4 per square mm. This is an extremely rare melanoma subtype. Author DW has encountered only two cases in a career involving in excess of one million signed out dermatopathology reports. A search of the literature has not discovered any previously published dermatoscopy images of a balloon cell melanoma.
    07/2013; 3(3):25-29. DOI:10.5826/dpc.0303a08.
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    ABSTRACT: Cutaneous melanoma can produce a wide variety of unusual morphological appearances, sometimes mimicking other tumors. We report on 4 cases of melanoma with carcinoid-like features, namely, arrangement of neoplastic cells in trabecules, ribbons, pseudorosettes, rosettes, and/or small round islands. A total of 10 biopsies from 4 patients were available for a histopathological study comprising congenital nevus, a nodule that had developed in this nevus and its persistence/recurrence, 3 primary cutaneous lesions, 3 metastases, and a recurrent/persistent lesion. In 7 of these 10 lesions, the most characteristic finding was a distinctive arrangement of the neoplastic cells as trabecules, ribbons, pseudorosettes, rosettes, or small round insular islands, thus closely resembling cell arrangement in carcinoids of various organs. All these tumors were positive for melanocytic markers. No neuroendocrine differentiation was demonstrated immunohistochemically. We conclude that the carcinoid-like pattern in melanoma, namely, the pattern in which neoplastic cells are arranged in trabecules, ribbons, cords, rosettes, pseudorosettes, and small round insular nests resembling those in carcinoids, is a distinctive pattern, which may rarely occur in primary cutaneous melanoma, its recurrence or metastasis, or in a melanoma associated with a large congenital nevus. This morphological type of melanoma may produce a serious diagnostic pitfall, but despite a confusing microscopic appearance, these tumors seem to demonstrate a conventional immunohistochemical profile.
    The American Journal of dermatopathology 09/2009; 31(6):542-50. DOI:10.1097/DAD.0b013e3181a8525a · 1.39 Impact Factor
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