PMC4855744_01
Cut sections of excision biopsy of left breast nodule showing a homogenous yellowish-tan appearance.
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Gross examination revealed a homogenous yellowish-tan cut surface without any hemorrhage or necrosis (Fig. 1).
Hematoxylin and eosin stained sections of excision biopsy specimen of the left breast nodule showing a lobulated proliferation of sheets of epithelioid cells featuring enlarged vesicular nuclei with conspicuous nucleoli and ample eosinophilic cytoplasm (x5) (A), accompanied by scattered intracytoplasmic brownish pigment (X20) (B). Focally the tumor cells display eccentric nuclei with hyaline cytoplasmic inclusions (x40) (C). Immunohistochemistry showed strong and diffuse staining for S100 (D) and melan-A (E). Focal positivity for HMB45 was noted (F).
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Histology revealed a lobulated proliferation of sheets of epitheloid cells featuring enlarged vesicular nuclei, conspicuous nucleoli and ample eosinophilic cytoplasm, accompanied by scattered intra-cytoplasmic brownish pigment (Fig. 2A and B). Focally the tumor cells display eccentric nuclei with hyaline cytoplasmic inclusions (Fig. 2C), giving rise to a rhabdoid morphology. The tumor cells showed strong and diffuse staining for S100 and melan-A with focal positivity for HMB45 (Fig. 2D-F), establishing their melanocytic lineage.
Hematoxylin and eosin stained sections showing a proliferation of tumor cells from follow up biopsy of small left breast nodule (x20) (A) and a residual focus of tumor in the left completion mastectomy specimen (x5) (B). The excision biopsy of the left arm lump showed an encapsulated tumor nodule (x5, hematoxylin and eosin) (C), composed of a sheet-like proliferation of tumor cells (x20, hematoxylin and eosin) (D). All of them showed a similar appearance to that of the initial excision biopsy.
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A vacuum-assisted biopsy was done with histology showing melanoma with an identical histo- morphology (Fig. 3A) and immuno-histochemical profile as the initial excision biopsy specimen. Histology of the breast showed a 1 mm focus of residual melanoma at the biopsy site (Fig. 3B). However, histology for the upper arm nodule showed the presence of a melanoma surrounded by a fibrous capsule (Fig. 3C and D), which raised the possibility of metastatic melanoma in a completely replaced lymph node.