PMC8671631_01
Microscopic findings and immunohistochemistry stains of initial lymph node FNA and subsequent needle-core biopsy. (A) Direct smear of lymph node FNA shows pleomorphic cells with scant sytoplasm and fine chromatin, presence of nucleoli was not detected. (B) Routine hematoxylin and eosin staining of cell block visualizes numerous small cell populations with high nuclear to cytoplasmic ratio. (C) Routine hematoxylin and eosin staining of needle-core biopsy shows populations of small pleomorphic cells. (D) High magnification image of needle-core biopsy displays golden-brown coloration resembling that of melanin. (E) Positive result for SOX10 staining, a biomarker for melanoma. (F) Positive results for S100 staining, another biomarker for melanoma.
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Nucleoli were inconspicuous or absent ( Figures 1A, B ). Review of the initial material, including close examination of the cell cytoplasm on negative control slides stained with hematoxylin only, allowed recognition of a small percentage of cells exhibiting fine, brown pigmented material in the cytoplasm, compatible with melanin ( Figures 1C-F ).
Image of left chest wall lesion.
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Clinical dermatologic examination revealed a new chest wall lesion ( Figure 2 ).
CT of the chest and abdomen pre and post treatment with combination nibolumab and ipiliimumab. (A) Intrathoracic lymphadenopathy anf right lower lobe lung nodule. (B) Interval resolution of intrathoracic lymphadenopathy and right lower lung nodule. (C) Numerous hepatic metastasis and retroperitoneal lymphadenopathy with the largest hepatic lesion measuring 3.7 cm. (D) Resolution of retroperitoneal lymphadenopathy and marked interval decrease size of hepatic metastasis with lesion now measuring 1.7 cm.
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No further progression in osseous metastasis was noted with stability in previously identified sclerotic lesions involving right humeral head, right L4, left S1, and right ilium. ( Figures 3A-D ).