PMC4061179_01
Pigmented melanoma metastasis constituted from pleomorphic epithelioid cells; hematoxylin and eosin stain, ob. 40x.. Abbreviation: ob, objective.
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Moreover, 6 months after the diagnosis, he returned with submandibular lymph node metastasis consistent with a pigmented melanoma with epithelioid cells (Figure 1).
PMC4061179_02
Bucopharyngoscopy: oropharyngeal (right palatine tonsil) melanoma.
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An otolaryngology clinic exam suspected a T2 tumor, approximately 3 cm in largest diameter (Figure 2), and an excision biopsy (right tonsillectomy) was performed.
Epithelioid malignant melanocytes with high pleomorphic nuclei and large macronucleoli; hematoxylin and eosin stain, ob. 40x.. Abbreviation: ob, objective.
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Histopathologic exam revealed a malignant tumor composed of epithelioid cells with one or more high pleomorphic nuclei and large nucleoli (Figure 3).
PMC4061179_03
Left nasal fossa polypoid mass.
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Otolaryngology clinical exam revealed a left nasal fossa polypoid mass arising from the level of middle meatus, extending to the choana (Figure 4).
PMC4061179_04
70  rigid hypopharyngolaryngoscopy: laryngeal melanoma.
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Otolaryngology clinic exam by indirect laryngoscopy and 70  rigid pharyngolaryngoscopy (Figure 5) revealed an infiltrative vegetative tumor that involved the laryngeal vestibule and the hypopharyngeal retrocricoid area, with normal vocal cord mobility and no cervical lymph node involvement.
PMC4061179_05
PMC4061179_06
Melan A positivity in the malignant melanocytes, ob. 40x.. Abbreviation: ob, objective.
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Further immunohistochemical reactions positive for melanocytic markers established the correct diagnosis (Figure 6).
PMC4061179_07