Document Detail

Mitotically active proliferative nodule arising in a giant congenital melanocytic nevus: a diagnostic pitfall.
MedLine Citation:
PMID:  23348144     Owner:  NLM     Status:  MEDLINE    
Proliferative (cellular) nodules (PN) which mimic malignant melanoma clinically and histologically are described in congenital melanocytic nevi (CMN) and may pose significant diagnostic challenges. We report the case of a 10-day-old male with a giant congenital nevus involving the neck, upper chest, back, and left shoulder containing several nodular lesions, some crusted. Biopsy of a nodule revealed densely packed nevus cells with hyperchromatic round to oval and occasionally irregularly shaped nuclei. There was no necrosis or pushing border, and the nodule blended with the adjacent nevus; however, the lesion demonstrated a significant number of mitoses (27 per mm2) and a 60% labeling index with Ki-67. Further analysis by fluorescence in situ hybridization (FISH) with a 4-color probe set targeting 6p25, 6q23, 11q13, and centromere 6 revealed increased chromosomal copy numbers of all 4 probes, which was interpreted as evidence of polyploidy. In addition, analysis of DNA copy number changes using a single nucleotide polymorphism microarray (Affymetrix, Santa Clara, CA) showed no chromosomal aberrations. The diagnosis of PN in a giant congenital nevus was eventually rendered. At 13-month follow-up, the nodules showed no evidence of growth. Our case illustrates that PNs in the neonatal period might demonstrate extreme mitotic activity. This feature is worrisome when encountered in melanocytic lesions; however, it should not trigger by itself a diagnosis of melanoma in the absence of other histologic criteria of malignancy. In addition, we document polyploidy by FISH in PN, which can potentially be misinterpreted as a FISH-positive result.
Thuy L T Nguyen; Amy Theos; David R Kelly; Klaus Busam; Aleodor A Andea
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The American Journal of dermatopathology     Volume:  35     ISSN:  1533-0311     ISO Abbreviation:  Am J Dermatopathol     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-25     Completed Date:  2013-07-26     Revised Date:  2014-04-08    
Medline Journal Info:
Nlm Unique ID:  7911005     Medline TA:  Am J Dermatopathol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e16-21     Citation Subset:  IM    
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MeSH Terms
Cell Proliferation*
Comparative Genomic Hybridization
DNA Copy Number Variations
Diagnosis, Differential
In Situ Hybridization, Fluorescence
Infant, Newborn
Ki-67 Antigen / analysis
Melanoma / pathology*
Nevus, Pigmented / chemistry,  congenital,  genetics,  pathology*
Oligonucleotide Array Sequence Analysis
Predictive Value of Tests
Skin Neoplasms / chemistry,  congenital,  genetics,  pathology*
Tumor Markers, Biological / analysis,  genetics
Reg. No./Substance:
0/Ki-67 Antigen; 0/Tumor Markers, Biological

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