Combined high-grade basosquamous carcinoma and malignant melanoma of the scalp (malignant basomelanocytic tumor) metastasizing to the breast. A case report. Antonio Pitino, Salvatore Squillaci*, Cinzia Spairani, Fiorina Ottelli Zoletti*, Maria Fabia Cosimi, Mauro Ferrari, Anna Tropiano, Pier Carlo Rassu**, Federico Tuo***, Paolo Maiocchi**. Division of Anatomic Pathology, San Giacomo Hospital, Novi Ligure (AL), Italy; *Division of Anatomic Pathology, Hospital of Vallecamonica, Esine (Bs), Italy. **Division of Surgery, San Giacomo Hospital, Novi Ligure (AL), Italy; ***Division of Obstetric and Gynecology, San Giacomo Hospital, Novi Ligure (AL), Italy Background. Basal cell carcinoma (BCC) is a very low grade, usually not metastasizing skin malignancy, which needs to be radically excised. Methods. An 80 year-old woman was treated for a 3x2,2 cm multinodular mass in the scalp. One month later an ultrasonography of the left breast showed a 5,5 cm mass which was excised with clean margins. Axillary lymph nodes were free of metastasis. Results. The dermal tumor presented well demarcated basaloid epithelial nests with squamous differentiation focally connected with the epidermis. They showed peripheral palisading and high nuclear grade with pleomorphism, brisk mitotic activity and multiple prominent nucleoli. Atypical cells, arranged as strips, nests or isolated elements, were observed at the tumor edge, separated by a grey-zone from the overlying malpighian epithelium. Immunostains were positive for cytokeratins, melanocytic (S-100/HMB-45/MART-1) and neuroendocrine (CD56/NSE/Cromogranin) markers. The 4,8 cm breast tumor corresponded to a high grade metastatic BCC with reactivity for epithelial markers, S-100 and CD56. Conclusions. The literature reported 32 cases of combined tumors composed of BCC and malignant melanoma (MM) with 5 patients showing local recurrences. The term <<malignant basomelanocytic tumor>> describes these biphasic tumors. The knowledge of this entity expands the differential diagnosis of skin tumors with melanocytic component. Acknowledgements: The authors would like to thank Prof. Juan Rosai (CDI, Milan, Italy) for his consultative opinion on this case. EE 250X EE 100X EE 400X EE 400X EE 100X S-100 protein HMB-45 Mart-1 Skin lesion AE1/AE3 CK 5/6 Ber-Ep4 CD56 Double stain P63/Mart-1 Double stain P63/Mart-1 EE 100X CK 7 EE 40X Double stain S-100/CK7 Breast metastasis 24 th European Congress of Pathology 8-12 September 2012 Praga

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Page 1: Combined high-grade basosquamous carcinoma and malignant ...rassusenologia.it/wp-content/uploads/2015/03/Praga_8-12-9-12.pdf · Combined high-grade basosquamous carcinoma and malignant

Background. Basal cell carcinoma (BCC) is a very low grade, usually not metastasizing skin malignancy, which needs to be radically excised. Methods. An 80 year-old woman was treated for a 3x2,2 cm multinodular mass in the scalp. One month later an ultrasonography of the left breast showed a 5,5 cm mass which was excised with clean margins. Axillary lymph nodes were free of metastasis. Results. The dermal tumor presented well demarcated basaloid epithelial nests with squamous differentiation focally connected with the epidermis. They showed peripheral palisading and high nuclear grade with pleomorphism, brisk mitotic activity and multiple prominent nucleoli. Atypical cells, arranged as strips, nests or isolated elements, were observed at the tumor edge, separated by a grey-zone from the overlying malpighian epithelium. Immunostains were positive for cytokeratins, melanocytic (S-100/HMB-45/MART-1) and

neuroendocrine (CD56/NSE/Cromogranin) markers. The 4,8 cm breast tumor corresponded to a high grade metastatic BCC with reactivity for epithelial markers, S-100 and CD56. Conclusions. The literature reported 32 cases of combined tumors composed of BCC and malignant melanoma (MM) with 5 patients showing local recurrences. The term <<malignant basomelanocytic tumor>> describes these biphasic tumors. The knowledge of this entity expands the differential diagnosis of skin tumors with melanocytic component. Acknowledgements: The authors would like to thank Prof. Juan Rosai (CDI, Milan, Italy) for his consultative opinion on this case.

EE 250X EE 100X EE 400X

EE 400X

EE 100X

S-100 protein HMB-45 Mart-1

Skin lesion

AE1/AE3 CK 5/6

Ber-Ep4 CD56

Double stain P63/Mart-1 Double stain P63/Mart-1

EE 100X CK 7

EE 40X Double stain S-100/CK7

Breast metastasis

24th European Congress of Pathology 8-12 September 2012 Praga