Ann Dermatol.  2018 Jun;30(3):356-360. 10.5021/ad.2018.30.3.356.

Metastatic Blue Nevus-Like Melanoma Detected by Liquid-Based Catheterized Urine Cytology

• Kim SK
• Yang JY
• Han JH
• Kwon JE

• KMID: 2419181
• DOI: http://doi.org/10.5021/ad.2018.30.3.356

Abstract

Primary or metastatic malignant melanoma can mimic benign blue nevus in rare cases, making the diagnosis challenging. Herein, we report an exceptionally rare case of blue nevus-like melanoma and its blue nevus-like metastasis which was detected by catheterized urine cytology. The patient presented with blue-colored papuloplaques on his temple which were diagnosed as blue nevus-like melanoma on punch biopsies. While he was admitted for administration of chemotherapy, hematuria was detected. Catheterized urine cytology revealed singly scattered oval to spindle-shaped pigmented cells with a moderate degree of variation in shape and size. Many of them had small nuclei with indiscernible to inconspicuous nucleoli while only a few cells showed nuclear enlargement and nuclear hyperchromasia, which could be diagnostic pitfalls. Most of the cells on the smear were positive for HMB45 immunostaining, which confirmed the diagnosis of metastatic blue nevus-like melanoma. To the best of our knowledge, the present case is the first report describing cytomorphologic findings of blue nevus-like metastasis of melanoma in the urine specimen.

Keyword

Blue nevus; Blue nevus-like melanoma; Cytology; Melanoma; Neoplasm metastasis; Urine

MeSH Terms

Biopsy
Catheters*
Diagnosis
Drug Therapy
Hematuria
Humans
Melanoma*
Neoplasm Metastasis
Nevus, Blue

Figure

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  Fig. 1 A large ill-defined dark blue patch studded with pinhead to bean sized cobblestone surfaced papulonodules and satellite papules on the left temple.

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  Fig. 2 Histologic figures of the specimen taken from the central (A, B) and peripheral (C, D) area of the lesion. (A) Solid proliferation of pigmented cells are noted in the entire dermis without junctional activity (H&E, ×40). (B) The tumor cells are composed of epithelioid and short spindle cells with mild to moderate nuclear enlargement, small nucleoli, and vesicular chromatin. A mitotic figure is identified in the deep dermis (arrowhead) (H&E, ×400). (C) The periphery of the lesion is composed of more spindle cells with minimal nuclear atypia (H&E, ×400). (D) Among the mildly atypical cells, there are rare bizarre atypical cells, visible on careful examination (arrow) (H&E, ×400).

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  Fig. 3 Catheterized urine cytology on liquid-based preparation. (A) The specimen is moderately cellular and composed of oval to spindle-shaped pigmented cells showing moderate degree of variations in size and shape, admixed with many red blood cells (papanicolaou [PAP] stain, virtual slide). (B) Many of the pigmented tumor cells have small nuclei, some of which are obscured by melanin pigment (arrowheads) (PAP, ×1,000). (C) A small number of cells shows increased nuclear to cytoplasmic ratio (arrow) (PAP, ×1,000). (D) Another atypical cell exhibit an enlarged angulated hyperchromatic nucleus (arrow) (PAP, ×1,000). (E) The pigmented cells are positive on HMB45 immunostaining (arrowheads) (amino ethyl carbazol [AEC], ×400).

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