J Pathol Transl Med.  2019 Mar;53(2):119-124. 10.4132/jptm.2018.10.18.

Primary Malignant Melanoma of the Breast: A Report of Two Cases

• Koh J
• Lee J
• Jung SY
• Kang HS
• Yun T
• Kwon Y

• KMID: 2465451
• DOI: http://doi.org/10.4132/jptm.2018.10.18

Abstract

Primary malignant melanoma of the breast (PMMB) is a rare tumor with only a few case reports available in the literature. We report two cases of PMMB, one derived from the breast parenchyma and the other from the breast skin. The first case consisted of atypical epithelioid cells without overt melanocytic differentiation like melanin pigments. The tumor cells showed diffuse positivity for S100 protein, tyrosinase, and BRAF V600E. However, the tumor cells were negative for cytokeratin, epithelial membrane antigen, and HMB-45. The second case showed atypical melanocytic proliferation with heavy melanin pigmentation. The tumor cells were positive for S100 protein, HMB-45, tyrosinase, and BRAF V600E. These two cases represent two distinct presentations of PMMB in terms of skin involvement, melanin pigmentation, and HMB-45 positivity. Although PMMB is very rare, the possibility of this entity should be considered in malignant epithelioid neoplasms in the breast parenchyma.

Keyword

Breast; Malignant melanoma; BRAF

MeSH Terms

Breast*
Epithelioid Cells
Keratins
Melanins
Melanoma*
Monophenol Monooxygenase
Mucin-1
Pigmentation
Skin
Keratins
Melanins
Monophenol Monooxygenase
Mucin-1

Figure

• 

  Fig. 1. (A, B) Breast magnetic resonance imaging (A) and positron emission tomography scan (B) show a solitary breast mass without regional or distant metastasis. (C) Gross examination reveals a grayish white solid mass within the breast parenchyma without skin involvement. (D–F) Microscopically, the tumor shows solid growth pattern (D) and focal tumor necrosis (E), consisting of atypical epithelioid cells. (G–L) The tumor cells are diffusely positive for S100 protein (G) and tyrosinase (H) and weakly positive for BRAF V600E (I), while they are negative for HMB-45 (J) and cytokeratin (K) with nonspecific weak staining for CD68 (L).

• 

  Fig. 2. (A, B) No remarkable findings other than mild thickening of the left breast skin are seen on breast magnetic resonance imaging (A) or positron emission tomography scan (B). (C) Gross examination reveals a relatively demarcated dark brown lesion. (D) Microscopically, the tumor is composed of atypical melanocytic proliferation with melanin pigmentation. (E–I) The tumor cells are strongly positive for S100 protein (E), tyrosinase (F), and HMB-45 (G); weakly positive for BRAF V600E (H); but negative for cytokeratin (I).

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