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10/07/16 1 Catherine M. Stefanato, MD, FRCPath Consultant in Dermatopathology St John’s Institute of Dermatology London, UK NEGATIVE IMMUNOSTAINS • MNF116: nega8ve • Cytokera8n 7: nega8ve • Cytokera8n 20: nega8ve • S100: nega8ve • Mel5: nega8ve Mel5 POSITIVE IMMUNOSTAINS • Melan A (cytoplasmic): posi8ve • MiTF1 (nuclear): posi8ve • SOX10 (nuclear): posi8ve Pseudomelanocy8c nests: What are they? • Aggregates of cells and cell fragments that include kera8nocytes, macrophages, lymphocytes • Transfer of melanosomes or melanocy8c epitopes to non-melanocy8c cells as consequence of lichenoid 8ssue reac8on • In the seUng of lichenoid inflamma8on pseudomelanocy8c nests may mimic an atypical melanocy8c prolifera8on

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Page 1: Catherine M. Stefanato, MD, FRCPath London, UK 2016 1.pdf · 10/07/16 1 Catherine M. Stefanato, MD, FRCPath Consultant in Dermatopathology St John’s Institute of Dermatology London,

10/07/16

1

Catherine M. Stefanato, MD, FRCPath Consultant in Dermatopathology

St John’s Institute of Dermatology London, UK

NEGATIVEIMMUNOSTAINS

•  MNF116:nega8ve•  Cytokera8n7:nega8ve•  Cytokera8n20:nega8ve•  S100:nega8ve•  Mel5:nega8ve

Mel5

POSITIVEIMMUNOSTAINS

•  MelanA(cytoplasmic):posi8ve•  MiTF1(nuclear): posi8ve•  SOX10(nuclear): posi8ve

Pseudomelanocy8cnests:Whatarethey?

•  Aggregatesofcellsandcellfragmentsthatincludekera8nocytes,macrophages,lymphocytes

•  Transferofmelanosomesormelanocy8cepitopestonon-melanocy8ccellsasconsequenceoflichenoid8ssuereac8on

•  IntheseUngoflichenoidinflamma8onpseudomelanocy8cnestsmaymimicanatypicalmelanocy8cprolifera8on

Page 2: Catherine M. Stefanato, MD, FRCPath London, UK 2016 1.pdf · 10/07/16 1 Catherine M. Stefanato, MD, FRCPath Consultant in Dermatopathology St John’s Institute of Dermatology London,

10/07/16

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AE1/AE3 MelanA

MiTF SOX10

Dx:Lichenplanuspigmentosus/erythemadyschromicumperstans

CLINICOPATHOLOGICALCORRELATION Pseudomelanocy8cnests:Howtoavoidthepi^all?

•  MelanAcanbedetectedinthecytoplasmofnon-melanocy8ccells(melanocy8cdebrisengulfedbymacrophagesintheseUngoflichenoidinflamma8on)

•  MiTFandSOX10arenuclearstainsBUTnottotallymelanocy8cspecific(SOX10:Schwanncellsandmyoepithelialcells.MiTFmacrophagesandmastcells)

•  S100nega8vity:mostspecificmarkerbutcomplexinterpreta8onduetoLangerhanscellsandmacrophages

Direct Immunofluorescence

•  IgM:granulardeposi1onalongtheBMZ&•  colloidbodies•  IgG:lineardeposi1onalongtheBMZ•  IgA:colloidbodies•  Fibrinogen:Lineardeposi1onalongtheBMZ•  ThioflavinT:nega1ve

A. Len8gomalignaB. LichenplanuspigmentosusC. Melano8clupusD. Pigmentedac8nickeratosis

Page 3: Catherine M. Stefanato, MD, FRCPath London, UK 2016 1.pdf · 10/07/16 1 Catherine M. Stefanato, MD, FRCPath Consultant in Dermatopathology St John’s Institute of Dermatology London,

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ACQUIREDFACIALMELANOSES•  Melasma•  Lichenplanuspigmentosus

•  Melano1c(Discoidlupuserythematosus

•  Drug-inducedmelanosis

•  Argyria•  Macularamyloidosis•  Fixeddrugerup1on

•  Ochronosis•  Acanthosisnigricans•  PoikilodermaofCivaQe

•  Riehl’smelanosis(pigmentedcontactderma11s)

•  Hori’snevus(acquiredbilateralnevusofOtalikemacules)

Melano1cLupuserythematosus

•  PigmentedmacularsubsetofDLE•  MorecommoninIndian/Asianpopula8on•  Hyperpigmenta8onarising‘denovo’withouterythema,indura8onorscaling

•  Confusedwithlichenplanuspigmentosus•  Immunofluorescencestudiesessen8alinthediagnosis

PatelAB,RKubba,AKubba:Clinicopathologicalcorrela8onofacquiredhyperpigmentarydisorders.IndianJDermatolVenereolLeprol2013;79:367

•  DrGianlucaPetrillo•  DrGerardoFerrara


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