Anorectal malignant melanoma: A clinicopathologic study, including immunohistochemistry and DNA flow cytometry

Ofer Ben-Izhak, Rivka Levy, Shoshana Weill, Gabriel Groisman, Hector Cohen, Selina Stajerman, Ines Misselevich, Sami Nitecky, Shmuel Eidelman, Hedviga Kerner

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53 Scopus citations

Abstract

BACKGROUND. Anorectal malignant melanoma is rare tumor with an extremely poor prognosis. DNA flow cytometric study as well as detailed immunohistochemical study have not been reported previously. METHODS. Eighteen cases of anorectal melanoma were studied, including immunohistology for melanoma markers and epithelial markers and DNA flow cytometric study of paraffin blocks. RESULTS. Most patients were Ashkenazi Jews, compared with Sephardi Jews and Arabs. Of the 17 patients followed, 14 died of disease at 4-39 months from presentation. Three patients were alive with disease at 12, 53, and 72 months of follow-up. Tumor thickness ranged from 3-35 mm (mean, 12.8 mm). The 2 long term survivors had tumor thickness ≤ 7 mm. No correlation was found between the mode of primary surgical treatment (8 patients: abdominoperineal resection; 10 patients: local excision) and outcome. Vimentin, HMB-45, and S-100 protein stainings were positive in 18, 17, and 15 tumors, respectively. Polyclonal carcinoembryonic antigen (CEA), broad-spectrum cytokeratin, epithelial membrane antigen monoclonal CEA, and TAG-72 (B72.3) stainings were positive in 13, 3 (only focal and are staining), 2, 0, and 0 tumors, respectively. Thirteen tumors had adequate material for DNA analysis, and all were DNA aneuploid. S-phase fraction could be assessed in 11 tumors and ranged from 7.7-24% (mean, 14%). An S-phase fraction of < 10% was observed in the 2 long term survivors. CONCLUSIONS. Anorectal melanoma in this study carried a grave prognosis. The frequent staining for polyclonal CEA (with negative monoclonal CEA staining) was probably due to nonspecific cross-reacting antigens. The occasional staining for epithelial markers warrants a comprehensive immunohistochemical study to ensure a correct diagnosis, especially in small biopsies of a melanotic undifferentiated tumors that lack junctional changes. The aneuploidy of all tested tumors reflected their highly malignant behavior. A trend toward longer survival was observed in patients with thin tumors and an S-phase fraction of <10%. However, due to the small number of survivors, the latter observation should be further tested in a larger scale series.

Original languageEnglish
Pages (from-to)18-25
Number of pages8
JournalCancer
Volume79
Issue number1
DOIs
StatePublished - 1 Jan 1997
Externally publishedYes

Keywords

  • DNA ploidy
  • anal canal
  • carcinoembroyonic antigen
  • cytokeratin
  • epithelial membrane antigen
  • flow cytometry
  • malignant melanoma
  • rectum

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