Melanotic schwannoma of the neck mimicking a malignant melanoma

We report a case of a 42-year-old female patient who presented with a 5-month history of a right cervical swelling. A fine-needle aspiration biopsy performed elsewhere led to the diagnosis of malignant melanoma. Clinical examination revealed pigmented skin and mucous-membrane lesions of the pharynx....

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Bibliographic Details
Published in:European archives of oto-rhino-laryngology 2005-03, Vol.262 (3), p.182-185
Main Authors: SCHMITZ, Klaus Jürgen, UNKEL, Claus, GRABELLUS, Florian, BABA, Hideo Andreas, DIRSCH, Olaf, NEUMANN, Andreas
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Biopsy, Needle
Dermatology
Diagnosis, Differential
Female
Humans
Medical sciences
Melanoma - diagnosis
Neurilemmoma - diagnostic imaging
Neurilemmoma - pathology
Neurilemmoma - surgery
Otorhinolaryngology. Stomatology
Pharyngeal Neoplasms - diagnostic imaging
Pharyngeal Neoplasms - pathology
Pharyngeal Neoplasms - surgery
Treatment Outcome
Tumors of the skin and soft tissue. Premalignant lesions
Ultrasonography
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Summary:We report a case of a 42-year-old female patient who presented with a 5-month history of a right cervical swelling. A fine-needle aspiration biopsy performed elsewhere led to the diagnosis of malignant melanoma. Clinical examination revealed pigmented skin and mucous-membrane lesions of the pharynx. Diagnostic exstirpation of the cervical tumor resulted in the intraoperative diagnosis of a malignant melanoma. Subsequent pathological examination including ultrastructural analysis allowed the revision of the diagnosis to that of melanotic schwannoma, a rare, pigmented nerve sheath tumor. Further analysis of the tissue obtained from neck dissection revealed additional melanotic schwannomas. With regard to prognostic and therapeutic issues, it is necessary to differentiate these tumors from the more common metastatic malignant melanoma. The preoperative differential diagnosis is very difficult, as light microscopy and immunocytochemistry allow no discrimination in small biopsies. Although the occurrence of multiple schwannomas points to a hereditary syndrome, our patient did not fulfill the criteria of Carney's syndrome or other known syndromes, suggesting a so far unknown genetic background.
ISSN:0937-4477
1434-4726
DOI:10.1007/s00405-004-0795-z