Letter - Dermatopathology
Melanoma with osteocartilaginous differentiation
Bennett Barroso de Carvalho
, Diogo Batista dos Santos Medeiros
Corresponding author
Division of Pathology, Hospital de Base do Distrito Federal, Brasília, DF, Brazil
Read
3954
Timeswas read the article
1457
Total PDF
2497
Total HTML
Share statistics
array:24 [ "pii" => "S0365059622002835" "issn" => "03650596" "doi" => "10.1016/j.abd.2022.04.004" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "676" "copyright" => "Sociedade Brasileira de Dermatologia" "copyrightAnyo" => "2022" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "pt" => array:19 [ "pii" => "S266627522200296X" "issn" => "26662752" "doi" => "10.1016/j.abdp.2022.12.007" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "676" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "pt" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Cartas ‐ Dermatopatologia</span>" "titulo" => "Melanoma com diferenciação osteocartilaginosa" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "266" "paginaFinal" => "269" ] ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1665 "Ancho" => 1675 "Tamanyo" => 556107 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Área de transição com diferenciação heteróloga condroide (Hematoxilina & eosina, 400×).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Bennett Barroso de Carvalho, Diogo Batista dos Santos Medeiros" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Bennett" "apellidos" => "Barroso de Carvalho" ] 1 => array:2 [ "nombre" => "Diogo" "apellidos" => "Batista dos Santos Medeiros" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0365059622002835" "doi" => "10.1016/j.abd.2022.04.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059622002835?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S266627522200296X?idApp=UINPBA00008Z" "url" => "/26662752/0000009800000002/v1_202302281436/S266627522200296X/v1_202302281436/pt/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S0365059622002744" "issn" => "03650596" "doi" => "10.1016/j.abd.2021.12.009" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "667" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Tropical/Infectious and parasitic dermatology</span>" "titulo" => "Cervical sporotrichosis simulating squamous cell carcinoma in a patient with photodamage" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "270" "paginaFinal" => "272" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2711 "Ancho" => 1167 "Tamanyo" => 815574 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Culture on modified Sabouraud agar medium with macromorphology showing a black filamentous colony with a white halo.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Emilly Neves Souza, Lucia Martins Diniz, Luana Amaral de Moura, Valentina Lourenço Lacerda de Oliveira, Henrique Vivacqua Leal Teixeira de Siqueira" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Emilly Neves" "apellidos" => "Souza" ] 1 => array:2 [ "nombre" => "Lucia Martins" "apellidos" => "Diniz" ] 2 => array:2 [ "nombre" => "Luana Amaral de" "apellidos" => "Moura" ] 3 => array:2 [ "nombre" => "Valentina Lourenço Lacerda de" "apellidos" => "Oliveira" ] 4 => array:2 [ "nombre" => "Henrique Vivacqua Leal Teixeira de" "apellidos" => "Siqueira" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275222002867" "doi" => "10.1016/j.abdp.2022.11.031" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275222002867?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059622002744?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000002/v1_202302171515/S0365059622002744/v1_202302171515/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0365059622002318" "issn" => "03650596" "doi" => "10.1016/j.abd.2021.09.017" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "642" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Clinical</span>" "titulo" => "Unilateral linear syringoma on the right chest and arm" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "263" "paginaFinal" => "265" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1119 "Ancho" => 1675 "Tamanyo" => 190890 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0070" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Closer look on the right chest. There is a wound after skin biopsy at the bottom.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Danyi Huang, Yanqing Chen, Jianjian Li, Han Ma" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Danyi" "apellidos" => "Huang" ] 1 => array:2 [ "nombre" => "Yanqing" "apellidos" => "Chen" ] 2 => array:2 [ "nombre" => "Jianjian" "apellidos" => "Li" ] 3 => array:2 [ "nombre" => "Han" "apellidos" => "Ma" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275222002430" "doi" => "10.1016/j.abdp.2022.11.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275222002430?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059622002318?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000002/v1_202302171515/S0365059622002318/v1_202302171515/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Dermatopathology</span>" "titulo" => "Melanoma with osteocartilaginous differentiation" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor,</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "266" "paginaFinal" => "269" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Bennett Barroso de Carvalho, Diogo Batista dos Santos Medeiros" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Bennett" "apellidos" => "Barroso de Carvalho" "email" => array:1 [ 0 => "bennettcarvalho@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Diogo" "apellidos" => "Batista dos Santos Medeiros" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Division of Pathology, Hospital de Base do Distrito Federal, Brasília, DF, Brazil" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1682 "Ancho" => 1675 "Tamanyo" => 657064 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0255" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Melanoma cells showing atypia, pleomorphism, evident nucleoli, and frequent mitotic figures (Hematoxylin & eosin, ×400).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Melanoma is a potentially lethal skin neoplasm that requires an accurate diagnosis to ensure that the patient will receive optimal treatment. Despite the advent of large-scale, high-resolution genomics, histopathological analysis remains the reference for diagnosis and the primary classification tool in correlation with clinical characteristics<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Melanoma can exhibit a variety of histopathological patterns, mimicking other malignant tumors. Based on their histopathological characteristics, several morphological subtypes have been described in addition to the classical forms, such as polypoid, verrucous, desmoplastic, myxoid, balloon-cell, rhabdoid, amelanotic, and spitzoid melanoma, among others<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. It may also rarely show heterologous differentiation patterns, including fibroblastic, smooth muscle, rhabdomyoblastic, osteocartilaginous, Schwannian, and ganglionic. Osteocartilaginous differentiation is one of the most uncommon patterns<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Osteocartilaginous differentiation is characterized by the formation of osteoid, bone, and cartilaginous tissue by the neoplastic cells. Its rarity and overlapping characteristics with those of other neoplasms make it difficult to diagnose, especially in small biopsies or when clinical/radiological information is limited. It may be confused with osteosarcomas or chondrosarcomas<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The mechanisms responsible for heterologous differentiation are not well understood. This report describes a case of melanoma with osteocartilaginous differentiation that developed on the distal region of the left upper limb.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In August 2019, a 52-year-old woman came to the Orthopedics outpatient clinic with a history of a darkened lesion in the subungual region of the left thumb, with an evolution of approximately three years. On physical examination, edema, local phlogosis, and signs suggestive of fungal infection were observed. She underwent specific treatment for the infection but did not show a complete response.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The subungual lesion was submitted to an incisional biopsy, and the histopathological and immunohistochemical study confirmed the diagnosis of melanoma. The patient was then referred to the Oncological Surgery service for specific treatment.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In November of the same year, after evaluation, she underwent amputation of the affected finger. Histopathological analysis confirmed the diagnosis of nodular melanoma, with the presence of lymphovascular invasion and a proliferative index of 17 mitoses/mm<span class="elsevierStyleSup">2</span>. After surgery, she had regular follow-up consultations at the Clinical Oncology department. After eight months, tumor growth was observed on the surgical scar. Computed tomography assessment showed a lesion suggestive of recurrence.</p><p id="par0040" class="elsevierStylePara elsevierViewall">She underwent surgical resection once again, with en bloc removal of the lesion. Histopathological analysis of the specimen showed local recurrence of the melanoma, with the presence of vascular and neural invasion, in addition to compromised surgical margins. Follow-up imaging studies demonstrated the presence of axillary involvement and the presence of pulmonary lesions suggestive of metastasis.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The patient was referred for adjuvant local and axillary radiotherapy in February 2021. She also started therapy with Dacarbazine and immunotherapy with Pembrolizumab in April 2021. In the same month, she had a new tumor growth in the area of ​​the previous resection. Computed tomography showed extensive expansive/infiltrative soft tissue lesions in the distal region of the left arm and hand, and palliative surgery was chosen, with surgical disarticulation at the elbow and left axillary lymphadenectomy, performed in July 2021.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Macroscopically, the surgical specimen showed a large tumor in the distal region of the left upper limb (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Histopathology showed the presence of melanoma with areas of heterologous osteocartilaginous differentiation (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2–4</a>), invading soft tissues and bone, with free surgical margins. The diagnosis of melanoma was confirmed by immunoreactivity with SOX10 and HMB45 (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). Axillary dissection showed metastatic melanoma in a left axillary lymph node. Molecular screening for the V600E mutation in the BRAF gene was negative.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Due to advanced and metastatic disease, the patient remained hospitalized, progressing with clinical worsening, signs of respiratory distress, and hemodynamic instability. With no possibility of disease-modifying therapy, she started exclusive palliative care, passing away in October 2021.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Osteocartilaginous differentiation in melanoma was first observed over 45 years ago<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>, but fewer than 40 reports have been published since then<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a>.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Osteoid, chondroid and mixed patterns have been described as appearing in predominantly acral and subungual sites. However, osteocartilaginous differentiation is not restricted to these regions, as it has been previously described in mucosal lesions, as well as in skin that is chronically or intermittently exposed to the sun<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The mechanism for the formation of the osteoid/chondroid matrix in these melanomas is unknown. Many are associated with a history of previous local trauma and the osteoid/chondroid matrix may be a form of host response to the lesion<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>. Another hypothesis is that osteoid/chondroid differentiation is a result of reactive responses induced by the melanoma in the surrounding stromal fibroblasts. However, there is often a lack of stromal cells in the matrix areas, which may arise from the neoplastic cells themselves<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Hypothetical intrinsic melanoma factors that could drive the production of this matrix include the expression of the “Melanoma inhibitory activity (MIA)” and “Runt-related transcription factor 2” (RUNX2) genes, transcriptional regulators of chondrogenesis and osteogenesis<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Although these genes can be expressed by most melanomas, studies have already shown that MIA and RUNX2 require the expression of other cofactors to drive osteoid/chondroid differentiation, and the lack of these genes may explain the rarity of osteocartilaginous melanoma despite frequent gene expression<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The diagnosis of melanoma can be supported by the presence of an “<span class="elsevierStyleItalic">in situ</span>” component, the presence of melanin pigment, or immunoreactivity with markers such as S100, Melan-A, HMB45, or SOX10<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. In melanomas with cartilaginous differentiation, the use of S100 is limited, as cartilaginous tissues and chondrosarcomas also express positivity<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>.</p><p id="par0095" class="elsevierStylePara elsevierViewall">In the molecular analysis, the presence of the V600E mutation in the BRAF gene can also support the diagnosis of melanoma, in addition to being crucial for planning its treatment<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>.</p><p id="par0100" class="elsevierStylePara elsevierViewall">It is not yet entirely clear whether the osteocartilaginous melanoma harbors only mutations and differentiation markers typical of melanoma or of the osteocartilaginous lesions it mimics as well<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Based on the literature review, the authors highlight the importance of applying an immunohistochemical panel with the inclusion of melanocytic differentiation markers in cases of neoplasms with osteoid/chondroid differentiation, mainly in acral lesions, and of including melanoma with heterologous differentiation among the differential diagnoses. Due to the rarity of the case, the development of guidelines for early diagnosis, management and prognosis for this cancer variant remains challenging.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0110" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors' contributions</span><p id="par0115" class="elsevierStylePara elsevierViewall">Bennett Barroso de Carvalho: drafting and editing of the manuscript or critical review of important intellectual content; critical review of the literature.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Diogo Batista dos Santos Medeiros: Effective participation in research orientation; drafting and editing of the manuscript or critical review of important intellectual content; approval of the final version of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors' contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-02-23" "fechaAceptado" => "2022-04-13" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Department of Pathology, Hospital de Base do Distrito Federal, Brasília, DF, Brazil.</p>" ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1460 "Ancho" => 1675 "Tamanyo" => 136881 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0250" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tumor in the distal region of the left upper limb.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1682 "Ancho" => 1675 "Tamanyo" => 657064 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0255" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Melanoma cells showing atypia, pleomorphism, evident nucleoli, and frequent mitotic figures (Hematoxylin & eosin, ×400).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1665 "Ancho" => 1675 "Tamanyo" => 556107 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0260" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Area of transition into heterologous chondroid differentiation (Hematoxylin & eosin, ×400).</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1666 "Ancho" => 1675 "Tamanyo" => 457530 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0265" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Area of transition into heterologous osteoid differentiation (Hematoxylin & eosin, ×400).</p>" ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1522 "Ancho" => 3341 "Tamanyo" => 642135 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0270" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A) Immunoreactivity with HMB45 (×400). (B) Immunoreactivity with SOX10 (×400).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "WHO Classification of Skin Tumours" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "International Agency for Research on Cancer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "4<span class="elsevierStyleSup">th</span> ed." "fecha" => "2018" "editorial" => "World Health Organization" "editorialLocalizacion" => "Lyon, France" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unusual histological variants of cutaneous malignant melanoma with some clinical and possible prognostic correlations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Rongioletti" 1 => "B.R. Smoller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.0303-6987.2005.00418.x" "Revista" => array:6 [ "tituloSerie" => "J Cutan Pathol" "fecha" => "2005" "volumen" => "32" "paginaInicial" => "589" "paginaFinal" => "603" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16176296" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Morphological and immunophenotypic variations in malignant melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.S. Banerjee" 1 => "M. Harris" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1365-2559.2000.00894.x" "Revista" => array:7 [ "tituloSerie" => "Histopathology" "fecha" => "2000" "volumen" => "36" "paginaInicial" => "387" "paginaFinal" => "402" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10792480" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1473309920304321" "estado" => "S300" "issn" => "14733099" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic lessons of mucosal melanoma with osteocartilaginous differentiation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.S. Banerjee" 1 => "J.D. Coyne" 2 => "L.P. Menasce" 3 => "C.J. Lobo" 4 => "P.J. Hirsch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1365-2559.1998.00494.x" "Revista" => array:6 [ "tituloSerie" => "Histopathology" "fecha" => "1998" "volumen" => "33" "paginaInicial" => "255" "paginaFinal" => "260" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9777392" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malignant melanoma with metaplastic cartilaginous transdifferentiation: A case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Berro" 1 => "N.A. Halim" 2 => "C. Khaled" 3 => "H.I. Assi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/cup.13539" "Revista" => array:6 [ "tituloSerie" => "J Cutan Pathol" "fecha" => "2019" "volumen" => "46" "paginaInicial" => "935" "paginaFinal" => "941" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31260118" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Osseous changes in malignant melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Pluta" 1 => "I. Malska-Waniewska" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Nowotwory" "fecha" => "1974" "volumen" => "24" "paginaInicial" => "37" "paginaFinal" => "43" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4824375" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Melanoma exhibiting cartilaginous differentiation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Murali" 1 => "S.W. McCarthy" 2 => "J. Bothman" 3 => "A. Cachia" 4 => "P. Janarthanan" 5 => "R. Sharma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2559.2010.03536.x" "Revista" => array:7 [ "tituloSerie" => "Histopathology" "fecha" => "2010" "volumen" => "56" "paginaInicial" => "815" "paginaFinal" => "821" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20546349" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673614609326" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Melanoma with osseous or chondroid differentiation: a report of eight cases including SATB2 expression and mutation analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.J. Gallagher" 1 => "T. Bailey" 2 => "R.V. Rawson" 3 => "A.M. Mahar" 4 => "J.F. Thompson" 5 => "G.V. Long" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pathol.2021.02.012" "Revista" => array:6 [ "tituloSerie" => "Pathology" "fecha" => "2021" "volumen" => "53" "paginaInicial" => "830" "paginaFinal" => "835" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34090666" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary chondro-osseous melanoma (chondrosarcomatous and osteosarcomatous melanoma)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.M. Ali" 1 => "W.L. Wang" 2 => "A.J. Lazar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/cup.13067" "Revista" => array:6 [ "tituloSerie" => "J Cutan Pathol" "fecha" => "2018" "volumen" => "45" "paginaInicial" => "146" "paginaFinal" => "150" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29068062" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Melanoma cartilagíneo: Caso clínico e revisão da literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.D. Parente" 1 => "J.M.P. da Silva Labareda" 2 => "E.A.F.L.F. Bártolo" 3 => "M.F.S.P.F. Santos" 4 => "E.M.S. do Vale" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/abd1806-4841.20131595" "Revista" => array:6 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2013" "volumen" => "88" "paginaInicial" => "403" "paginaFinal" => "407" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23793189" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Osteogenic melanoma: report of a case mimicking osteosarcoma and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Savant" 1 => "S. Kenan" 2 => "S. Kenan" 3 => "L. Kahn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00256-017-2835-y" "Revista" => array:6 [ "tituloSerie" => "Skeletal Radiol" "fecha" => "2018" "volumen" => "47" "paginaInicial" => "711" "paginaFinal" => "716" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29196822" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009800000002/v1_202302171515/S0365059622002835/v1_202302171515/en/main.assets" "Apartado" => array:4 [ "identificador" => "95152" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter - Dermatopathology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009800000002/v1_202302171515/S0365059622002835/v1_202302171515/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059622002835?idApp=UINPBA00008Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 25 | 8 | 33 |
| 2024 October | 131 | 62 | 193 |
| 2024 September | 193 | 82 | 275 |
| 2024 August | 192 | 111 | 303 |
| 2024 July | 175 | 91 | 266 |
| 2024 June | 141 | 65 | 206 |
| 2024 May | 125 | 69 | 194 |
| 2024 April | 159 | 96 | 255 |
| 2024 March | 130 | 77 | 207 |
| 2024 February | 133 | 83 | 216 |
| 2024 January | 116 | 49 | 165 |
| 2023 December | 87 | 62 | 149 |
| 2023 November | 84 | 93 | 177 |
| 2023 October | 80 | 76 | 156 |
| 2023 September | 78 | 79 | 157 |
| 2023 August | 79 | 27 | 106 |
| 2023 July | 87 | 48 | 135 |
| 2023 June | 72 | 50 | 122 |
| 2023 May | 75 | 28 | 103 |
| 2023 April | 90 | 34 | 124 |
| 2023 March | 105 | 61 | 166 |
| 2023 February | 95 | 59 | 154 |
| 2023 January | 45 | 47 | 92 |
Show all
