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Abstract
BackgroundNon-small cell lung cancer (NSCLC) and melanoma are frequent entities in routine diagnostics. Whereas the differential diagnosis is usually straight forward based on histomorphology, it can be challenging in poorly differentiated tumors as melanoma may mimic various histological patterns. Distinction of the two entities is of outmost importance as both are treated differently. HMB45 and MelanA are recommended immunohistological markers for melanoma in this scenario. SOX10 has been described as an additional marker for melanoma. However, comprehensive large-scale data about the expression of melanoma markers in NSCLC tumor tissue specimen are lacking so far.MethodsTherefore, we analyzed the expression of these markers in 1085 NSCLC tumor tissue samples. Tissue microarrays of NSCLC cases were immunohistochemically stained for HMB45, MelanA, and SOX10. Positivity of a marker was defined as ≥1% positive tumor cells.ResultsIn 1027 NSCLC tumor tissue samples all melanoma as well as conventional immunohistochemical markers for NSCLC could be evaluated. HMB45, MelanA, and SOX10 were positive in 1 (< 1%), 0 (0%) and 5 (< 1%) cases. The HMB45 positive case showed co-expression of SOX10 and was classified as large cell carcinoma. Three out of five SOX10 positive cases were SqCC and one case was an adenosquamous carcinoma.ConclusionsExpression of HMB45, MelanA and SOX10 is evident but exceedingly rare in NSCLC cases. Together with conventional immunomarkers a respective marker panel allows a clear-cut differential diagnosis even in poorly differentiated tumors.
Highlights
Non-small cell lung cancer (NSCLC) and melanoma are frequent entities in routine diagnostics
Applied immunohistological markers in this scenario are S100, Human Melanoma Black (HMB45), melanoma antigen recognized by T cells 1 (MelanA), SRY-related HMG-box 10 (SOX10), cytokeratin 5/6 (CK5/6), NapsinA, p63 (p40) and thyroid transcription factor-1 (TTF-1) [12, 13]
We systematically analyzed the expression of Human Melanoma Black 45 (HMB45), MelanA, SOX10, CK5/6, NapsinA, p63 and TTF-1 in 1027 NSCLC cases including 498 adenocarcinomas (ADC), 424 squamous cell carcinomas (SqCC), 44 adenosquamous carcinomas (ADSqCC), 51 large cell carcinomas (LC) and 10 pleomorphic carcinomas (PC)
Summary
Non-small cell lung cancer (NSCLC) and melanoma are frequent entities in routine diagnostics. Whereas the differential diagnosis is often feasible based on histomorphology alone, especially in resection specimens or when melanin pigment is evident, the distinction of both can be challenging in small biopsies or cytology preparations This is especially true for cases with undifferentiated morphology as melanoma may mimic various histological patterns [1]. A tumor situated in the lung is more likely to be lung cancer, the lung is a frequent site of metastatic spread especially in Kriegsmann et al Diagnostic Pathology (2018) 13:68 comprehensive expression of melanoma markers in NSCLC has not been analyzed in a large NSCLC tumor tissue cohort to date, except for S100 [17] This is surprising as especially SOX10 has prompted recent interest and has been reported in various other cancer entities. We systematically analyzed the expression of HMB45, MelanA, SOX10, CK5/6, NapsinA, p63 and TTF-1 in 1027 NSCLC cases including 498 adenocarcinomas (ADC), 424 squamous cell carcinomas (SqCC), 44 adenosquamous carcinomas (ADSqCC), 51 large cell carcinomas (LC) and 10 pleomorphic carcinomas (PC)
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