path results and I have a question.

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10/6/2010 3:46pm
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Replies: 4

path report #1
Ten cross sections of four deifferent lymph nodes are examined on multiple slides. All cross sections are immunostained for HMB45. On one slide only, slide B2, in a subcapsular location four cells exhibit immunoreactivity for HMB45 staining. The cells are not cytologically abnormal. I can't say with certainty they represent malignant melanoma. They could represent nuvus cells within a lymph node.

Sent the slides to Mayo and here is what they said.....

I am writing regarding the material that you sent from RB, a 32-year-old women. These are very interesting and challenging slides. I am in complete agreement with the original diagnosis of malignant melanoma on the right leg. There are occasional mitotic figures present with lision as well as the measured depth of 1.1 mm. Sentinel lymph node is quite interesting. On H&E, there is a clear-cut deposition of melanocystic type cells present within the capsule of the nevus. A few of these cells stain positive for HMB-45, but the vast majority of them do not stain for HMB-45. This is an intersting pattern in that the majority of capsular melanocytic nevi are Melan-A/Mart-1 positive, but these cells as well as their architectural location that these are most consistent with a capsular melanocytic nevus.

My questions are.....
1. they say "nothing to be worried about" but then I heard something about a micro-matasti.....what is that, and should I be worried?
2. I was dx with a 2a, but no ulceration and with it being a depth of 1.1 wouldn't that be a stage1???

Thanks for reading and for those that reply...thanks for that too!

"micro - mets " - that is what they are looking for in the lymph nodes.  In yours, they found melanocytes - maybe an actual mole.  But the melanocytes were normal looking, not malignant.  This basically means that there were no micro (microscopic) or macro (visible to the naked eye) metastases in the lymph node.

Yes, I read a 1.1mm depth with no ulceration as being stage IB.  (T2AN0M0).

Best wishes,

Janner

I can help with your #1 question. Here's the best I could do understanding your path report.  There are others who are better at this, but I'll take a hack.

In one lymph node, your first pathologist saw four cells that look normal (normal shapes and cell parts) but they stained positive for HMB45, which indicates melanin (pigment) is present.  But since the cells look normal, he thinks they could just be basically a mole (nevus) in your lymph node, NOT a micro met [micro-metastisis would be a small area of melanoma growing separate from your original tumor].  In my recollection, HMB45 isn't the most specific stain in the world and can have false positives, so the fact that the cells look normal is a good thing and evidence for the "just a mole" theory. 

The guy from Mayo, I'm less clear what he's saying.  When he says "H&E", that is a basic stain that is used to make the cells visible. Based on this visualization technique, you have cells in your sentinel node that look like pigment-containing cells.  Like the first pathologist, he notes that only a few of them test postitive for melanin pigment using the HMB45 test.  Melan-A/Mart-1 is a newer, more specific melanoma stain, and he seems to say that most of your cells DON'T stain with this one, even though he would expect them to do so if you had a normal "mole in your lymph node."  So he's confused why that is.   He then goes on to say that because of how these cells look and where they are, he still thinks they're normal, non-cancerous cells.

Was there more in the path report, like an overall impression? 

So to your question - a micro met is a small metastisis that can only be seen through microscopic examination; it hasn't grown large enough to be felt in the lymph node.  Your pathologists are debating whether or not you have one.  I cant tell without a final overall impression, but I think they have concluded that you have pigment-containing cells in your lymph node that AREN'T melanoma because the cells are acting/growing normally.  If so, "nothing to be worried about" is correct.

For the staging question, I"m not as up on that - someone else should be able to help though.

 

I think it's a pretty good outcome for your path report.  I hope you never hear from MM ever again :-)

 

KatyWI

Just keep going!

Hi Ranisa - this is good news.  I know it is hard to digest and very confusing.  They are saying that due to the location of the cells and because they dont look abnormal, they seem to be benign.  We had a similar experience with my husband's sentinel node path report (1.3 Breslow) but we didnt get the good news you did.  We got a second opinion from UCSF (it took them 2 months to come to this conclusion) but they agreed with the original diagnosis of single cell nodal metastasis (versus benign nevus cells) because the 1-2 cells were positive for Melan A and S-100 markers and they had enlarged nuclei (which is a sign of cancerous cells) and they were in the parenchyma versus the capsule.   Because of those 1-2 cells, he is Stage 3A versus Stage 1.   

My best to you!

Emily - wife of Mike, Stage 3a

Our experience with melanoma: http://emandmichael.wordpress.com/

Thanks for all of your replies guys it helped a bunch!  Emily my thoughts and prayer go out to you and your husband, heres hoping for a GREAT OUTCOME!!!