Desmoplastik Malign Melanom Tanısında Güçlü Tanısal Belirteç: Fascin Olabilir mi?

Desmoplastik melanom, malign melanomun nadir görülen bir varyantıdır. Klasik malign melanomun geleneksel klinikopatolojik özelliklerini göstermez. İmmunohistokimyasal HMB-45 ve Melan-A negatifliği desmoplastik malign melanom tanısında zorluk oluşturmakta ve olguların yanlış tanı almalarına neden olmaktadır. Bu nedenle S-100 immunohistokimyasal boyasının yanında ek immunohistokimyasal belirteçlere gerek duyulmaktadır. Olgu serimizde fascinin desmoplastik malign melanom tanısında yardımcı bir marker olarak kullanılabilirliğine bakmayı amaçladık. Desmoplastik malign melanom tanısı alan beş olgunun parafin bloğundan hazırlanan lizinli kesitlere otomatik doku boyama cihazıyla immünohistokimyasal fascin boyaması yapıldı. İmmunohistokimyasal değerlendirmede sitoplazmik immunreaktivite gösterenler “pozitif”, immunreaktivite göstermeyenler “negatif” olarak değerlendirildi. S-100 pozitifliği dışında melanosit belirleyicilerin negatif olduğu tüm desmoplastik malign melanom olgularında fascin sitoplazmik pozitif bulundu. Üç olguda fascin pozitifliği diffüz ve kuvvetliydi. Desmoplastik malign melanomda olgulara doğru tedavi modalitelerinin uygulanmasında kesin ayırıcı tanısının yapılması son derece önemlidir. Bu nedenle S-100 pozitivitesi yanında Fascin pozitifliğinin de gösterilmesinin tanı sürecinde yararlı olacağı düşüncesindeyiz.

Strong Diagnostic Marker in Desmoplastic Malignant Melanoma Diagnosis: Can it Be Fascin?

Desmoplastic melanoma is a rare variant of melanoma and it does not show the classical clinicopathological features of melanoma. Immunohistochemically HMB-45 and Melan-A negativity in desmoplastic melanoma creates difficulty in diagnosis and causes misdiagnosis. For this reason, additional immunohistochemical markers besides S-100 are needed. In our case series, we aimed to investigate the diagnostic utility of fascin as an ancillary marker for the diagnosis of desmoplastic malignant melanoma. Sections obtained from five desmoplastic malignant melanoma cases diagnosed histopathologically and immunohistochemically were stained by automated slide stainer for immunohistochemistry. The cases showing cytoplasmic immunoreactivity were evaluated as 'positive' and the ones with no immunoreactivity as 'negative'. All desmoplastic melanoma cases with immunohistochemically negative for melanocyte markers except S-100 were positive for fascin. Fascin positivity was diffuse and strong in three cases. There is a difficulty in diagnosis of desmoplastic melanoma due to its peculiar clinical and histopathological features. Accurate differential diagnosis is extremely important for the correct treatment of the demoplastic melanoma. Therefore, we think that showing fascin positivity besides S-100 will be also useful in the diagnostic process.

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