By Paul J. Donald
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Cohesive nests of plump, polygonal cells are adjoined by intracellular bridges. Keratinization is not present in this section. ) sheets of plump, polygonal cells with abundant pink cytoplasm. Melanoma may be distinguished from squamous carcinoma by the absence of intercellular bridges. Less reliable features include the characteristic nuclear inclusions of melanoma and variably present cytoplasmic brown pigmentation. Immunohistochemistry is usually definitive in distinguishing these entities, with squamous cell carcinoma reactive lo cytokeratin and melanoma reactive to S-100 and HMB-45.
Melanoma. HMB-45, a "melanoma-specific" marker, intensely decorates individual tumor cells in this nasal mucosal melanoma. " The papillary growth pattern can be confused with a papillary carcinoma or atypical papilloma. The diagnosis may be initially missed without a high index of suspicion for this lesion. The identification and confirmation of melanoma is, however, relatively straightforward with modern immunohistochemical techniques. Definition. A metastasis is a secondary focus of tumor that has spread from an often distant primary site by lymphatic or vascular routes.
Olfactory neuroblastomas are sometimes graded hislologically on a scale of I (well differentiated) to IV (poorly differentiated). Some have found this grading system to have prognostic significance, whereas others have not. Differential Diagnosis. The differential diagnosis includes innumerable "small round cell'' tumors that occur in the sinonasal tract (43). Among the more common ones are malignant lymphoma. rhabdomyosarcoma, undifferentiated carcinoma, and malignant melanoma. Most often, these tumors can be distinguished by the use of immune stains.