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Nov 2011

Atypical Cellular Neurothekeoma in a Pregnant Woman

Author Affiliations

Author Affiliations: Department of Pathology, The University of Texas Medical School at Houston, Texas (Drs Gullett and Jimenez-Quintero); Departments of Pathology and Dermatology, The University of Texas MD Anderson Cancer Center, Houston (Drs Prieto and Ivan).

Arch Dermatol. 2011;147(11):1342-1343. doi:10.1001/archdermatol.2011.333

A 20-year-old pregnant woman was evaluated for a 5   ×  4-mm pink papule on the nasal tip, which arose during her first trimester and rapidly enlarged. A shave biopsy was performed. The neoplasm exhibited a predominantly intradermal proliferation of epithelioid cells infiltrating the subcutaneous tissue without involvement of the overlying epidermis (Figure, A). The tumor had a nodular, nested growth pattern and was composed of epithelioid cells with focal pleomorphism, abundant cytoplasm, and ovoid nuclei with small nucleoli. No intracytoplasmic pigment was identified. There were numerous mitotic figures (up to 4/mm2) raising the possibility of a malignant neoplasm (Figure, B [inset]). The differential diagnosis included spitzoid melanoma and atypical Spitz nevus. Based on histologic findings, the diagnosis of melanoma was favored.

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