Monster Cells in Malignant Melanoma

Abstract

Cells with significantly enlarged nuclei have been described in basal cell carcinomas, dermatofibromas, and pleomorphic fibromas, to name a few. These cells are typically visible using low power microscopy and have been termed "pleomorphic" or "monster cells." They have not been previously described in cutaneous melanomas. We sought to determine the prevalence of monster cells in otherwise conventional biopsies of primary cutaneous melanomas and its association with other histopathologic features of this malignancy. Ninety-nine superficial spreading melanomas, nodular melanomas, and acral lentiginous melanomas/lentigo malignas were retrospectively evaluated for the presence of monster cells, multinucleated giant cells, ulceration, inflammation, and depth of invasion (Breslow level). Thirteen cases of melanoma containing monster cells were found. A statistically significant association was noted between the presence of these cells, the histologic subtype of nodular melanoma (P = 0.0125), ulceration (P = 0.0127), the depth of invasion (P = 0.0103), and the presence of multinucleated giant cells (P = 0.0016). The finding of monster cells is not an uncommon occurrence and is seen more often in nodular melanomas.

‘Monster cell’ melanoma with pulmonary metastasis and cyclin D1 amplification

“…In this case, immunohistochemical staining was utilized to support a diagnosis of melanoma, in addition to providing information about tumor behavior. To explore whether monster cells represent actively proliferating cells, Boyd et al stained two melanomas with monster cells for MIB‐1 and found negative staining of monster cells, with surrounding tumor cell positivity . In the current case, the tumor cells (including monster cells) were strongly and diffusely positive for MIB‐1, indicating active proliferation of these cells.…”

“…The use of the term ‘monster cells’ has since been used to describe findings in other cutaneous proliferations including malignancies such as basaloid squamous cell carcinoma, basal cell carcinoma and melanoma; in contrast to the original descriptor, monster cells in these malignancies show prominent mitotic activity. The term was first utilized to characterize cells in melanomas in the identification of 13 cases of melanoma with monster cells in a case series by Boyd et al in 2005 . Previously, terms such as ‘pleomorphic’ or ‘anaplastic’ signified melanomas with cells containing large, bizarre and hyperchromatic nuclei with atypical mitotic figures, which typically stain positively with immunohistochemical markers of melanoma such as S‐100, NKI‐C3 and HMB‐45.…”

“…Previously, terms such as ‘pleomorphic’ or ‘anaplastic’ signified melanomas with cells containing large, bizarre and hyperchromatic nuclei with atypical mitotic figures, which typically stain positively with immunohistochemical markers of melanoma such as S‐100, NKI‐C3 and HMB‐45. Such cases have been described from melanoma tissue samples from skin and lymph nodes, central nervous system, mucous membranes of the head and neck and ileum . Melanomas with monster cells have been associated with aggressive behavior; in fact Sidhu and Sidhu proposed naming these tumors ‘monstrocellular melanomas’ .…”

Unusual variants of cutaneous melanoma

“…Giant cell melanoma 4,6,27,28 Uncommonly, primary or secondary melanomas may be composed almost entirely of multinucleated pleomorphic tumour giant cells (''monster cells''). IHC is essential for confirmation of the diagnosis and exclusion of a host of other malignant neoplasms that can exhibit similar morphology, especially if melanin pigment is sparse or absent, or if an intra-epidermal component is lacking.…”

Ossifying Dermatofibroma With Osteoclast-Like Giant Cells: Report of a Case and Literature Review

“…12 Many of the clinical and histologic features seen in these and other variants of dermatofibromas have clinicopathologic overlap with unrelated and often more insidious lesions. Not only are vascular and melanocytic lesions often considered in the differential diagnosis both clinically and histologically [13][14][15] but also a variety of melanocytic lesions have been reported to arise in association with dermatofibromas. 16,17 Osteoclast-like giant cells 18 and ossification 19 are features that have been described in dermatofibromas.…”