Meprin alpha is a useful additional marker in differentiating primary from secondary mucinous adenocarcinomas of the ovary.

The local recurrence rate in this series was lower than the rates reported in historic control groups and in the authors' previous temporal cohort. The results indicated that clear surgical margins are of paramount importance in minimizing local recurrence; when margins are compromised, the addition of RT may reduce local recurrence rates compared with historic controls. A prospective randomized trial is needed to quantify the risk reduction with adjuvant RT.

The nm23 gene is a putative tumour and metastasis suppressor gene. A number of studies have found that reduction of its expression is associated with increased metastatic potential in several human malignancies. Similarly, clinical studies have shown correlation between reduced nm23 protein expression and a poor prognosis. The aim of this study was to determine if a relationship exists between nm23 expression in primary cutaneous melanomas with or without cerebral metastases. Paraffin-embedded tissues were retrieved from 21 patients with primary cutaneous melanomas (n=21) and who subsequently developed cerebral metastases (n=24). Primary cutaneous melanomas with no regional or organ metastases within a 10 year period were used as control cases (n=34). Nm23 staining was localized in the cytoplasm of the tumour cells. Most of the control cases showed strong expression, whereas the majority of the primary melanomas with cerebral metastases showed no or weak expression of nm23. The cerebral metastases mostly showed strong expression. In summary, the results of this study may have significant prognostic implications for patients presenting with cutaneous melanoma. Patients with cutaneous melanomas with a low expression of nm23 appear to be more at risk of developing brain metastases.

Although uncommon, it is well recognized that salivary gland-type tumors can occur as primary lung tumors, probably arising from minor salivary-type glands lining the bronchial tree. Polymorphous low-grade adenocarcinoma (PLGA) is a rare tumor that usually originates from oral minor salivary glands. There are only 2 reported cases showing metastasis to the lung; however, a primary lung tumor has not been reported so far. In this report we describe the clinical and pathological features of another case of PLGA involving the lung, but in a patient with no evidence of a previous oropharyngeal primary. While our case probably represents another example of metastatic PLGA to the lung, to our knowledge, it is the first description of a PLGA involving the lung in the absence of a history of a previous primary oral salivary gland tumor.

This is the first study to provide objective evidence that synoptic pathology reports for melanoma are more complete than non-synoptic reports (regardless of whether the reports are generated within or outside a specialist melanoma centre). All synoptic reports should include the facility for free text, be tailored to individual institutional requirements and be updated regularly to be of maximal value.

Differentiation between malignant melanomas (MMs) and benign nevi based on histologic features can sometimes be difficult. This study evaluated the diagnostic effectiveness of argyrophilic staining of nucleolar organizer regions (AgNORs) in separating benign nevi from MMs by assessing 27 compound nevi (CN), 20 dysplastic nevi (DN), 10 Spitz nevi (SN), and 24 MMs. Both AgNOR count and morphology variables were measured from the superficial, middle, and deep zones of the lesions using video image analysis. Malignant melanomas had a significantly greater AgNOR number per nucleus, mean AgNOR area per nucleus, and variation in AgNOR area per nucleus compared with all types of benign nevi (p < 0.05). In multivariate discriminant analysis using a combination of four AgNOR counts and morphometric parameters, all CN and DN, 8 of 10 SN, and 23 of 24 MMs could be correctly classified as benign or malignant. The results suggest that both AgNOR count and morphology help to separate benign and malignant melanocytic lesions and that the combination of both sets of parameters improves their discriminating ability.

Confident separation of benign naevi and malignant melanoma can sometimes be very difficult using conventional microscopy. This study evaluated the combined diagnostic abilities of multiple cytometric markers in separating various types of naevi from melanomas. The lesions studied included 27 benign compound naevi, 20 dysplastic naevi, 10 Spitz naevi and 24 melanomas. The cytometric features investigated were: (i) nuclear DNA content and chromatin compactness, measured by video imaged DNA microdensitometry; (ii) nuclear morphology, measured by nuclear morphometry (karyometry); (iii) transcriptional activity of nucleolar organizer regions, measured as the number and size of argyrophilic staining of nucleolar organizer regions (AgNORs); and (iv) cellular proliferative activity detected by quantifying the immunoreactivity of MIB1-Ki67 antigen. These variables were evaluated in the superficial, middle and deep zones of each lesion. Using multivariate discriminant analysis, a total diagnostic effectiveness of 97% could be achieved in separating the benign and malignant melanocytic lesions by co-evaluating variables for DNA microdensitometry, karyometry and AgNORs. A diagnostic effectiveness of 100% could be achieved if further co-evaluation with MIB1-Ki67 immunoreactivity was performed. Our study suggests that co-evaluation of multiple cytometric markers can improve the diagnostic abilities of individual techniques in separating benign naevi from malignant melanomas. This may be of particular significance in the diagnosis of melanocytic lesions whose biological behaviour cannot be confidently predicted by their histological features using conventional microscopy.

This study is the first to report the prognostic value of DC-LAMP(+) DC counts in SLNs containing metastatic melanoma. Patients with a high density of mature DCs (>or=200/mm(2)) have the lowest risk of death. It also provides evidence that a lack of maturation in the SLNs is important in biological facilitation of melanoma progression.