Undifferentiated sinonasal malignant melanoma (MM) is a rare type of tumor, which can be easily misdiagnosed. The present study reports a 41-year-old male patient who presented with a 4-day history of epistaxis. Clinical examination and radiological imaging lead to the detection of a mass in the right sinonasal region. Histopathological examination revealed that the mass was composed of malignant epithelioid cells arranged in nests and sheets. These cells displayed a hemangiopericytoma-like pattern with antler-like branching vessels. Immunohistochemical staining revealed that the tumor cells exhibited negative expression of melanocytic markers. This increased the difficulty of distinguishing undifferentiated MM from other malignant tumors located in the sinonasal area, particularly undifferentiated nasopharyngeal carcinoma. The diagnosis of undifferentiated MM was determined by ultrastructures, including the mature melanosomes and premelanosomes, in tumor cells by transmission electron microscopy. The present study suggests that the analysis of cancer stem cell marker and vasculogenic mimicry may be an important auxiliary tool for the diagnosis of MM.
Keywords: diagnosis; melanoma; pathology; undifferentiated.