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Below find the answer and discussion to the quiz by Savoia et al. presented in the previous issue of Dermatology Practical & Conceptual (http://dx.doi.org/10.5826/dpc.0401a12).

The term large plaque type blue nevus with subcutaneous cellular nodules (LPTBN-SN) refers to a huge blue nevus, usually located on the trunk, that develops subcutaneous nodules many years after the lesion has appeared. The potential malignancy of an LPTBN-SN was only discovered in 2012. We report the case of a 56-year-old Caucasian man that developed a cutaneous melanoma on an LPTBN-SN of the trunk. The first diagnosis was made more than 10 years before his death due to melanoma metastasis. The case reported here highlights the malignant potential of an LPTBN-SN, the very long course even without treatment and the possible coexistence of benign, borderline or malignant subcutaneous nodules in the same LPTBN-SN. Patients with large congenital blue nevi should be advised on the potential oncologic transformation of these lesions, the importance of follow-ups should be emphasized and, whenever possible, a preventive complete surgical removal should be evaluated before subcutaneous nodules develop.

background The validation of epiluminescence microscopy (ELM) for the diagnosis of pigmented skin lesions is conditional on the demonstration of consistent histologic correlates of the ELM patterns. The ELM characteristics of malignant blue nevus (MBN) have never been reported previously. objective To evaluate the histologic counterparts of the ELM features of a case of MBN. methods Comparison between the histologic characteristics observed in step-sections of the lesion and the structures observed in a digital ELM image. results On ELM, the lesion showed a diffuse whitish-blue veil, round black blotches, a collection of dark colored punctate spots, and fragmented bluish reticular-like formations in the periphery. At histologic examination, the black blotches and the spots appeared to correlate with areas of intense focal necrosis in the papillary and reticular dermis, and the reticular-like structures were demonstrated to correspond to the presence of free melanin and melanophages in the papillary dermis. conclusion In this case of MBN, blotches and spots seen on ELM correlated with intense necrosis in the papillary and reticular dermis, and reticular-like formations were the counterparts of free melanin and melanophages in the papillary dermis.

Sertoli-Leydig cell tumors (SLCTs) are rare neoplasms, accounting for less than 0.2% of ovarian tumors. The endometrioid-like variant of yolk sac tumor (YST) is very rare, and the most extensive series reported only 8 cases. We present a case of ovarian SLCT with endometrioid-like YST in a patient with a 46,XX karyotype with Y-chromosomal material. A 26-year-old woman had undergone a right salpingo-oophorectomy for SLCT with endometrioid-like YST. Chromosomal analysis revealed a 46,XX karyotype with Y-chromosomal material insertion into chromosome 1. The patient’s father and sister, and 7 other paternal relatives (4 male and 3 female) presented the same chromosome variant without evidence of cancer. The YST component relapsed to the right side of the uterine wall and then metastasized to the peritoneum and liver, while SLCT was eradicated with primary surgery. Several chemotherapeutic regimens were totally ineffective to control tumor progression. She died of disease progression 54 months after the diagnosis. We adopted the policy of a close surveillance for ovarian neoplasms for the 22-year-old sister of the patient, who presented the same Y-chromosomal material in her karyotype. In very rare tumors, new methods, based on molecular and cytogenetic models, are requested to define recommended management.