播散性Spitz痣3例

Spitz痣又称梭形和上皮样细胞痣(spindle cell and epithelioid cell nevus),是一种后天发生的良性黑素细胞增生性疾病,在组织病理上容易与黑素瘤混淆.本病多发生于儿童和青少年的颜面部和四肢,通常表现为后天发生的单发丘疹.多发性Spitz痣较为罕见,根据其临床皮损形态和分布的不同又分为簇发性Spitz痣和播散性Spitz痣.现将笔者诊断的3例播散性Spitz痣临床及组织病理特点报告如下.     

结缔组织增生性Spitz痣和色素性梭形细胞痣临床及组织病理学特征

目的:分析结缔组织增生性Spitz痣和色索性梭形细胞痣的临床及组织病理学特点.方法:回顾性分析确诊的8例结缔组织增生性Spitz痣和9例色素性梭形细胞痣患者的临床和组织病理学特征.结果:结缔组织增生性Spitz痣表现为梭形或上皮样痣细胞增生并伴有显著的胶原硬化和均质化,色素性梭形细胞痣表现为真、表皮交界处梭形细胞增生并伴有纤细的色素颗粒沉积.结论:结缔组织增生性Spitz痣和色素性梭形细胞痣是Spitz痣中较少见的特殊类型.其中色素性梭形细胞痣需要与黑素瘤相鉴别.     

足跖和阴茎Spitz痣

报告2例发生在跖部和阴茎的Spitz痣。1例患者皮损位于阴茎，另1例位于跖部，其中位于跖部的Spitz痣需要和黑素瘤相鉴别。     

Spitz痣25例临床病理分析

对2011-2017年西安交通大学第二附属医院的25例Spitz痣患者的临床及组织病理资料进行回顾性分析。25例患者中男11例,女14例,其中﹤10岁患者16例。皮损位于面部12例,下肢5例,上肢4例,躯干3例,头皮1例。皮损主要表现为扁平隆起或半球形,多有色素增加。84%的Spitz痣具有良性肿瘤的特点,16% Spitz痣结构不对称或境界不清楚。     

泛发型斑点状黑子样痣1例

报告1例泛发型斑点状黑子样痣。患儿男，2岁，就诊时发现双上肢和躯干等部位有巨大的咖啡斑，在其基础上散布多个斑点状黑子样痣和Spitz痣。根据病变的发生过程和组织病理改变，诊断为斑点状黑了样痣的一个亚型。     

多发性簇发型斯皮茨痣

斯皮茨(Spitz)痣是一种来源于黑素细胞的后天性良性肿瘤,又称为梭形或上皮样细胞痣(spindle cell or epithelioid cellnevus)、良性幼年性黑素瘤.本病多见于儿童和青少年,好发于面部及四肢.皮损多为单发,但也可多发.多发性皮损临床少见,现将我科诊治的1 例多发性簇发型Spitz 痣报告如下.     

9例血管瘤样Spitz痣临床及组织病理分析

目的：分析血管瘤样Spitz痣的临床、组织病理和免疫组化特征。方法：回顾性分析2005年——2020年第四军医大学西京皮肤医院确诊的9例血管瘤样Spitz痣的临床和组织病理特点。结果：9例血管瘤样Spitz痣患者中男5例,女4例。组织病理表现为真皮内上皮样、梭形细胞或两者混合增生,散在或呈小巢状分布在增生的厚壁小血管周围及增粗的胶原纤维间,痣细胞间及血管周围可见较多的肥大细胞浸润。免疫组化显示增生的细胞均表达S-100蛋白、S-100A6蛋白和Melan-A,血管内皮细胞CD31阳性且平足蛋白（D2-40）阴性。结论：血管瘤样Spitz痣是Spitz痣罕见的组织亚型,其组织病理有一定特征性,应注意与血管肿瘤及退行期的恶性黑素瘤相鉴别。     

Spitz痣样黑素瘤

报告1例Spitz痣样黑素瘤。患者男,53岁,左前臂快速增大的无痛性皮肤结节3个月。皮肤科检查见左前臂直径0.8 cm的肤色半球形肿物,边界清楚,表面粗糙,上覆灰白色鳞屑,质韧。临床表现、组织病理及免疫组化检查结果均符合Spitz痣样黑色素瘤。行手术切除,术后未行其他治疗。术后9个月随访,未见复发及转移。     

胰岛素样生长因子ⅡmRNA结合蛋白3在恶性黑素瘤及良性痣中的表达

目的 探讨胰岛素样生长因子Ⅱ mRNA结合蛋白3(IMP3)在良性痣及黑素瘤组织中的表达,及其在恶性黑素瘤进展及诊断中的作用.方法 用IMP3抗体对28例恶性黑素瘤、8例Spitz痣、6例发育不良性痣和25例良性痣患者的标本组织进行免疫组化研究.结果 28例恶性黑素瘤组织标本中23例IMP3阳性,8例Spitz痣中4例阳性,6例发育不良性痣中2例阳性,25例良性痣均不表达.IMP3在黑素瘤中的表达明显高于Spitz痣及发育不良性痣(P<0.05),侵袭性黑素瘤表达明显高于原位黑素瘤(P<0.01).结论 IMP3可能是良性痣发展至恶性黑素瘤的一个生物学标志,在鉴别黑素瘤和良性痣之间存在一定的价值.     

簇发性斯皮茨痣

报告1例簇发性斯皮茨(Spitz)痣(良性幼年黑素瘤)。患儿男,10岁。1年前左耳郭出现1枚小丘疹,曾在当地医院行手术将丘疹切除,术后2个月在手术切口周围出现数个丘疹,并逐渐增大,融合成斑片,部分皮损呈乳头瘤样。皮损组织病理学检查及免疫组化染色结果符合Spitz痣的组织病理学改变。结合临床及组织病理学改变,确诊为簇发性Spitz痣。     

Spitz nevus and Reed nevus

Spitz and Reed nevi, also called spindle and/or epithelioid cell nevi, are a special group of melanocytic lesions due to their peculiar clinical, dermoscopic and histopathological features. The study of these nevi is of great interest because both their nomenclature and classification are still a matter of discussion. Most importantly, the difficulty to differentiate them from melanoma can lead to inadequate therapies. In this context, dermoscopy, a link between clinical and anatomopathological examinations, appears as a helpful diagnostic tool whose accuracy can reach 93%. "Borderline" lesions are still a great challenge and object of research, including molecular studies. The present study explores the relevant characteristics of these nevi, with emphasis on dermoscopic findings, aiming at understanding their natural history, as well as discussing treatment and patient follow-up.     

Malignant blue nevus in Ota's nevus

A 21-year-old Caucasian woman with congenital nevus of Ota developed a subcutaneous tumor below the lacrimal sack within the area of discoloration. The tumor, located subcutaneously, has been present for 4 years. Histologically, parts of the tumor showed neuroid structures as well as those like cellular blue nevus. In one part, however, malignant transformation features could be found.     

Becker's nevus coexistent with connective-tissue nevus

Becker's nevus (BN) has been reported in association with smooth-muscle hamartoma, and an acneiform eruption and underlying structural anomalies of bone and soft tissues. We report a case of BN coexistent with a large connective-tissue nevus (CTN) on the right shoulder of a 74-year-old man. Whether this phenomenon represents the mere chance occurrence of two distinct cutaneous hamartomatous processes coexistent in the same anatomic site, an exaggerated manifestation of minor dermal changes previously described, or an association heretofore unrecognized due to the often subtle clinical and histologic features of both BN and CTN, is conjectural.     

Dysplastic nevus (atypical nevus)

Atypical nevum (dysplastic) is considered an important factor associated with increased risk of developing cutaneous melanoma. It is believed that atypical nevi are precursor lesions of cutaneous melanoma. They may be present in patients with multiple melanocytic nevi (atypical nevus syndrome) or isolated and in small numbers in a non-familial context. The disease usually begins at puberty and predominates in young people. It has a predilection for sun-exposed areas, especially the trunk. The major challenge in relation to atypical nevi lies in the controversy of defining its nomenclature, clinical diagnosis, dermoscopic criteria, histopathological diagnosis and molecular aspects. This review aims at bringing knowledge, facilitating comprehension and clarifying doubts about atypical nevus.     

Desmoplastic nevus: An entity distinct from spitz nevus and blue nevus

Desmoplastic (sclerotic) nevus is an infrequently reported poorly characterized benign melanocytic proliferation, with only 4 case series published to date. To better define this nevus, we examined the clinical and histologic features of 25 lesions. Desmoplastic nevus is seen in both children and adults and can be located on the face, trunk, or extremities. There is a female predominance. Clinically, it can resemble intradermal nevus, atypical nevus, melanoma, and pigmented basal cell carcinoma. These are generally small, symmetric, and well-circumscribed lesions, averaging 3.5 mm in diameter. The most distinctive features include predominantly compound growth, a zonal configuration with greater cellularity in the superficial portion of the lesion, and a mixture of melanocytic phenotypes including type A, B, and C nevus cells, ovoid and dendritic melanocytes, and Spitzoid melanocytes. A distinctive eosinophilic stroma which either resembles that of a dermatofibroma or neurofibroma is always present. Variable amounts of melanin pigment are found in both tumor cells and macrophages, but this is not a prominent feature. Mitotic activity is exceedingly rare (1 case), and pleomorphism is minimal. These lesions are distinct from typical compound nevus, Spitz nevus, epithelioid blue nevus, and desmoplastic melanoma, to which they are often compared. Strict application of these histologic features allows definitive diagnosis of desmoplastic nevus as a distinct form of a benign melanocytic nevus.     

A case of combined nevus: compound nevus and spindle cell Spitz nevus

Combined nevi consisting of a Spitz nevus and an acquired nevus are unusual, and, to our knowledge, the combination of a spindle cell Spitz nevus and an overlying compound nevus has not been previously reported. We report a 17-year-old girl with a nodule on the left anterior lower extremity. The nodule was asymptomatic, firm, brown, symmetrical, dome-shaped, 8 mm in diameter, and not found with ulceration. Histological findings showed proliferation of spindle-shaped cells with an overlying compound nevus. The spindle-shaped cells were large, non-pigmented, uniform in size and shape, with rare mitoses and without nuclear atypia, and arranged in a storiform pattern in thick collagen bundles. They stained positively for S-100 and negatively for HMB-45. The lesion was considered to be a new type of combined nevus consisting of a spindle cell Spitz nevus and an overlying compound nevus.