Spitz样肿瘤320例临床及组织病理分析

【摘要】 目的 总结Spitz样肿瘤的临床及组织病理特征。方法 回顾2005年1月至2020年1月西京皮肤医院确诊的320例Spitz样肿瘤患者的临床及病理资料。结果 320例患者中,男141例,女179例,年龄0 ~ 65（12.5 ± 11.7）岁,病程1个月至30年;其中,Spitz痣307例,不典型Spitz肿瘤（AST）8例,Spitz痣样黑素瘤（SM）5例。皮损多为单发,可见于头面部、躯干和四肢,边界均清楚。307例Spitz痣皮损以黑色（132例,43.0%）和红色（108例,35.1%）为主,多数色素均匀（262例,85.3%）且表面平滑（272例,88.6%）。Spitz痣存在特殊临床亚型,11例 （3.6%）发生在斑痣上,11例 （3.6%）呈簇发性,6例（2.0%）播散性,7例（2.3%）结节性,1例（0.3%）为瘢痕疙瘩样。Spitz痣特征性病理表现包括表皮内痣细胞呈Paget样扩散（123例,40.1%）,真表皮交界处出现Kamino小体（74例,24.1%）,痣细胞呈水平带状（177例,57.8%）及楔形分布（118例,38.4%）,痣细胞巢周围出现裂隙（177例,57.8%）,可见生理性核分裂象（117例,38.1%）,核染色质均细腻。根据特殊组织病理表现,Spitz痣又分为色素性上皮样Spitz痣（9例,2.9%）、结缔组织增生性Spitz痣（13例,4.2%）、血管瘤样Spitz痣（8例,2.6%）、疣状Spitz痣（12例,3.9%）、黏液样Spitz痣（10例,3.3%）、晕痣样Spitz痣（4例,1.3%） 等。4例AST皮损为黑色,7例色素均匀,3例皮损表面粗糙;特征病理表现包括细胞均有轻度至中度的异型性,均可见核分裂象（7例为2 ~ 6个/mm2）,5例核染色质粗糙。3例SM皮损呈红色,4例色素不均匀,3例表面粗糙;特征病理表现包括黑素细胞呈Paget样扩散（3例）,瘤细胞呈无极性浸润性生长且均未见成熟现象,均有明显异型性,并可见病理性核分裂象（3例, > 6个/mm2）,核染色质均粗糙且核膜明显着色。结论 Spitz样肿瘤的临床及组织病理表现具有特征性,Spitz痣的临床及病理亚型繁多,AST同时具有Spitz痣和黑素瘤的临床及组织学特征。     

先天性巨大色素痣伴黏液沉积

报告1例先天性巨大色素痣伴黏液沉积。患儿男,2月龄,躯干黑色斑块2个月。皮肤科检查:背部、腰部、双侧臀部、右侧外阴及右侧大腿近端可见黑色斑片,表面有稀疏毛发分布,边界清楚,部分皮损上分布黄豆至鸡蛋大结节。皮损组织病理检查:表皮大致正常,角质形成细胞间散在色素颗粒,真皮内可见痣细胞散在或成巢分布,并见成熟现象,部分痣细胞包绕毛囊及附属器,真皮可见大量色素颗粒。阿辛蓝染色示真皮胶原间大量黏液样物质沉积。诊断:先天性巨大色素痣伴黏液沉积。     

125例不同部位色素痣样皮损临床病理特征及误诊原因分析

目的 比较不同部位的125例色素痣样皮损的临床诊断与病理诊断的符合率,分析临床误诊的原因,提高皮肤科医生对色素痣的认识。方法 回顾性分析某医院门诊2019年1月至12月临床诊断为色素痣且均行手术切除及病理检查的125例患者的临床及病理资料。分析不同年龄和性别中各种色素痣样皮损的分布情况。结果 125例患者中,病理诊断为色素痣75例、脂溢性角化29例、蓝痣2例、皮肤纤维瘤4例、疣状痣4例、基底细胞癌1例,其他如角化棘皮瘤、血管瘤、日光性角化、毛母质瘤等共10例;其中的75例色素痣患者包括交界痣7例(9.3%)、皮内痣49例(65.3%)、混合痣19例(25.4%)。结论色素痣样皮损的病理类型较多,虽然是常见多发病,但临床诊断符合率较低,正确诊断必须结合病理检查;并且发现特定病理类型的色素痣与发病部位有相关性。     

炎性线状疣状表皮痣2例

报告2例炎性线状疣状表皮痣。2例患者均为女性,自觉皮损瘙痒剧烈;其中1例出生后即发病,皮损双侧分布,表现为角化性丘疹、斑块和浸渍、糜烂;另1例6岁发病,皮损单侧分布,为炎性、角化性丘疹及斑块。组织病理改变主要为角化过度伴角化不全,棘层肥厚,真皮浅层及血管周围炎性细胞浸润。炎性线状疣状表皮痣在临床及病理上不同于线状银屑病和线状苔藓。     

痣样黑素瘤三例临床及组织病理学分析

【摘要】 目的 探讨痣样黑素瘤的临床和组织病理学特征。方法 回顾性分析2000—2020年西京皮肤医院诊断的3例痣样黑素瘤患者的临床和组织病理资料。结果 3例痣样黑素瘤患者中,女2例,男1例,皮损初始表现为黑斑、丘疹。2例在手术切除后皮疹复发增大成斑块或新发结节样皮损。组织病理学检查：表皮及真皮内上皮样黑素细胞增生,细胞有异型性,部分细胞核深染。免疫组化结果显示,皮损内瘤细胞Melan-A、S100表达阳性;HMB45在真皮瘤细胞内弥漫阳性,局部阴性;Ki67增殖指数升高,细胞周期蛋白D1表达活跃。结论 痣样黑素瘤易误诊为色素痣或脂溢性角化病;对于组织学诊断为色素痣,但临床出现复发或者转移的患者,需高度警惕痣样黑素瘤的可能。     

先天性色素痣伴增生性结节10例临床病理分析

【摘要】 目的 探讨先天性色素痣伴增生性结节的临床特点及组织病理特征。方法 收集第四军医大学西京皮肤医院2015—2019年经临床和病理确诊的10例先天性色素痣伴增生性结节患者的临床及病理资料，并进行回顾性分析。结果 10例患者年龄2～45岁（平均15岁），9例增生性结节发生于婴儿，1例发生于成人。皮损位于四肢4例，头面部3例，躯干2例，躯干及四肢同时受累1例。临床表现为黑色斑片或斑块中出现1个或多个结节，6例增生性结节为多发，4例为单发，单个结节直径0.2～1.5 cm，仅1例出现溃疡。组织病理检查显示增生性结节内黑素细胞均存在成熟现象，核分裂象少，细胞无明显异型性，无坏死现象，免疫组化检查显示痣细胞弥漫表达Melan-A，不表达或仅部分表达HMB45，Ki67增殖指数 < 5%。结论 先天性色素痣伴增生性结节可发生于四肢、头面部及躯干；临床表现为原先天性色素痣皮损上的单发或多发结节；病理上增生性结节内黑素细胞可见成熟现象，免疫组化HMB45及Ki67染色有助于诊断，其预后有待长期随访。     

1366例色素痣样皮损病理结果分析

目的探讨色素痣样皮损临床与病理诊断的关系。方法对1 366例临床诊断色素痣的病例作临床表现及病理诊断回顾性分析。结果1 366例临床诊断为色素痣的病例中病理结果符合色素痣者958例,占总例数的70.13%,其中皮内痣、混合痣、交界痣及蓝痣各761例、95例、32例、52例,分别占色素痣的79.44%、9.92%、3.34%、5.43%;有408例病理结果与临床诊断不吻合,占29.87%,不吻合病例的前3位病理诊断为脂溢性角化症(227/408)、基底细胞上皮瘤(47/408)、皮肤纤维瘤(23/408)。结论色素痣的正确诊断必须结合病理检查。     

线状痣样型基底细胞样毛囊错构瘤

报告1 例线状痣样型基底细胞样毛囊错构瘤.患者女,41 岁.左侧颈、背部丘疹20 余年,无自觉症状.皮损表现为数百个粟粒至黄豆大肤色或浅褐色丘疹,聚集成片,呈线状痣样排列,分布于左侧颈部及腰背部.皮损组织病理检查符合基底细胞样毛囊错构瘤.免疫组化:基质细胞波形蛋白(vimentin)、CD10、CD34 均阳性,基底样细胞S-100蛋白(-)、Bcl-2(-)、Ki-67 蛋白表达< 5%.     

晕皮炎2例

报告发生于脂溢性角化病及色素痣上的晕皮炎各1例．例1．女，24岁。左小腿丘疹3年，周围出现红斑、丘疹及脱屑2个月。皮损中心组织病理检查符合脂溢性角化改变。相邻皮损组织病理检查见角化不全．海绵形成，真皮淋巴细胞浸润。切除该丘疹3d后原周围湿疹样改变逐渐消失。例2．女，43岁。躯干、四肢色素痣周围相继出脱红斑、丘疹及鳞刷，湿疹样改变自行消退时中心色素痣逐渐缩小、消失，局部留下萎缩性瘢痕。     

皮肤Rosai-Dorfman病临床表现及组织病理学特征分析

目的 探讨皮肤Rosai?Dorfman病（CRDD）的临床表现、皮损形态特征和组织病理学特点。方法 收集20例CRDD患者的基本情况及临床资料,分析其皮损特征并进行分型,同时对皮损进行组织病理学检查和免疫组化染色。结果 20例CRDD患者中,多发皮损11例,单发皮损9例;按累及的解剖部位分单处16例,多处4例,共计24处。皮损表现为丘疹结节型10处（41.67%）、浸润斑块型12处（50.00％）和肿瘤样型2处（8.33％）。20例中6例皮损表现为混合型（丘疹结节型/浸润斑块型5例,浸润斑块型/肿瘤样型1例）。24处组织标本病理表现大致相同,即真皮和（或）皮下脂肪层可见数量不一、体积较大的组织细胞散在或片状分布,伴大量以淋巴细胞和浆细胞为主的炎症细胞浸润,组织细胞胞质内吞噬有数量不一的淋巴细胞、中性粒细胞等。免疫表型均为组织细胞S100阳性、CD68阳性、CD1a阴性。17处皮损病变累及真皮全层,其中13处病变侵入脂肪层;6处病变仅累及真皮浅中层;1处病变仅累及真皮深层及脂肪层。不同形态类型皮损之间的病变累及范围和炎症浸润模式均无明显差异。结论 CRDD临床皮损以丘疹结节型和浸润斑块型为主,肿瘤样型少见。不同形态皮损组织病理均可见数量不等具有伸入运动的组织细胞。S100蛋白、CD68等免疫组化染色有助于CRDD的诊断与鉴别诊断。     

Reed痣26例临床病理特征分析

【摘要】 目的 分析总结Reed痣的临床病理特点。方法 分析2015年1月至2019年6月于第四军医大学西京皮肤医院确诊的26例Reed痣患者的临床病理特征。结果 男15例,女11例,平均发病年龄17.35岁,中位发病年龄13.85岁。发病部位：下肢12例,面部6例,上肢5例,躯干3例。皮疹颜色均呈黑色,7例为斑疹,19例为扁平丘疹,22例皮疹形态类圆形,4例皮疹形态不规则。皮疹直径2 ~ 10 mm,23例直径 ≤ 5 mm。组织病理：15例为交界痣,11例为混合痣,26例黑素细胞形态均呈梭形,细胞色素明显,4例痣细胞巢与周围表皮融合,22例与周围表皮形成明显的裂隙,均未见明显细胞异型性及有丝分裂象,6例可见Kamino小体。皮损均予手术切除,随访1 ~ 5年无复发。结论 Reed痣皮疹形态可不规则,组织病理可出现呈Paget样分布的大小不一梭形细胞,需与黑素瘤鉴别。     

Behavior of pigment cells on lesions of the pigmented venus with vitiligo.

When vitiligo occurred on lesions of the pigmented nevus, the behavior of pigment cells in this nevus was investigated. Three cases of giant hairy nevi, seven cases of moles, three cases of Mongolian spots and eleven specimens in nine cases of halo nevi were used. Giant hairy nevi combining with vitiligo showed intensive decreases in nevus cells, particularly superficial A and B-type nevus cells. The epidermal dopa-positive melanocytes and melanin granules in the epidermis decreased, but still remained. On the other hand, moles in vitiligo showed an almost complete disappearance of epidermal dopa-positive melanocytes and melanin granules in the epidermis; nevus cells in the dermis decreased only slightly. Mongolian spots with vitiligo showed an epidermis similar to vitiligo, but the dermal melanocytes were hardly changed. Halo nevi exhibited an intensive decrease and degeneration of nevus cells and marked lymphocytic infiltration. Some of them showed disappearance of epidermal dopa-positive melanocytes and melanin granules in the epidermis. The characteristic findings of vitiliginous skin are mostly restricted to epidermis. In contrast, however, it is interesting to note that, on the lesions of nevocellular nevi with vitiligo, the dermis also exhibited some decrease and degeneration of nevus cells and lymphocytic infiltration.     

Meyerson痣6例临床及病理分析

目的:探讨Meyerson痣临床及组织病理特征。方法:回顾性分析2015年1月至2020年1月第四军医大学西京皮肤医院确诊的6例Meyerson痣患者临床及病理资料。结果:6例患者中,男3例,女3例,年龄7个月至28岁,中位年龄10.5岁。3例皮损位于四肢,3例位于躯干。4例发生于先天性色素痣,2例发生于获得性色素痣。...     

Keratotic melanocytic nevus: a clinicopathologic and immunohistochemical study

BACKGROUND: Epidermal hyperplasia in melanocytic nevi is a common but little-investigated phenomenon. METHODS: We prospectively examined all melanocytic nevi diagnosed in our department over an 8-month period, for the criteria of keratotic melanocytic nevus (KMN), namely the presence of marked epidermal hyperplasia with or without horn pseudocyst formation, hyperkeratosis, and papillomatosis. In addition to routine histologic review, we studied 12 representative cases with immunohistochemistry to examine expression of Ki-67, epidermal growth factor receptor (EGFR), Bcl-2, and Bax. RESULTS: From a total of 1,527 melanocytic nevi, 95 were KMN (prevalence 6%). The average age was 34 years, with a male:female ratio of 1:2. The predominant location was the trunk (76%), followed by head and neck (20%), and extremities (4%). Clinical diagnoses were atypical nevus (44%), nevus not otherwise specified (43%), and others including seborrheic keratosis, acrochordon, and basal cell carcinoma. Two KMN were junctional, 44 compound, and 49 intradermal. Twenty-three KMN (24%) had histologic features suggesting congenital onset, and 15 (16%) had mild to moderate dysplastic features. Two cases demonstrated induction of sebaceous glands. Significantly increased Ki-67 expression was detected in the hyperplastic epidermis, particularly in deeper areas related to keratinous cysts and hair follicles. Bcl-2 and Bax (anti- and pro-apoptosis proteins, respectively) and EGFR were expressed similarly in both normal and hyperplastic epidermis overlying the KMN. CONCLUSIONS: KMN are commonly biopsied skin lesions, mostly located on the trunk. Many such lesions are clinically considered atypical, in contrast to their benign histologic appearance. The epidermal hyperplasia on top of KMN demonstrates increased cellular proliferation, in the context of adequately regulated apoptosis and EGFR expression. The cellular proliferation seems to commence in hair follicles.     

Proliferation, apoptosis, and survivin expression in a spectrum of melanocytic nevi

BACKGROUND: Apoptosis is important for maintenance of tissue homeostasis and often dysregulated in cutaneous neoplasms. The apoptosis inhibitor survivin is expressed in melanoma and non-melanoma skin cancers and benign keratinocytic lesions. Its expression has not been studied in melanocytic nevi. OBJECTIVE: We determined the expression pattern of survivin in benign melanocytic nevi in comparison to markers of proliferation and apoptosis. METHODS: Six cases of each of the following melanocytic nevi were retrieved from a dermatopathology archive: compound dysplastic nevus, intradermal nevus, compound nevus, neurotized intradermal nevus, and Spitz nevus. Survivin expression was evaluated by in situ hybridization. Apoptotic and proliferation indices were calculated by counting immunoreactive cells in terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end labeling and proliferating cell nuclear antigen immunostained sections, respectively. RESULTS: All nevi, regardless of histologic type, expressed survivin. Compound melanocytic lesions expressed survivin in both epidermal and dermal compartments. The apoptotic rate was low for dysplastic, compound, and Spitz nevi, and apoptotic cells were not identified in any neurotized nevus. The proliferative index was highest for Spitz nevi, while all other nevi demonstrated rare positive cells. CONCLUSIONS: Survivin is consistently expressed in benign melanocytic lesions, while apoptotic cells are rarely identified, suggesting the dysregulation of apoptotic pathways with the accumulation of cells in these neoplasms.     

Displacement of dermal solar elastosis in malignant melanoma

BACKGROUND: Ultraviolet radiation (UVR) is a major environmental causal factor for skin malignancy. In this study, we investigated the morphology of the solar elastosis (SE) band in benign and malignant melanocytic lesions. METHODS: We measured the SE band in perilesional and lesional skin of 13 melanomas (9 invasive and 4 in situ) and 11 melanocytic nevi (5 usual intradermal nevi, 4 blue nevi and 2 desmoplastic nevi) occurring in sun-exposed areas. RESULTS: The melanoma and nevus groups had similar age range, gender ratio and anatomic distribution. The mean SE thickness was 0.35 mm in melanomas and 0.29 mm in nevi (p = 0.56), indicating similar UVR exposure. There was a mean downward SE displacement (SED) of 0.43 mm in melanomas and essentially no displacement (-0.02 mm) in nevi (p < 0.005). Tumor cells and inflammatory host response were responsible for SED in melanoma. CONCLUSIONS: SED may help in the differential diagnosis of melanocytic lesions in sun-exposed areas. In melanoma, the new lesion depresses the pre-existing SE band. Conversely, the long-standing nevus co-exists with the SE band without significant displacement. Evaluation of the SE band may help to differentiate melanoma with chronic sun-induced damage as they have a distinct set of molecular alterations.     

A preliminary report of the treatment of blue nevus with dermal injection of riboflavin and exposure to near-ultraviolet/visible radiation (ribophototherapy)

Dye lasers are useful for treating pigmented skin lesions, but their equipment is expensive and bulky. A simple and cheap phototherapy would be acceptable to dermatologists for treating pigmented skin lesions such as nevus of Ota. We investigated as a pilot study whether dermal injection of riboflavin and exposure to near-ultraviolet/visible radiation (ribophototherapy) decreases the dermal pigment of blue nevi which are recalcitrant to laser therapy. The therapeutic efficacy was assessed by comparison of the amount of dermal pigment in hematoxylin-eosin specimens taken before and after treatment. Pigmentation of the nevus became faint to the depth of 1 mm with little noticeable epidermal change after 21 treatments. At the deeper dermis somewhere between 3 and 4 mm from the epidermis, ballooning degeneration of the dermal cells was observed in hematoxylin-eosin specimens. Ribophototherapy is hopeful for treating pigmented skin lesions.     

Superficial cutaneous nevus lipomatosus (Hoffmann-Zurhelle)]

Neviform hand-sized yellowish or skin colored plaques or linear lesions with flattened papules or folded surface in the gluteal regions, especially in females, point out to nevus lipomatosus superficialis (Hoffmann-Zurhelle). These nevi consisting of mature fat cells among the dermal collagen are rare lesions. The case report of two female patients should remind of this clinical and histological picture.     

手术治疗炎症型线状表皮痣1例

患儿女,11岁,左侧大腿淡红色斑块、丘疹10年余。组织病理示:表皮角化过度,伴角化不全,棘层肥厚,呈银屑病样增生,真皮内炎症细胞浸润。诊断:炎症型线状表皮痣。予手术切除后愈后良好,患者仍在随访中。