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。     

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。     

皮脂腺痣继发肿瘤21例临床病理分析

目的 探讨皮脂腺痣继发肿瘤的临床表现与组织病理特征.方法 回顾分析21例皮脂腺痣继发肿瘤患者的临床和病理资料.结果 21例患者中,男12例,女9例,皮脂腺痣发生继发肿瘤的平均年龄为30.75岁.皮损位于头顶16例,位于面部5例.组织病理结果显示,皮脂腺痣继发肿瘤中,良性肿瘤为19例,常见肿瘤类型依次为毛母细胞瘤、乳头状...     

13例浅表脂肪瘤样痣临床及病理分析

目的：分析浅表脂肪瘤样痣患者的临床表现、组织病理和治疗情况,提高对本病的认识。方法：回顾分析13例浅表脂肪瘤样痣患者的临床和病理组织学特点及治疗情况,并温习相关文献,对本病的临床特征进行分析。结果：浅表脂肪瘤样痣临床分多发（经典型）和单发两种类型,组织病理提示真皮中上层见无包膜且分化良好的脂肪细胞团块,与下方的皮下脂肪不相连。弹力纤维染色显示弹力纤维有不同程度的减少,破碎和断裂。结论：浅表脂肪瘤样痣是以真皮内异位的成熟脂肪细胞为特征的一种良性错构瘤。临床上,多发型易误诊为结缔组织痣或神经纤维瘤,单发型易误诊为软纤维瘤。     

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。     

41例皮肤基底细胞癌的临床病理及误诊分析

目的：分析总结41例皮肤基底细胞癌的临床病理特点及误诊情况。方法：对41例皮肤基底细胞癌的临床及病理资料进行回顾性分析。结果：41例皮肤基底细胞癌中,发病年龄中位数为59岁（34～82岁）,多发于头面部,共39例,占95．1％,通过组织病理检查,41例均证实为基底细胞癌。其中9例进行免疫组化标记示CK（＋）,S-100（-）。临床诊断为基底细胞癌24例,占58．5％,误诊为脂溢性角化4例,黑素细胞痣3例,鳞状细胞癌、黑素细胞瘤、寻常狼疮各2例,误诊为其他4例。结论：被误诊的皮肤基底细胞癌患者大多数年龄较大,病程缓慢,临床表现不典型。尽早行组织病理检查,并结合免疫组化标记进行识别,可提高皮肤基底细胞癌的诊断准确率。     

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。     

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.     

痣样乳头乳晕角化过度症四例

目的 报道4例痣样乳头乳晕角化过度症.方法 收集和分析4例痣样乳头乳晕角化过度症患者的临床资料和组织病理学资料.结果 4例患者中,女3例,男1例,平均年龄32岁,平均病程4.5年,均表现为乳头和(或)乳晕角化过度和疣状增生.组织病理检查:表皮角化过度,乳头瘤样增生,皮突延长.结论 痣样乳头乳晕角化过度症是乳头乳晕角化过度症的一种亚型,临床较为少见,好发于年轻女性,临床和组织学都有一定特点.     

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。     

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.     

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。     

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.     

Spitz nevus on the palmar surface

Relatively little is known about the incidence of Spitz nevus on palmar surfaces. This report places a case study in the context of the Japanese literature regarding the occurrence of Spitz nevus on palmar surfaces. Although the proportion of palms and soles in relation to the body surface is about 5%, the incidence of the Spitz nevus was 2%. The mean age at onset was 17.8 years, and all 4 cases were women. The clinical features were a black macule or flatly elevated small modules. The size of the lesions was relatively small, extending from 3.5 mm to 8.0 mm. Although the backs of the hands and insteps have almost the same area as the palms and soles, the incidence of onset in these regions was 6.3% (13 cases). We thus concluded that Spitz nevus tends to be rare on palms and soles.     

Angiomatoid Spitz Nevus

Spitz nevus is a variant of melanocytic nevus which is histopathologically defined as large spindle and/or epithelioid cells. Angiomatoid Spitz nevus is a rare histologic variant of desmoplastic Spitz nevus characterized by prominent vasculature. We present a case of angiomatoid Spitz nevus, celluar type, that has not been reported before. We provide another example to show the remarkable diversity of Spitz nevus.     

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。     

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。     

Spitz nevi arising in speckled lentiginous nevus: clinical, histologic, and molecular evaluation of two cases

Spitz nevi are small dome-shaped nodules that sometimes arise in areas of preexisting hyperpigmentation, such as a speckled lentiginous nevus (nevus spilus), where they present a diagnostic dilemma. We report clinical, histopathological, and molecular findings of two cases of multiple Spitz nevi arising in a speckled lentiginous nevus. We used immunohistochemistry to assess expression of Ki-67, epidermal growth factor receptor, vascular endothelial growth factor, and RelA in two cases of Spitz nevi arising in a speckled lentiginous nevus. We observed rare staining for the proliferative marker Ki-67, but positive staining for the growth and antiapoptotic factors epidermal growth factor receptor, vascular endothelial growth factor, and RelA. Characterization of the molecular phenotype of Spitz nevi arising in speckled lentiginous nevi may provide a useful adjunct to long-term monitoring in this rare but difficult clinical presentation.     

Polypoid Spitz nevus: two cases evaluated with genetic technique, prolonged follow up, and sentinel lymph node biopsy

Polypoid Spitz nevus represents a spitzoid melanocytic neoplasm that frequently has worrying and challenging histopathological details. Distinction from polypoid melanoma may not be straightforward. Two cases of polypoid Spitz nevus with striking histopathological features were studied. One case had prolonged follow up (Case 1) and one patient had undergone sentinel lymph node biopsy (Case 2), and fluorescence in situ hybridization (FISH) analysis was also completed (both cases). Follow up and genetic analysis of three control cases of polypoid melanoma is also presented. Our clinical and genetic results suggest that both the polypoid Spitz nevi were benign. The patients are alive with no evidence of disease. FISH analysis did not show abnormalities with probes tested. This is in sharp contrast with the control cases of polypoid melanoma, wherein genomic alterations were detectable. Our data indicate that the two polypoid lesions presented here are most probably benign, despite their worrying histopathological features. More cases with long-term follow up and greater numbers of DNA probes are necessary to extend this conclusion to other ambiguous melanocytic tumors.