Harris G R, Shea C R, Horenstein M G, Reed J A, Burchette J L, Prieto V G
Department of Pathology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Am J Surg Pathol. 1999 Jul;23(7):786-94. doi: 10.1097/00000478-199907000-00006.
Desmoplastic (sclerotic) nevus, a benign melanocytic neoplasm characterized by predominantly spindle-shaped nevus cells within a fibrotic stroma, can be confused with fibrous lesions and other melanocytic proliferations, including desmoplastic melanoma. We compared the histologic and immunohistochemical features of 16 desmoplastic nevi, nine desmoplastic melanomas, four hypopigmented blue nevi, and six dermatofibromas. The similarities between desmoplastic nevi and dermatofibromas included epidermal hyperplasia (12 of 16), presence of keloidal collagen (15 of 16), hypercellularity (16 of 16), and increased numbers of factor XIIIa-positive dendritic cells (12 of 12). The absence of adnexal induction (0 of 16), the rarity of lesions with multinucleated cells (3 of 16) or epidermal hyperpigmentation (2 of 16), and the presence of S-100 immunoreactivity (16 of 16) and melanocytic proliferation (9 of 16) helped differentiate desmoplastic nevi from dermatofibromas. The similarities between desmoplastic nevi and desmoplastic melanomas included the presence of atypical cells (16 of 16) and HMB-45 expression in the superficial portion of the lesions (11 of 16). The infrequent location on the head or neck (1 of 16), the absence of mitotic figures (0 of 16), a significantly lower number of Ki-67-reactive cells, and a decrease in HMB-45 expression in the deep area of the lesions (8 of 11) helped distinguish desmoplastic nevi from desmoplastic melanoma. Desmoplastic nevi had overlapping features with hypopigmented blue nevi, but features tending to favor the latter included a predominance of ovoid nuclei, higher numbers of atypical cells, and homogeneous staining with HMB-45. We conclude that a combination of histologic and immunohistochemical criteria facilitates the reliable diagnosis of desmoplastic nevus from its simulators.
促纤维增生性（硬化性）痣是一种良性黑素细胞肿瘤，其特征为在纤维化基质中主要是梭形痣细胞，可与纤维性病变及其他黑素细胞增生性病变相混淆，包括促纤维增生性黑色素瘤。我们比较了16例促纤维增生性痣、9例促纤维增生性黑色素瘤、4例色素减退性蓝痣和6例皮肤纤维瘤的组织学和免疫组化特征。促纤维增生性痣与皮肤纤维瘤的相似之处包括表皮增生（16例中的12例）、瘢痕疙瘩样胶原的存在（16例中的15例）、细胞增多（16例中的16例）以及XIIIa因子阳性树突状细胞数量增加（12例中的12例）。无附属器诱导（16例中的0例）、多核细胞病变罕见（16例中的3例）或表皮色素沉着（16例中的2例），以及S-100免疫反应性的存在（16例中的16例）和黑素细胞增生（16例中的9例）有助于将促纤维增生性痣与皮肤纤维瘤区分开来。促纤维增生性痣与促纤维增生性黑色素瘤的相似之处包括非典型细胞的存在（16例中的16例）以及病变浅表部分HMB-45表达（16例中的11例）。头颈部少见（16例中的1例）、无核分裂象（16例中的0例）、Ki-67反应性细胞数量显著减少以及病变深部区域HMB-45表达降低（11例中的8例）有助于将促纤维增生性痣与促纤维增生性黑色素瘤区分开来。促纤维增生性痣与色素减退性蓝痣有重叠特征，但更倾向于后者的特征包括卵圆形核占优势、非典型细胞数量较多以及HMB-45均匀染色。我们得出结论，组织学和免疫组化标准相结合有助于从其相似病变中可靠诊断促纤维增生性痣。
