Granter S R, McKee P H, Calonje E, Mihm M C, Busam K
Department of Pathology and the Division of Dermatopathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
Am J Surg Pathol. 2001 Mar;25(3):316-23. doi: 10.1097/00000478-200103000-00005.
The term "malignant blue nevus" refers to a rare and heterogeneous group of melanomas that arise in several clinical settings. This includes melanomas arising in association with a common or cellular blue nevus and those arising de novo and resembling cellular blue nevi. We reviewed the clinicopathologic features of 10 cases of malignant blue nevi. Six cases proved to be de novo melanoma mimicking cellular blue nevus, but lacking a clear-cut benign component. Two melanomas arose in association with a common blue nevus, and two with a cellular blue nevus. The patients' (5 males, 5 females) ages ranged from 11 to 77 years (average age, 48.1 years). The head and neck was the most common location (6 of 10 patients), with five scalp tumors. Four tumors were located on the trunk; none was located on the extremities. Tumor size ranged from 0.5 to 2.2 cm (average size, 1.1cm). Most lesions had been present for many years before surgical removal. Pigmented dendritic cells were observed in 9 of 10 cases. The malignant and benign components were easily distinguished in the four cases that arose in association with a common or cellular blue nevus. Abrupt transition between a benign blue nevus and melanoma was readily recognized at scanning magnification as distinctive nodules of epithelioid to spindled cells with a sheet-like growth pattern. In all cases, malignancy was evidenced by increased mitotic rate, necrosis, nuclear atypia, pleomorphism, hyperchromasia, and prominent nucleoli. All 7 patients with follow-up information experienced recurrence (3 patients) or metastasis (4 patients). Three patients died of disease. Malignant blue nevus is a heterogeneous group of melanomas that are highly aggressive and often lethal, with a propensity for metastasis to the lymph nodes and lungs.
“恶性蓝痣”一词指的是一组罕见且异质性的黑色素瘤，其出现在多种临床情况下。这包括与普通蓝痣或细胞性蓝痣相关的黑色素瘤，以及新发且类似细胞性蓝痣的黑色素瘤。我们回顾了10例恶性蓝痣的临床病理特征。6例被证实为新发黑色素瘤，模仿细胞性蓝痣，但缺乏明确的良性成分。2例黑色素瘤与普通蓝痣相关，2例与细胞性蓝痣相关。患者（5例男性，5例女性）年龄在11至77岁之间（平均年龄48.1岁）。头颈部是最常见的部位（10例患者中有6例），其中5例为头皮肿瘤。4例肿瘤位于躯干；四肢均无肿瘤。肿瘤大小在0.5至2.2厘米之间（平均大小1.1厘米）。大多数病变在手术切除前已存在多年。10例中有9例观察到色素性树突状细胞。在与普通蓝痣或细胞性蓝痣相关的4例中，恶性和良性成分很容易区分。在扫描放大倍数下，良性蓝痣与黑色素瘤之间的突然转变很容易识别，表现为上皮样至梭形细胞的独特结节，呈片状生长模式。在所有病例中，有丝分裂率增加、坏死、核异型性、多形性、核深染和明显核仁均表明存在恶性。所有7例有随访信息的患者均出现复发（3例）或转移（4例）。3例患者死于该病。恶性蓝痣是一组异质性的黑色素瘤，具有高度侵袭性且往往致命，倾向于转移至淋巴结和肺部。
