Crotty Kerry A, Scolyer Richard A, Li LingXiLawrence, Palmer A Allan, Wang Lixiang, McCarthy Stanley W
Department of Anatomical Pathology, Melanoma and Skin Cancer Research Institute, Sydney, NSW, Australia.
Pathology. 2002 Feb;34(1):6-12. doi: 10.1080/00313020120111212-1.
Spitz naevus is a benign melanocytic lesion that shares many histological features with melanoma. While Spitz naevi characteristically occur in children and young adults and melanomas in the middle-aged and elderly, either tumour can occur in patients of any age. In many cases, the histopathological diagnosis of Spitz naevus is straightforward, particularly in small lesions displaying many or all of the typical histological features and occurring in young patients. Tumours that deviate from the classic description, however, cause difficulties in diagnosis. In this review, we highlight histopathological features of Spitz naevi and those that may be useful in distinguishing Spitz naevi from melanomas. We find that the presence of good symmetry, Kamino bodies, and uniformity of cell nests or sheets from side-to-side favours a Spitz naevus. The presence of abnormal mitoses, a dermal mitotic rate of >2/mm2, and mitotic figures within 0.25 mm of the deep border of the lesion favours a melanoma. Immunohistochemical stains for HMB45 and Ki67 sometimes provide additional useful information. Despite this, in some cases it may not be possible to give an unequivocal diagnosis. Recommendations for the reporting of such cases are provided. New techniques have also demonstrated chromosomal, molecular and genetic differences between Spitz naevi and melanomas. This report highlights these new data and speculates on their possible future role in the diagnosis of borderline lesions.
斯皮茨痣是一种良性黑素细胞病变，与黑色素瘤有许多组织学特征相同。虽然斯皮茨痣典型地发生于儿童和年轻人，而黑色素瘤发生于中年人和老年人，但这两种肿瘤都可发生于任何年龄的患者。在许多情况下，斯皮茨痣的组织病理学诊断很简单，尤其是在小病变中显示出许多或所有典型组织学特征且发生于年轻患者时。然而，偏离经典描述的肿瘤会导致诊断困难。在本综述中，我们强调斯皮茨痣的组织病理学特征以及那些可能有助于将斯皮茨痣与黑色素瘤区分开来的特征。我们发现，良好的对称性、卡米诺小体以及细胞巢或细胞片从一侧到另一侧的均匀性有利于诊断为斯皮茨痣。异常有丝分裂、真皮有丝分裂率>2/mm²以及病变深部边界0.25mm内的有丝分裂象有利于诊断为黑色素瘤。HMB45和Ki67的免疫组织化学染色有时可提供额外的有用信息。尽管如此，在某些情况下可能无法做出明确诊断。本文提供了此类病例报告的建议。新技术也已证明斯皮茨痣和黑色素瘤之间存在染色体、分子和基因差异。本报告强调了这些新数据，并推测了它们未来在交界性病变诊断中可能发挥的作用。
