Arumi-Uria Montserrat, McNutt N Scott, Finnerty Bridget
Dermatopathology Division, Department of Pathology, Weill Medical College of Cornell University, New York, New York 10021, USA.
Mod Pathol. 2003 Aug;16(8):764-71. doi: 10.1097/01.MP.0000082394.91761.E5.
Nevi with architectural disorder and cytologic atypia of melanocytes (NAD), aka "dysplastic nevi," have varying degrees of histologic abnormalities, which can be considered on a spectrum of grades of atypia. Somewhat controversial and subjective criteria have been developed for grading of NAD into three categories "mild," "moderate," and "severe." Grading involves architectural and cytological features, which often correlate with each other. Architectural criteria were intraepidermal junctional extension beyond any dermal component, complex distortion of rete ridges, and dermal fibrosis. Cytological criteria were based on nuclear size, dispersion of chromatin, prominence of nucleoli, hyperchromasia and variation in nuclear staining. Few tests have been made of the relationship between specific grades of atypia and patient risk for melanoma. Retrospective review of pathology reports was performed on 20,275 nevi examined between 1989 and 1996. From the total, 6,275 were diagnosed as NAD, which were in 4,481 patients. These patients were divided into those whose worst NAD was mild (2,504), moderate (1,657), or severe (320). Review of accession data revealed that a personal history of melanoma was present in 5.7% of patients with mild, 8.1% with moderate, and 19.7% with severe atypia. The male/female ratios were similar in each group. In the three groups, the mean ages of men were similar and of women were similar, but the mean age of men tended to be 6-11 yrs. older than women in each group. Family histories of melanoma were not considered. The odds ratio as a measure of association between NAD and personal history of melanoma, shows an odds ratio of 4.08 (2.91-5.7) for NAD-severe versus NAD mild, odds ratio 2.81 (2-3.95) for NAD-severe versus NAD-moderate and odds ratio 1.45 (1.13-1.87) for NAD moderate versus NAD-mild. These data show that the probability of having personal history of melanoma, for any given NAD patient, correlates with the NAD grade. Likewise, the risk of melanoma is greater for persons who tend to make nevi with high grade histological atypia.
具有黑素细胞结构紊乱和细胞学异型性的痣（NAD），又称“发育异常痣”，具有不同程度的组织学异常，可根据异型性等级范围来考虑。已制定了一些存在一定争议且主观的标准，将NAD分为“轻度”“中度”和“重度”三类。分级涉及结构和细胞学特征，二者通常相互关联。结构标准包括表皮内交界区超出任何真皮成分、 rete嵴的复杂扭曲以及真皮纤维化。细胞学标准基于核大小、染色质分散、核仁突出、核深染以及核染色变化。针对特定异型性等级与患者患黑色素瘤风险之间的关系，所做的测试很少。对1989年至1996年间检查的20275个痣的病理报告进行了回顾性分析。其中，6275个被诊断为NAD，涉及4481名患者。这些患者被分为最差的NAD为轻度（2504例）、中度（1657例）或重度（320例）的患者。对登记数据的审查显示，轻度异型性患者中有5.7%有黑色素瘤个人史，中度异型性患者中有8.1%有黑色素瘤个人史，重度异型性患者中有19.7%有黑色素瘤个人史。每组的男女比例相似。在这三组中，男性的平均年龄相似，女性的平均年龄也相似，但每组中男性的平均年龄往往比女性大6至11岁。未考虑黑色素瘤家族史。作为衡量NAD与黑色素瘤个人史之间关联的比值比显示，重度NAD与轻度NAD相比，比值比为4.08（2.91 - 5.7），重度NAD与中度NAD相比，比值比为2.81（2 - 3.95），中度NAD与轻度NAD相比，比值比为1.45（1.13 - 1.87）。这些数据表明，对于任何给定的NAD患者，有黑色素瘤个人史的概率与NAD等级相关。同样，对于倾向于形成具有高级别组织学异型性痣的人来说，患黑色素瘤的风险更大。
