Barnhill Raymond L, Kutzner Heinz, Schmidt Birgitta, Ali Liaqat, Bagot Martine, Janin Anne, Lugassy Claire
Department of Dermatology, Hôpital Saint-Louis, Université Paris VII, 1 avenue Claude-Vellefaux, Paris, France.
Am J Dermatopathol. 2011 May;33(3):236-43. doi: 10.1097/DAD.0b013e3181f8c0e1.
Atypical spitzoid melanocytic neoplasms (ASMN) may prove difficult to distinguish microscopically from melanoma, and their biological behavior may be unpredictable. ASMN may result in regional lymph node (LN) metastases and frequent sentinel lymph node (SLN) deposits. Angiotropism and extravascular migratory metastasis may account for locoregional metastases in melanoma and thus may potentially explain such locoregional involvement in ASMN. Nine ASMN with angiotropism from 2006 to 2010 were studied. Angiotropism was defined as melanocytes closely opposed to the external surfaces of microvascular channels without intravasation. There were 5 women and 4 men aged 6-40 (mean 18.7) years with ASMN involving the head and neck (5), the extremities (3), and the trunk (1), and the lesions ranged in diameters from 3.5 to 10 (mean 6.2) mm. Breslow thicknesses ranged from 0.66 to 5.35 (mean 3.21) mm, 5 lesions Clark level IV and 4 level V, and dermal mitotic rates varied from 1 to 5 (mean 2.4) per square millimeter. Despite follow-up of 6 months or less in 4 subjects, 5 patients showed regional tumor spread based on detection of SLN deposits, local recurrence, or clinical satellite and LN metastases. Four of 5 patients (80%) undergoing SLN biopsy showed nodal positivity with 2 SLN deposits of >6 mm. Among 4 patients not having SLN biopsy, 1 patient developed local LN metastases after 2 years. We report for the first time angiotropism in ASMN and suggest that such angiotropism seems to correlate with and may explain regional tumor spread in this neoplastic system.
非典型梭形细胞黑色素细胞瘤（ASMN）在显微镜下可能难以与黑色素瘤区分，并且其生物学行为可能不可预测。ASMN可能导致区域淋巴结（LN）转移和频繁的前哨淋巴结（SLN）沉积。血管侵袭和血管外游走转移可能是黑色素瘤局部区域转移的原因，因此可能潜在地解释了ASMN中的此类局部区域受累情况。对2006年至2010年间9例具有血管侵袭的ASMN进行了研究。血管侵袭定义为黑素细胞紧密贴近微血管通道的外表面而无血管内侵入。9例患者中，5例女性，4例男性，年龄6至40岁（平均18.7岁），ASMN累及头颈部（5例）、四肢（3例）和躯干（1例），病变直径范围为3.5至10毫米（平均6.2毫米）。Breslow厚度范围为0.66至5.35毫米（平均3.21毫米），5个病变为Clark分级IV级，4个为V级，真皮有丝分裂率每平方毫米从1至5个不等（平均2.4个）。尽管4例患者的随访时间为6个月或更短，但5例患者基于SLN沉积、局部复发或临床卫星灶及LN转移的检测显示有区域肿瘤扩散。5例行SLN活检的患者中有4例（80%）显示淋巴结阳性，有2个SLN沉积>6毫米。在4例未进行SLN活检的患者中，1例患者在2年后发生了局部LN转移。我们首次报道了ASMN中的血管侵袭现象，并表明这种血管侵袭似乎与该肿瘤系统中的区域肿瘤扩散相关且可能解释了这种现象。
