Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Am J Surg Pathol. 2011 Oct;35(10):1540-8. doi: 10.1097/PAS.0b013e31822e9f5e.
Combined melanocytic nevi are composed of 2 or more distinct populations of nevomelanocytes. Most commonly used to describe the combination of blue nevi with common nevi, it may also be applied to other combinations of benign melanocytic proliferations, including Spitz nevi and nevi with deep dermal pigmented nevomelanocytes. We report the incidence and distribution of these tumors at the Massachusetts General Hospital over the past decade and review guidelines for diagnostic criteria and nomenclature. Between 2000 and 2010 we identified 511 cases of combined nevi, represented by 4 histologically distinct diagnostic categories: (1) blue nevus, (2) nevi with deep dermal pigmented nevomelanocytes (plexiform/deep penetrating, inverted type A/clonal), (3) Spitz or pigmented spindled cell nevus, combined with another type of nevus (usually common or dysplastic), and (4) other combinations including 2 or more nevus types. Nearly one fifth of these tumors displayed atypical features; atypia was observed more often in combined nevi with Spitz or deep pigmented elements (26 of 55, 47%, and 25 of 98, 26%, respectively) than in combined common and blue nevi (37 of 336, 11%). Clinical follow-up data were available for 83% of the patients with atypical combined nevi; none developed recurrence or metastasis with a mean follow-up of over 4 years.
复合性黑素细胞痣由 2 种或以上不同的黑素细胞巢组成。最常用于描述蓝色痣与普通痣的组合，也可用于描述其他良性黑素细胞增生的组合，包括 Spitz 痣和真皮深部有色素的黑素细胞痣。我们报告了过去十年在马萨诸塞州综合医院这些肿瘤的发病率和分布情况，并回顾了诊断标准和命名的指南。在 2000 年至 2010 年间，我们共发现了 511 例复合性痣，代表了 4 种组织学上不同的诊断类别：（1）蓝色痣，（2）真皮深部有色素的黑素细胞痣（弥漫性/深层穿透性，A型倒置/克隆性），（3）Spitz 痣或色素性梭形细胞痣，与另一种痣（通常为普通痣或发育不良痣）结合，以及（4）其他组合，包括 2 种或以上的痣类型。这些肿瘤中近五分之一显示出非典型特征；在有 Spitz 或深色素成分的复合性痣中，非典型性更为常见（55 例中的 26 例，47%，98 例中的 25 例，26%），而在复合性普通痣和蓝色痣中则少见（336 例中的 37 例，11%）。83%的具有非典型性复合性痣的患者有临床随访数据；平均随访超过 4 年后，无 1 例复发或转移。
