Gammon Bryan, Ali Liaqat, Guitart Joan, Gerami Pedram
Department of Dermatology, School of Medicine, Northwestern University, 676 N.St. Clair, Chicago, IL 60611, USA.
Am J Dermatopathol. 2012 Jul;34(5):487-90. doi: 10.1097/DAD.0b013e31823894f8.
Homogeneous staining regions (HSRs) have been previously shown to confer a worse prognosis in solid tumors and myelodysplastic syndromes. We previously reported a single case of melanoma with HSR for cyclin D1 and postulated that HSR for cyclin D1 is an independent poor prognostic indicator. Herein, we report 7 cases of melanoma with HSR for cyclin D1. The cases occurred in elderly men and women with an average age of 65 years. Three cases occurred in areas of intermittent sun exposure, 2 cases occurred in chronically sun-damaged areas, and 2 cases were acral. HSR correlated with aggressive histology. The average Breslow depth was 2.7 mm (range, 1-11 mm), the average mitotic index was 5.1 per square millimeter, and 5 of the 7 cases were ulcerated. Clinical follow-up was available for 6 of the 7 cases. Five of the 6 cases for which clinical follow-up was available metastasized, and 1 patient died of metastatic melanoma. Three cases with metastatic disease occurred in primary melanomas with lower Breslow depths, ranging from 1.0 to 1.4 mm. These additional cases of melanoma with an aggressive clinical course provide further evidence of the prognostic significance of HSR for cyclin D1 in melanoma. Larger cohort studies are needed to validate this observation.
以往研究表明，均质染色区（HSRs）在实体瘤和骨髓增生异常综合征中提示预后较差。我们之前报道过1例伴有细胞周期蛋白D1均质染色区的黑色素瘤病例，并推测细胞周期蛋白D1均质染色区是一个独立的不良预后指标。在此，我们报告7例伴有细胞周期蛋白D1均质染色区的黑色素瘤病例。这些病例发生在老年男性和女性中，平均年龄为65岁。3例发生在间歇性阳光照射部位，2例发生在长期阳光损伤部位，2例为肢端型。均质染色区与侵袭性组织学相关。平均Breslow深度为2.7mm（范围1 - 11mm），平均有丝分裂指数为每平方毫米5.1个，7例中有5例发生溃疡。7例中有6例有临床随访资料。有临床随访资料的6例中有5例发生转移，1例患者死于转移性黑色素瘤。3例发生转移的病例其原发性黑色素瘤的Breslow深度较低，范围为1.0至1.4mm。这些具有侵袭性临床病程的额外黑色素瘤病例进一步证明了细胞周期蛋白D1均质染色区在黑色素瘤中的预后意义。需要更大规模的队列研究来验证这一观察结果。
