Honda Rie, Iino Yuka, Ito Shusaku, Tanaka Masaru
Division of Dermatology, Hitachi General Hospital, Hitachi, Tokyo, Japan.
Department of Dermatology, Tokyo Woman's Medical University Medical Center East, Tokyo, Japan.
Case Rep Dermatol. 2013 Nov 2;5(3):304-8. doi: 10.1159/000356470. eCollection 2013.
A 23-year-old female presented with a reddish-brown dome-shaped hyperkeratotic nodule of 11 × 10 mm on the left lower leg. Dermoscopic examination demonstrated a prominent whitish scaly area with ring-like appearance, pinkish-white structureless areas, a few milia-like cysts, dotted and glomerular vessels, and light brown globules. The lesion was completely excised under the diagnosis of verruca vulgaris or dermatofibroma. Histopathological examination revealed a well-circumscribed symmetric lesion with hyperkeratosis, acanthosis, and pseudohorn cysts. The lesion was composed of spindle-shaped and epithelioid melanocytes with large cytoplasm arranged in confluent nests surrounded by stromal fibrosis. Mitotic figures and Kamino bodies were absent. Moderate proliferation of capillaries was found in the papillary dermis. Immunohistochemical staining with melan-A or S-100 was positive for tumor cells, but the staining with HMB-45 was negative. Melan-A staining was weaker in the deeply situated cells than in the superficial ones, which is known as stratification. Finally, we made a diagnosis of verrucous Spitz nevus based on these findings. We should have been aware of the entity of verrucous Spitz nevus as a variant of Spitz nevus and its dermoscopic features in order to reach a correct diagnosis before excision.
一名23岁女性，左小腿出现一个11×10毫米的红棕色圆顶状角化过度结节。皮肤镜检查显示有一个突出的白色鳞屑区域，呈环状外观，粉白色无结构区域，一些粟丘疹样囊肿，点状和肾小球样血管，以及浅棕色小球。该病变在诊断为寻常疣或皮肤纤维瘤的情况下被完整切除。组织病理学检查显示病变边界清晰、对称，有角化过度、棘层肥厚和假角囊肿。病变由梭形和上皮样黑素细胞组成，细胞质大，排列成融合巢状，周围有间质纤维化。未见核分裂象和卡米诺小体。在乳头真皮层发现中等程度的毛细血管增生。用黑素A或S-100进行免疫组化染色，肿瘤细胞呈阳性，但HMB-45染色为阴性。黑素A染色在深部细胞中比在浅表细胞中弱，这被称为分层现象。最后，根据这些发现我们诊断为疣状斯皮茨痣。为了在切除前做出正确诊断，我们应该了解疣状斯皮茨痣作为斯皮茨痣的一种变体及其皮肤镜特征。
