Kong Yunyi, Dai Bo, Cai Xu, Deng Jingjing, Kong Jincheng
Department of Pathology, Shanghai Cancer Center, Fudan University; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
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Zhonghua Bing Li Xue Za Zhi. 2014 Sep;43(9):609-12.
To study the clinicopathologic features, differential diagnosis and prognosis of proliferative nodules(PNs) in congenital melanocytic nevi(CMN).
Histopathologic evaluation and immunohistochemical study by EnVision method were carried out in 8 cases of PNs in CMN. The clinical information and follow-up data were analyzed.
The age of patients ranged from 1 to 54 years (mean 27.6 years). Tumors were located on face (3 cases), on back (2 cases), upper extremities (2 cases) and lower extremities(1 case). Microscopically, PNs with expansile growth were observed in 8 cases of CMN. Melanocytes in PNs show variable pleomorphism with a mitotic activity of 0 to 4 per 10 high power fields. Blending of cells with adjacent CMN was noted in 6 cases. According to the morphology of melanocytes in PNs, it was classified into different types including large oval melanocytes (4 cases), small melanocytes (2 cases) and Spitz-nevus-like forms (2 cases). Immunohistochemically, melanocytes in PNs were consistent with those in adjacent CMN. They were diffusely positive for S-100 protein, but were either negative or focally positive for HMB45. Less than 5% of melanocytes were positive for Ki-67 in 8 cases of PN. Follow-up was available in all cases, ranging from 9 to 82 months. Seven patients with excision of single PN in CMN were alive with no evidence of disease, while 1 patient with multiple PNs in CMN was stable with disease after 62 months follow-up.
PN is a rare melanocytic lesion arising in CMN. Recognition of its specific histologic features can help to avoid being misdiagnosed as melanoma. Long term follow-up should be recommended in patients with PNs, especially in those with atypical histologic features. Further investigation is needed to elucidate its clinical behavior.
研究先天性黑素细胞痣（CMN）中增殖性结节（PNs）的临床病理特征、鉴别诊断及预后。
对8例CMN中的PNs进行组织病理学评估及采用EnVision法进行免疫组化研究。分析临床资料及随访数据。
患者年龄1至54岁（平均27.6岁）。肿瘤位于面部（3例）、背部（2例）、上肢（2例）及下肢（1例）。显微镜下，8例CMN中均观察到呈膨胀性生长的PNs。PNs中的黑素细胞表现出不同程度的多形性，每10个高倍视野中有0至4个有丝分裂活性。6例可见PNs中的细胞与相邻CMN融合。根据PNs中黑素细胞的形态，可分为不同类型，包括大椭圆形黑素细胞（4例）、小黑素细胞（2例）及Spitz痣样形态（2例）。免疫组化显示，PNs中的黑素细胞与相邻CMN中的黑素细胞一致。它们对S-100蛋白弥漫性阳性，但对HMB45阴性或局灶性阳性。8例PN中，不到5%的黑素细胞Ki-67阳性。所有病例均有随访，时间为9至82个月。7例CMN中单个PN切除的患者存活且无疾病证据，而1例CMN中有多个PN的患者在随访62个月后病情稳定。
PN是CMN中罕见的黑素细胞病变。认识其特定的组织学特征有助于避免误诊为黑色素瘤。对于PN患者，尤其是具有非典型组织学特征的患者，应建议进行长期随访。需要进一步研究以阐明其临床行为。
