Hung Tawny, Argenyi Zsolt, Erickson Lori, Guitart Joan, Horenstein Marcelo G, Lowe Lori, Messina Jane, Piepkorn Michael W, Prieto Victor G, Rabkin Michael S, Schmidt Birgitta, Selim Maria A, Shea Christopher R, Trotter Martin J, Barnhill Raymond L
*Department of Pathology, UCLA Geffen School of Medicine, Los Angeles, CA, USA; †Division of Dermatology, University of Washington, Seattle, WA, USA; ‡Department of Pathology, Mayo Clinic, Rochester, MN, USA; §Departments of Dermatology and Pathology, Northwestern University School of Medicine, Chicago, IL, USA; ¶The Dermatology Group, West Orange, NJ, USA; ‖Departments of Pathology and Dermatology, University of Michigan, Ann Arbor, MI, USA; **Department of Pathology, University of South Florida and Moffitt Cancer Center, Tampa, FL, USA; ††Division of Pathology, MD Anderson Cancer Center, Houston, TX, USA; ‡‡Rabkin Dermatopathology Laboratory, Pittsburgh, PA; §§Department of Pathology, Children's Hospital and Harvard Medical School, Boston, MA, USA; ¶¶Department of Pathology, Duke University Medical Center, Durham, NC, USA; ‖‖Departments of Medicine and Pathology, University of Chicago, Chicago, IL, USA; ***Department of Pathology, St. Paul's Hospital, Vancouver, BC, Canada; and †††Department of Pathology, Institut Curie, Paris, France.
Am J Dermatopathol. 2016 Jul;38(7):499-503. doi: 10.1097/DAD.0000000000000483.
Cellular blue nevomelanocytic lesions (CBNLs) frequently pose diagnostic problems to pathologists, and their biological potential may be difficult to establish. In this study, the authors have analyzed the clinical, histological, and outcome data of 37 cellular blue nevomelanocytic lesions and the molecular characteristics of 4 lesions. The cohort of cases comprised 8 cellular blue nevi (CBNs), 17 atypical cellular blue nevi (ACBNs), and 12 blue-nevus-like melanomas (BNLMs) with a mean follow-up of 5 years. The average age at diagnosis was 25.9 years for patients with ACBN, versus 30.4 years for CBN, and 44.6 years for BNLM. Both CBN and ACBN occurred most frequently on the trunk or extremities, whereas BNLM primarily involved the scalp. Histologically, CBN and ACBN were characterized by a mean diameter of <1 cm, absence of necrosis, low mitotic rate (mean: 1-2 mitotic figures/mm), little or no infiltrative properties, and usually low-grade cytologic atypia. In contrast, BNLM had a mean diameter of 1.6 cm, necrosis, tissue infiltration, greater mitotic activity (mean: 6 mitotic figures/mm), and high-grade cytologic atypia. ACBNs often were larger, more densely cellular, exhibited higher mitotic counts, and were cytologically more atypical than CBN. Seven CBN cases with follow-up had a benign clinical course (average follow-up of 4.7 years). Among 6 patients with ACBN who underwent sentinel lymph node (SLN) biopsy, 3 were positive, and a single additional case had 1 positive non-SLN (this patient did not have a SLN biopsy performed). All 14 cases of ACBN with follow-up were alive and without recurrence with mean follow-up of 5 years. Of the 9 melanoma cases with follow-up, 3 patients with SLN and non-SLN involvement died from their disease (average follow-up of 4.8 years). Array comparative genomic hybridization was performed on 2 ACBNs and 1 BNLM: One of the 2 ACBNs showed chromosomal aberrations and 1 BNLM showed multiple chromosomal gains and losses. Multiplex polymerase chain reaction was performed on 1 ACBN, and no mutations were found. From these results, the authors conclude that ACBN occupy an intermediate position within the spectrum of CBN and BNLM, yet many lesions cannot be reliably distinguished from either CBN or BNLM because of overlapping histologic features. However, in general, ACBNs seem to aggregate more closely with CBN in terms of clinical, histological, molecular profile (limited data), and biological behavior.
细胞性蓝色痣黑素细胞性病变（CBNLs）常常给病理学家带来诊断难题，其生物学潜能可能难以确定。在本研究中，作者分析了37例细胞性蓝色痣黑素细胞性病变的临床、组织学和转归数据以及4例病变的分子特征。病例队列包括8例细胞性蓝色痣（CBN）、17例非典型细胞性蓝色痣（ACBN）和12例蓝色痣样黑色素瘤（BNLM），平均随访5年。ACBN患者的诊断时平均年龄为25.9岁，CBN为30.4岁，BNLM为44.6岁。CBN和ACBN最常发生于躯干或四肢，而BNLM主要累及头皮。组织学上，CBN和ACBN的特征为平均直径<1 cm、无坏死、有丝分裂率低（平均：1 - 2个有丝分裂象/mm）、几乎没有或没有浸润性、通常细胞学异型性低。相比之下，BNLM的平均直径为1.6 cm，有坏死、组织浸润、有丝分裂活性更高（平均：6个有丝分裂象/mm）以及高级别细胞学异型性。ACBN通常更大、细胞更密集、有丝分裂计数更高，并且在细胞学上比CBN更具异型性。7例有随访的CBN病例临床过程为良性（平均随访4.7年）。在6例行前哨淋巴结（SLN）活检的ACBN患者中，3例为阳性，另有1例有1个非SLN阳性（该患者未进行SLN活检）。所有14例有随访的ACBN病例均存活且无复发，平均随访5年。在9例有随访的黑色素瘤病例中，3例SLN和非SLN受累患者死于疾病（平均随访4.8年）。对2例ACBN和1例BNLM进行了阵列比较基因组杂交：2例ACBN中的1例显示染色体畸变，1例BNLM显示多个染色体的增减。对1例ACBN进行了多重聚合酶链反应，未发现突变。根据这些结果，作者得出结论，ACBN在CBN和BNLM谱系中占据中间位置，但由于组织学特征重叠，许多病变无法可靠地与CBN或BNLM区分开来。然而，总体而言，ACBN在临床、组织学、分子特征（数据有限）和生物学行为方面似乎与CBN聚集得更紧密。
