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黑素细胞痣与非肿瘤性色素沉着。

Melanocytic nevi and non-neoplastic hyperpigmentations.

作者信息

Clemente C

机构信息

Servizio di Anatomia Patologica e Citodiagnostica, I.R.C.C.S. Policlinico San Donato, Milano.

出版信息

Pathologica. 2017 Jun;109(2):67-96.

Abstract

This is the first of three chapters that will be progressively published on Pathologica as updating activity of the Italian Study Group of Dermatopathology (GISD), Italian Society of Pathology and Cytology (SIAPeC IAP). The first chapter concerns non-neoplastic hyperpigmented skin lesions and nevi, the second will address the topics of dysplastic nevus, borderline and low malignant potential melanocytic proliferations and the third melanoma in its variants and differential diagnoses with a supplement on the immunohistochemistry and molecular support to diagnostic and prognostic definition of nevi and melanomas. Although we believe that great advances were made in the application of ancillary genetic, immunohistochemical and molecular techniques, for the diagnosis and biological characterization of melanocytic tumors the morphology still remains the gold standard. These chapters are not intended as substitutes or even claim to be compared to the numerous and valuable texts that are also recently published, but they want to present, concisely and quickly available, all of those traits that we believe essential to the histopathological evaluation of a melanocytic lesion. No morphological parameter is exclusive and individually sufficient to make the correct diagnosis of nevus or melanoma but to reach a final conclusive and appropriate interpretation a set of morphological characters must be evaluated and compared. I was lucky enough to be able to examine several thousand cases and to draw lessons from each of these increasing my diagnostic experience. I had a great lesson by my teacher and good friend Prof. Martin C. Mihm Jr of Boston, dermato-pathologist with undisputed international reputation, who, with great passion, patience and friendship, transferred me much of his experience and knowledge and for which I always thank him. Special thanks I would like to address Dr. Agostino Crupi, dermatologist, skin-oncologist and brilliant dermatoscopist who taught me how the diagnosis of melanocytic lesions starts from the clinic examination and the mutual comparison between dermatologist and pathologist is a great richness of knowledge for both. Finally thank to my collaborators Barbara Rubino, Barbara Bruni and Antonella Festa for the large number of material collected in these years at the Pathology Service of the IRCCS Policlinico San Donato and a particular thank to Marco Turina who collaborated in the drafting of this text.

摘要

这是将在《病理学》(Pathologica)上陆续发表的三章内容中的第一章,作为意大利皮肤病理学研究组(GISD)、意大利病理学与细胞学会(SIAPeC IAP)的更新活动。第一章涉及非肿瘤性色素沉着性皮肤病变和痣,第二章将探讨发育异常痣、交界性和低恶性潜能黑素细胞增生性病变的相关主题,第三章则是黑色素瘤的不同变体及其鉴别诊断,并附带关于免疫组织化学和分子检测的内容,以辅助痣和黑色素瘤的诊断及预后判定。尽管我们认为在辅助性基因、免疫组织化学和分子技术的应用方面取得了巨大进展,但对于黑素细胞肿瘤的诊断和生物学特征描述而言,形态学仍然是金标准。这些章节并非旨在替代,甚至也无意于与近期出版的众多有价值的文献相媲美,而是希望简洁明了且快速可得地呈现我们认为对黑素细胞病变进行组织病理学评估至关重要的所有特征。没有任何一个形态学参数是排他的,也没有一个参数能单独足以正确诊断痣或黑色素瘤,而是必须评估和比较一组形态学特征才能得出最终的确切且恰当的诊断。我有幸能够检查数千个病例,并从每一个病例中吸取经验教训,从而增加我的诊断经验。我从我的老师兼好友、波士顿的马丁·C·米姆(Martin C. Mihm Jr)教授那里学到了很多,他是一位享有无可争议的国际声誉的皮肤病理学家,他满怀热情、耐心和友谊,传授给了我他的许多经验和知识,对此我一直心怀感激。我要特别感谢皮肤科医生、皮肤肿瘤学家兼出色的皮肤镜专家阿戈斯蒂诺·克鲁皮(Agostino Crupi)博士,他教会了我黑素细胞病变的诊断如何从临床检查开始,以及皮肤科医生和病理学家之间的相互比较对双方来说都是知识的极大丰富。最后感谢我的合作者芭芭拉·鲁比诺(Barbara Rubino)、芭芭拉·布鲁尼(Barbara Bruni)和安东内拉·费斯塔(Antonella Festa),感谢他们这些年来在IRCCS圣多纳托综合医院病理科收集的大量资料,还要特别感谢参与本文撰写的马尔科·图里纳(Marco Turina)。

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