From the Department of Ophthalmic Pathology (Drs Eiger-Moscovich, Eagle, and Milman) and the Ocular Oncology Service (Drs Lally, C. L. Shields, and J. A. Shields), Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania; the Institute of Ophthalmology and Visual Science, Rutgers University, Newark, New Jersey (Dr Langer); the Department of Ophthalmology, University of Washington, Seattle (Dr Sheehan); and the Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia (Dr Milman).
Arch Pathol Lab Med. 2020 Apr;144(4):457-465. doi: 10.5858/arpa.2019-0053-OA. Epub 2019 Aug 30.
CONTEXT.—: Granular cell change in melanocytic nevus is underrepresented in the literature with only 4 well-documented cases, 1 described in the conjunctiva. Unfamiliarity with the clinical and pathologic features of these lesions contributes to the diagnostic difficulty.
OBJECTIVE.—: To delineate the clinical and histopathologic features of conjunctival nevi with granular cell change.
DESIGN.—: In a retrospective observational case series, the medical records of all patients with conjunctival nevi and granular cell change diagnosed between December 2016 and October 2018 were reviewed. Data collected included age, sex, clinical presentation, pathologic findings, and follow-up.
RESULTS.—: Twelve patients, 6 males and 6 females, with a median age of 14 years (range, 8-82 years) were identified. The nevus manifested as a pigmented, well-circumscribed nodule (7 of 9; 78%) or patch (2 of 9; 22%) in the bulbar and limbal conjunctiva (7 of 9; 78%) or in the plica semilunaris/caruncle (2 of 9; 22%). Cysts were noted in 7 of 9 lesions (78%). Features prompting surgical excision included atypical pigmentation (8 of 9; 89%), growth (7 of 9; 78%), and atypical vascularity (4 of 9; 44%). Microscopically, all lesions comprised a conventional melanocytic nevus with focal granular cell change and immunoreactivity for Melan-A, SOX10, and HMB-45, with Ki-67 proliferative index of less than 2%. Of the 9 lesions with follow-up information, there were no recurrences over mean follow-up of 11.2 months (range, 1-23 months).
CONCLUSIONS.—: Granular cell change in melanocytic nevi is an underrecognized finding that can simulate melanoma clinically and histopathologically. Young age at diagnosis, lack of associated conjunctival melanosis, bulbar location, cysts, and the absence of mitotic figures with a low Ki-67 proliferative index are helpful clinical and pathologic diagnostic clues.
颗粒细胞改变在黑素细胞痣中的报道较少，仅有 4 例有详细的文献记载，其中 1 例发生于结膜。由于对这些病变的临床和病理特征不熟悉，导致诊断困难。
描述具有颗粒细胞改变的结膜痣的临床和组织病理学特征。
在一项回顾性观察性病例系列研究中，回顾了 2016 年 12 月至 2018 年 10 月期间诊断为结膜痣伴颗粒细胞改变的所有患者的病历。收集的数据包括年龄、性别、临床表现、病理发现和随访。
共确定了 12 例患者，6 例为男性，6 例为女性，中位年龄为 14 岁（范围为 8-82 岁）。该痣表现为位于球结膜和角膜缘的色素性、边界清楚的结节（9 例中的 7 例；78%）或斑块（9 例中的 2 例；22%），或半月皱襞/穹隆结膜（9 例中的 2 例；22%）。7 例病变中有囊肿。提示手术切除的特征包括非典型色素沉着（9 例中的 8 例；89%）、生长（9 例中的 7 例；78%）和非典型血管（9 例中的 4 例；44%）。显微镜下，所有病变均由一个常规的黑素细胞痣组成，伴有局灶性颗粒细胞改变，免疫组织化学显示 Melan-A、SOX10 和 HMB-45 阳性，Ki-67 增殖指数小于 2%。在 9 例有随访信息的病变中，平均随访 11.2 个月（范围为 1-23 个月）后无复发。
颗粒细胞改变在黑素细胞痣中是一种认识不足的发现，它在临床上和组织病理学上可模拟黑色素瘤。诊断时年龄较小、无相关结膜黑色素沉着、球结膜位置、囊肿和缺乏有丝分裂象，Ki-67 增殖指数较低是有帮助的临床和病理诊断线索。
