Department of Ophthalmology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA; Department of Pathology, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.
Department of Ophthalmology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA; Biostatistics Consulting Core, Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.
Am J Ophthalmol. 2021 Feb;222:148-156. doi: 10.1016/j.ajo.2020.09.033. Epub 2020 Sep 28.
To determine the usefulness of melan-A, SOX10, HMB45, and p16 immunohistochemical stains in the distinction between the low-grade and high-grade conjunctival melanocytic intraepithelial lesions, either independently or as components of an immunohistochemical panel.
Retrospective observational case series.
Institutional pathology records between 2014 and 2018 were searched for all patients with conjunctival melanocytic intraepithelial lesions. Biopsies without supporting clinical history or tissue available for review and immunohistochemical analysis were excluded. Clinical, histopathologic, and immunohistochemical (p16, SOX10, HMB45, and Ki-67) findings were recorded.
Thirty-one patients underwent 47 biopsies for conjunctival melanocytic lesions between 2014 and 2018. Pathologic diagnoses were low-grade conjunctival melanocytic intraepithelial lesion (n = 18, 38%) and high-grade conjunctival melanocytic intraepithelial lesion/melanoma in situ (n = 29, 62%). The addition of melan-A and SOX10 immunohistochemical stains resulted in an upgrade of conjunctival melanocytic intraepithelial lesion from low-grade to high-grade in 2 (4%) of 47 cases. The addition of melan-A and SOX10 immunohistochemical stains did not downgrade any of the histomorphologically high-grade lesions. In a clinical-pathologic multivariable model, the parameters most predictive of high-grade melanocytic intraepithelial lesion/melanoma in situ were involvement of the caruncle (odds ratio [OR] = 19, confidence interval [CI] 1.6-212; P = .02] and p16 cytoplasmic H-score >30 (OR = 81, CI 2.7 to >999; P = .01) CONCLUSION: Although the stains for melanocytic markers melan-A and SOX10 facilitate assessment of melanocytic intraepithelial lesions, the current immunohistochemical panels have limited value in distinction between the low-grade and high-grade intraepithelial melanocytic proliferations and need to be used judiciously.
确定黑素瘤相关抗原（melan-A）、SOX10、HMB45 和 p16 免疫组化染色在鉴别低级别和高级别结膜黑色素细胞上皮内病变中的作用，包括单独使用和作为免疫组化组合使用。
回顾性观察性病例系列研究。
2014 年至 2018 年，检索机构病理学记录，寻找所有结膜黑色素细胞上皮内病变患者。排除无支持临床病史或无组织可供回顾和免疫组化分析的活检。记录临床、组织病理学和免疫组化（p16、SOX10、HMB45 和 Ki-67）结果。
2014 年至 2018 年期间，31 名患者进行了 47 次结膜黑色素细胞病变活检。病理诊断为低级别结膜黑色素细胞上皮内病变（n=18，38%）和高级别结膜黑色素细胞上皮内病变/原位黑色素瘤（n=29，62%）。添加黑素瘤相关抗原和 SOX10 免疫组化染色后，47 例中的 2 例（4%）从低级别升级为高级别。添加黑素瘤相关抗原和 SOX10 免疫组化染色并未将任何组织形态学上的高级别病变降级。在临床病理多变量模型中，最能预测高级别黑色素细胞上皮内病变/原位黑色素瘤的参数是 caruncle 受累（优势比[OR] 19，置信区间[CI] 1.6-212；P=0.02）和 p16 细胞质 H 评分>30（OR 81，CI 2.7->999；P=0.01）。
尽管黑色素细胞标志物黑素瘤相关抗原和 SOX10 的染色有助于评估黑色素细胞上皮内病变，但目前的免疫组化组合在鉴别低级别和高级别上皮内黑色素细胞增生方面价值有限，需要谨慎使用。
