Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Histopathology. 2021 Sep;79(3):291-305. doi: 10.1111/his.14371. Epub 2021 May 27.
An accurate diagnosis of melanocytic lesions requires a thorough histopathological evaluation accompanied by appropriate correlation with clinical examination findings. Although most melanocytic lesions can readily be classified as one of the defined diagnostic entities according to well-established diagnostic criteria, a subset of melanocytic lesions, particularly those with blue naevus-like (pigmented dendritic) morphology, have notoriously constituted an enduring challenge for pathologists. These lesions are rare and often show histological ambiguities, with features of both benignity and malignancy, thereby making accurate risk assessment and prediction of their biological behaviours difficult on histological grounds alone. Herein, we outline a practical and systematic approach for the diagnosis of melanocytic lesions with dendritic morphology, with a particular focus on histological and immunophenotypic features that help to distinguish one entity from another. In this review, we provide the most current knowledge on these melanocytic lesions in the literature and our experience with these rare entities, and we discuss the utility of molecular techniques as an ancillary tool, especially in histologically ambiguous and/or borderline lesions.
准确诊断黑素细胞病变需要进行彻底的组织病理学评估，并与临床检查结果进行适当的关联。虽然大多数黑素细胞病变可以根据既定的诊断标准轻易地归类为已定义的诊断实体之一，但一部分黑素细胞病变，特别是那些具有蓝色痣样（色素性树突状）形态的病变，一直以来都是病理学家面临的一个持久挑战。这些病变较为罕见，且常表现出组织学上的模糊性，具有良性和恶性的特征，因此仅凭组织学特征很难准确评估其风险并预测其生物学行为。在此，我们概述了一种用于诊断具有树突状形态的黑素细胞病变的实用且系统的方法，特别关注有助于区分不同实体的组织学和免疫表型特征。在这篇综述中，我们提供了文献中关于这些黑素细胞病变的最新知识以及我们对这些罕见实体的经验，并讨论了分子技术作为辅助工具的效用，尤其是在组织学上存在模糊性和/或边界性的病变中。
