Hu J, Ren M, Cai X, Shen X X, Dai B, Kong Y Y
Department of Pathology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University; Institute of Pathology, Fudan University, Shanghai 200032, China.
Department of Urology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Zhonghua Bing Li Xue Za Zhi. 2021 May 8;50(5):494-499. doi: 10.3760/cma.j.cn112151-20200817-00648.
To investigate the clinicopathological characteristics, differential diagnosis and prognosis of nodal nevi (NN). Eighteen cases of NN diagnosed at Fudan University Shanghai Cancer Center, Shanghai, China from 2009 to 2019 were collected. The clinicopathological characteristics and follow-up data were retrospectively analyzed. Histopathologic evaluation and immunohistochemical studies were carried out. The Vysis Melanoma FISH Probe Kit, combined with 9p21(CDKN2A) and 8q24(MYC) assays were performed in 2 cases. There were 2 males and 16 females in the case series. The age of the patients ranged from 36 to 70 years (average 48.2 years). Fifteen cases located in axillary lymph nodes, 1 in inguinal lymph node, 1 in cervical lymph node, and 1 in external iliac lymph node. NN was found in only one lymph node in each case. Histologically, the nevus cell aggregates were found in capsule of lymph nodes in all cases. Nevus cells grew along the capsule into trabeculae in 8 cases, with 3 of them scattered in parenchyma. In one of these 8 cases, nevus cell aggregates massively occupied the parenchyma of the lymph node. The largest lesions in the 18 NN cases measured from 0.2 to 6.5 mm. All of the NN cases were classified as conventional nevi. The majority of the cases were composed of uniform nevus-like cells and identical to cutaneous pigmented nevi without atypia, necrosis, or mitosis. In the NN case that massively occupied parenchyma, some areas had abundant nevus cells and displayed atypical cytologic features, including increased nucleo-cytoplasmic ratio, small nucleoli, and occasional mitotic figures. Immunohistochemistry was performed in 13 cases. All of them were positive for S-100, SOX10, Melan A, and p16. HMB45 showed weak staining in rare cells of only one case out of 13 cases. Ki-67 labeling index <1% was found in all 13 cases. Additionally, the results of FISH assay were both negative. All patients were followed up for 13 to 129 months (median 31.5 months). Except that one patient died of the salivary gland carcinoma, the other patients all survived without tumor during the follow-up period. NN is a benign melanocytic lesion in lymph node. It is important to distinguish NN from metastatic melanoma when nevus cells occur in parenchyma and subcapsular sinus of lymph nodes, or show some atypical cytologic features. The morphology of bland nevus cells in capsule and trabeculae is a valuable clue. Besides, immunohistochemical profiling and FISH assay are helpful in the differential diagnosis.
探讨淋巴结痣（NN）的临床病理特征、鉴别诊断及预后。收集2009年至2019年在中国上海复旦大学附属肿瘤医院确诊的18例NN病例。对其临床病理特征及随访资料进行回顾性分析。进行了组织病理学评估和免疫组化研究。对2例病例采用Vysis黑色素瘤荧光原位杂交（FISH）检测试剂盒，联合9p21（CDKN2A）和8q24（MYC）检测。病例系列中有2例男性和16例女性。患者年龄在36岁至70岁之间（平均48.2岁）。15例位于腋窝淋巴结，1例位于腹股沟淋巴结，1例位于颈部淋巴结，1例位于髂外淋巴结。每例病例仅在一个淋巴结中发现NN。组织学上，所有病例的淋巴结包膜内均可见痣细胞团。8例病例中痣细胞沿包膜生长至小梁，其中3例散在于实质内。在这8例病例中的1例中，痣细胞团大量占据淋巴结实质。18例NN病例中最大病变大小为0.2至6.5mm。所有NN病例均分类为普通痣。大多数病例由形态一致的痣样细胞组成，与皮肤色素痣相同，无异型性、坏死或核分裂象。在大量占据实质的NN病例中，部分区域痣细胞丰富并表现出非典型细胞学特征，包括核质比增加、小核仁及偶见核分裂象。对13例病例进行了免疫组化检测。所有病例S-100、SOX10、Melan A和p16均呈阳性。13例病例中仅1例罕见细胞HMB45呈弱阳性染色。13例病例Ki-67标记指数均<1%。此外，FISH检测结果均为阴性。所有患者均随访13至129个月（中位31.5个月）。除1例患者死于涎腺癌外，其他患者在随访期间均无肿瘤存活。NN是淋巴结中的一种良性黑素细胞病变。当痣细胞出现在淋巴结实质和被膜下窦或表现出一些非典型细胞学特征时，将NN与转移性黑色素瘤区分开来很重要。包膜和小梁中形态温和的痣细胞形态是一个有价值的线索。此外，免疫组化分析和FISH检测有助于鉴别诊断。
