Carson K F, Wen D R, Li P X, Lana A M, Bailly C, Morton D L, Cochran A J
Department of Pathology and Laboratory Medicine, University of California Los Angeles School of Medicine 90095-1732, USA.
Am J Surg Pathol. 1996 Jul;20(7):834-40. doi: 10.1097/00000478-199607000-00006.
Nevocytes in melanoma-draining lymph nodes can be mistaken for melanoma metastases and may possibly transform to melanoma. During the development of a new technique for managing high-risk primary melanomas, selective lymph node dissection, we examined 4,821 nodes from 208 melanoma patients by light microscopy and immunohistochemistry. Nodal nevi were identified in 49 of 226 lymphadenectomy specimens (22%), a frequency considerably higher than previously recorded (5-6%). Nevi occurred in 57 of 4,821 nodes (1.2%), in 84% of patients in one node, in 13% of patients in two nodes, and in 3% of patients in three nodes. Nevocytes were detected in hematoxylin and eosin-stained sections in 38 of 49 cases (78%) and exclusively by immunocytochemistry with an antibody to S-100 protein in 11 of 49 (22%). Nevi were in the peripheral capsule in 93% of cases and in internal trabecula in the remaining 7%. Nevocytes surrounded a small vessel in 33% of cases. Nevi were more frequent in axillary (37 of 140, 26%) and cervical nodes (seven of 40, 18%) than in inguinal nodes (five of 46, 11%). Nevi were more frequent in sentinel nodes, the first nodes on the lymphatics draining a primary melanoma (11 of 284, 3.9%), than in nonsentinel nodes (46 of 4,537, 1.01%; p < 0.0008). One of 1,071 nodes from 50 patients with breast cancer (0.1%) and none of 521 nodes from 50 patients with pelvic cancer contained nevocytes. That nodal nevi are selectively present in melanoma patients raises the possibility of their origin from nodal melanocytes influenced by tumor products. Alternatively, the association may indicate that the nevocytes of cutaneous nevi can be disrupted and displaced by the growth of an adjacent melanoma.
黑色素瘤引流淋巴结中的痣细胞可能被误诊为黑色素瘤转移灶，并且可能会转变为黑色素瘤。在开发一种用于治疗高危原发性黑色素瘤的新技术——选择性淋巴结清扫术的过程中，我们通过光学显微镜和免疫组织化学检查了208例黑色素瘤患者的4821个淋巴结。在226例淋巴结切除标本中的49例（22%）中发现了淋巴结痣，这一频率明显高于之前记录的（5 - 6%）。在4821个淋巴结中的57个（1.2%）发现了痣，84%的患者有一个淋巴结出现痣，13%的患者有两个淋巴结出现痣，3%的患者有三个淋巴结出现痣。在49例病例中，38例（78%）在苏木精和伊红染色切片中检测到痣细胞，49例中的11例（22%）仅通过抗S - 100蛋白抗体免疫细胞化学检测到痣细胞。93%的病例中痣位于外周包膜，其余7%位于内部小梁。33%的病例中痣细胞围绕着小血管。腋窝淋巴结（140个中的37个，26%）和颈部淋巴结（40个中的7个，18%）中的痣比腹股沟淋巴结（46个中的5个，11%）更常见。前哨淋巴结（引流原发性黑色素瘤的淋巴管上的第一个淋巴结）中的痣（284个中的11个，3.9%）比非前哨淋巴结（4537个中的46个，1.01%；p < 0.0008）更常见。50例乳腺癌患者的1071个淋巴结中有1个（0.1%）含有痣细胞，50例盆腔癌患者的521个淋巴结中均未发现痣细胞。淋巴结痣选择性地出现在黑色素瘤患者中，这增加了它们起源于受肿瘤产物影响的淋巴结黑素细胞的可能性。或者，这种关联可能表明皮肤痣的痣细胞会被相邻黑色素瘤的生长破坏和移位。
