Tran T A, Carlson J A, Basaca P C, Mihm M C
Department of Pathology, Albany Medical College, New York 12208, USA.
J Cutan Pathol. 1998 May;25(5):252-8. doi: 10.1111/j.1600-0560.1998.tb01729.x.
Atypical cellular blue nevus (ACBN) has clinicopathologic features intermediate between typical cellular blue nevus (CBN) and the rare malignant blue nevus (MBN)/malignant melanoma (MM) arising in a CBN. Herein we report 9 cases of ACBN. The patients were caucasian (6 females and 3 males) with a mean and median age of 47/51 years. Two patients complained of recent changes and about half of these tumors were located on the buttocks or scalp, averaging 1.5 cm in diameter. Histologically, they were characterized by architectural atypia (infiltrative margin and/or asymmetry) and/or cytologic atypia (hypercellularity, nuclear pleomorphism, hyperchromasia, mitotic figures, and/or necrosis). Assessment of the expression of 3 tissue markers demonstrated rare solitary cell staining with oncogene product bcl-2, and a proliferative index of 23+/-19 and 39+/-30 cells/10 high power field with antibodies to PCNA and Mib-1, respectively. No significant differences were detected comparing the above levels of expression to a control group of 15 CBN; however, ACBNs tended to show a higher proliferative index by PCNA and Mib-1 as well as a significantly higher mitotic rate (1/10 HPF vs. 0; p=0.001). Analysis of DNA content showed DNA aneuploidy in both groups. Follow-up data on 9 of 9 patients showed 1 patient dead without disease and 8 alive without disease (mean/median follow-up 42/32 months, range 15-96 months). No patient during this follow-up time has experienced either a local recurrence or lymph node or visceral metastasis. These findings highlight the close resemblance of ACBN to the natural history of CBN. Nevertheless, many of the distinguishing histologic features of ACBN are also those of MBN. Because of these intermediate clinicopathologic features, ACBN warrant close scrutiny and long-term follow-up.
非典型细胞性蓝痣（ACBN）具有介于典型细胞性蓝痣（CBN）和罕见的起源于CBN的恶性蓝痣（MBN）/恶性黑色素瘤（MM）之间的临床病理特征。在此，我们报告9例ACBN。患者为白种人（6名女性和3名男性），平均年龄和中位年龄分别为47/51岁。2例患者主诉近期有变化，约一半的这些肿瘤位于臀部或头皮，平均直径为1.5厘米。组织学上，它们的特征为结构异型性（浸润性边缘和/或不对称性）和/或细胞异型性（细胞增多、核多形性、核深染、有丝分裂象和/或坏死）。对3种组织标志物表达的评估显示，癌基因产物bcl-2呈罕见的单个细胞染色，分别用抗PCNA和Mib-1抗体检测，增殖指数为23±19和39±30个细胞/10个高倍视野。与15例CBN的对照组相比，上述表达水平未检测到显著差异；然而，ACBN倾向于显示PCNA和Mib-1的增殖指数更高，以及有丝分裂率显著更高（1/10高倍视野 vs. 0；p = 0.001）。DNA含量分析显示两组均存在DNA非整倍体。9例患者中的9例随访数据显示，1例患者无病死亡，8例患者无病存活（平均/中位随访42/32个月，范围15 - 96个月）。在此随访期间，没有患者出现局部复发、淋巴结转移或内脏转移。这些发现突出了ACBN与CBN自然病程的密切相似性。然而，ACBN许多独特的组织学特征也是MBN的特征。由于这些中间的临床病理特征，ACBN需要密切观察和长期随访。
