肢端Spitz痣50例病例中P16及P21免疫组织化学表达的临床病理研究

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  --本文经《美国外科病理学杂志》授权发布,其他媒体转载或引用须经《美国外科病理学杂志》同意,否则追究法律责任。
 
  肢端Spitz痣罕见且文献报道极少。表皮交界处的非典型结构及Spitz样的细胞学特点导致其易被误诊为恶性黑色素瘤。为研究其临床病理及免疫组织化学染色特征,从科室存档资料中选取50例位于肢端的Spitz痣病例,获取其临床资料和随访信息,并分析其组织学特征。对50例肢端 Spitz痣进行P16及P21免疫组织化学染色,并与10例肢端雀斑样恶性黑色素瘤及10例肢端痣进行对比。肢端Spitz痣常发生在年轻(中位数:24.5岁;范围:4~61岁)女性患者,足部多发。色素性病变大小1~15mm(中位数:4mm)。45例患者的有效随访资料(中位数:48个月;范围:4~228个月)显示无局部复发、转移及死亡。组织学上,肢端Spitz痣由大的上皮样和/或梭形痣细胞组成,界限清晰,有时分布稍不对称,在交界处形成雀斑样和巢状生长方式及形成“肩部”。常见明显的派杰样生长和贯穿表皮的痣细胞巢。可见局部痣细胞成熟性改变,无细胞核异型及核分裂象。与肢端痣及肢端雀斑样恶性黑色素瘤不同,肢端Spitz痣弥漫强阳性表达P16和P21。肢端Spitz痣是具有良性生物学行为的Spitz痣的特殊类型。关注其细微的组织学鉴别点及P16/P21蛋白表达模式有助于将其与恶性黑色素瘤相区分。
  Am J Surg Pathol 2018;42:821-827
  美国外科病理学杂志中文版2019年第一期摘要NO.6
  孔令非翻译/审校
 
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