发育不良性痣11例临床病理学分析

Eleven cases of dysplastic nevus: a clinicopathological study

目的探讨发育不良性痣的临床病理学特点。方法对11例临床表现为色素性损害的手术标本行H-E染色,结合临床指标及评分进行研究和分析。结果临床表现:皮损直径≥5mm者8例,多发性损害者7例,边界模糊者4例,外形不规则者6例,痣表面色素不匀者4例,基底色红者6例。光镜下:交界痣3例,复合痣8例。发育不良性痣较为特异的组织学表现为真表皮交界处雀斑样增生,痣细胞巢增生紊乱倾向于形成“桥型”融合。表皮下方的非典型黑素细胞在基底层呈“Paget”样蔓延,真表皮交界处的黑素细胞向周围延伸,并超过真皮内的痣细胞成分。非典型黑素细胞:细胞核较角质形成细胞核大,多形性,出现核仁,深染。结论临床和组织病理相结合是诊断发育不良性痣的可行性标准,仅根据组织学的非典型性不能诊断发育不良性痣。

Objective To study the clinicopathologic characteristics of dysplastic nevus. Methods The specimens from 11 patients with dysplastic nevus were studied for their histological characteristics using haematoxylin and eosin staining, and the patients were analyzed for their clinical manifestations. Results Among the 11 patients, 7 had multiple lesions while the remaining 4 had single lesion. Of the 11 studied lesions, 8 had a diameter ≥5 mm; 4 had an obscure margin; 6 had an irregular shape; 4 were irregularly pigmented; 6 displayed an erythematous base. Skin biopsy demonstrated that 3 cases were junctional nevus and 8 were compound nevus. Lent/ginous proliferation along the dermal-epidermal junction was observed as a typical histological pattern of all cases. The nevus cells proliferated irregularly and tended toward confluence, forming an appearance of ＂bridging＂. Atypical melanocytes spread subepidermally in a pagetoid manner. Extensive proliferation of melanocytes at the epidermal-dermal junction was observed, with some cells extending beyond the dermal nevus component. Cytological criteria for melanocytic atypia included a nucleus, which was polymorphous and larger than that of a keratinocyte, presence of nucleoli, and hyperchromasia as well as variation in nuclear staining. Conclusions It is important to evaluate the relationship between the histopathologic characteristics and clinical phenotypes of dysplastic nevus, which cannot be diagnosed only based on the atypia of its histological appearance.