肢端色素痣的病理诊断与鉴别诊断

Pathologic diagnosis and differential diagnosis of acral nevus

目的探讨肢端色素痣的病理学特征,并与其他部位痣和恶性黑色素瘤进行比较分析。方法选取2010-07—2018-02肢端色素痣17例和肢端恶性黑色素瘤1例,分析两者显微镜下特点,同时查阅多篇国外文献报道。结果 17例病变中,皮内痣1例,交界痣6例,混合痣10例。10例的痣细胞不仅仅位于深皮脊(皮脊标志表皮下方的表皮突部分),还位于深皮沟(皮沟标志表皮下方的表皮突部分),6例患者的痣细胞呈派杰样向表皮内扩散, 16例的黑色素颗粒主要垂直排列于角质层的皮沟内,1例主要排列于角质层的皮脊内。1例恶性黑色素瘤的瘤细胞粘附性差、融合,瘤细胞呈派杰样向表皮内扩散,角质层内的黑色素颗粒排列杂乱,真皮内较多淋巴细胞浸润。结论肢端色素痣的痣细胞可以在表皮内呈派杰样扩散,黑色素颗粒也可以垂直排列于角质层的皮沟内,而恶性黑色素瘤的瘤细胞可在表皮内呈派杰样扩散,黑色素颗粒可垂直排列于角质层的皮脊内或杂乱排列,这是两者的鉴别要点。

Objective To investigate the pathologic features of acral nevus, compared with other part nevus and melanoma. Methods Microscopic features of 13 acral nevi and 1 acral melanoma were analyzed between July 2010 and February 2018, with review of the literature. Results One of 17 acral nevi was intradermal nevus. 6 of 17 acral nevi were junction nevus. 10 of 17 acral nevi were compound nevus. Proliferation of melanocytes was detected not only in the crista profunda but also in the crista profunda intermedia in 10 acral nevi. Pagetoid spread of melanocytes in epidermis was detected in 6 acral nevi. Melanin granules in the cornified layer were arranged in a column-like fashion located under the surface furrows in 16 cases of acral nevus. Melanin granules in the cornified layer were detected under the surface ridges in 1 acral nevus. In 1 melanoma, the tumor cells had poor adhesion, mixed together. Pagetoid spread of melanocytes in epidermis was detected. Melanin granules were found in wide areas of the keratinocytic layer. More lymphocytes infiltrated in dermis. Conclusion Pagetoid spread of melanocytes in epidermis is found in acral nevus. Melanin granules in the cornified layer are arranged in a column-like fashion located under the surface furrows in acral nevus. But pagetoid spread of melanocytes in epidermis is detected in melanoma. Melanin granules in the cornified layer are present under the surface ridges or random arrangement, which is a key point of differential diagnosis between acral nevus and melanoma.