黑素细胞痣1011例的特殊组织病理学特征分析

Analysis of special histopathological characteristics of 1011 cases of melanocytic nevi

目的分析黑素细胞痣的特殊组织病理学特征及其与年龄、性别、部位和病理亚型之间的关系。方法回顾北京医院皮肤科2005年1月至2019年1月就诊的1011例黑素细胞痣患者的临床及病理资料。计数资料的比较采用χ^2检验,计量资料的比较采用t检验。结果1011例黑素细胞痣患者就诊年龄为(40.90±19.19)岁,男289例,女722例。皮损发生及取材部位:躯干402例(39.8%),面颈部268例(26.5%),四肢138例(13.6%),手足133例(13.2%),头皮53例(5.2%),外阴17例(1.7%)。病理亚型:皮内痣580例(57.4%),混合痣333例(32.9%),交界痣98例(9.7%)。特殊组织病理学特征:172例(17.0%)有神经化、155例(15.3%)有脂肪增生表现,女性多于男性、年长患者多于年轻患者、头皮部位多于其他部位(均P<0.05);313例(31.0%)有血管增生表现,头皮部位多于其他部位(P<0.05);502例(49.7%)可见痣细胞沿毛囊/皮脂腺分布,面颈部多于其他部位(P<0.05);203例(20.1%)有痣细胞松解、384例(3&0%)有裂隙表现;以上特征皮内痣多于混合痣(均P<0.05)。20例(2.0%)有痣细胞沿血管分布的表现,四肢多于躯干、手足(P<0.05),混合痣多于皮内痣(P<0.05)。结论黑素细胞痣的多种特殊组织病理学特征如神经化、脂肪增生、血管增生、痣细胞沿毛囊/皮脂腺分布等,与患者的年龄、性别、皮损发生部位和病理亚型有关。

Objective To analyze special histopathological characteristics of melanocytic nevi and their associations with age,gender,anatomical locations and pathological subtypes.Methods Clinical and histopathological data were collected from 1011 patients with melanocytic nevi,who visited Beijing Hospital from January 2005 to January 2019,and analyzed retrospectively.Statistical analysis was carried out by using chi-square test for comparing enumeration data,and t test for comparing measurement data.Results Among the 1011 patients with melanocytic nevi,the age at the clinic visit was 40.90±19.19 years,and there were 289 males and 722 females.Lesional(biopsy)sites included the trunk(402 cases,39.8%),face and neck(268 cases,26.5%),extremities(138 cases,13.6%),hands and feet(133 cases,13.2%),scalp(53 cases,5.2%)and vulva(17 cases,1.7%).Pathological subtypes included intradermal nevus(580 cases,57.4%),compound nevus(333 cases,32.9%)and junctional nevus(98 cases,9.7%).Among special histopathological characteristics,neuralization and adipose cell hyperplasia were observed in 172(17.0%)and 155(15.3%)cases respectively,and the prevalence of neuralization and adipose cell hyperplasia was significantly higher in female patients than in male patients,higher in elderly patients than in young patients,and higher on the scalp than on the other sites(all P<0.05);vascular proliferation was observed in 313(31.0%)cases,and more commonly occurred on the scalp than on the other sites(P<0.05);nevus cells distributed along the hair follicles/sebaceous glands were observed in 502(49.7%)cases,and more commonly seen on the face and neck than on the other sites(P<0.05);nevus cell lysis occurred in 203(20.1%)cases,and fissures were observed in 384(38.0%).All the above histopathological characteristics were more frequently observed in the intradermal nevus subtype than in the compound nevus subtype(all P<0.05).Nevus cells distributed along the blood vessels were observed in 20(2.0%)cases,and more commonly seen on the extremities than on the trunk,hands and feet(P<0.05),as well as in the compound nevus subtype than in the intradermal nevus subtype(P<0.05).Conclusions There are many special histopathological characteristics in melanocytic nevi,such as neuralization,adipose cell hyperplasia,vascular proliferation,and nevus cells distributed along the hair follicles/sebaceous glands,which are associated with patients'age,gender,lesional locations and histopathological subtypes.