淋巴结内痣2例临床病理学特征及文献复习

Clinicopathological features of two cases of nodal nevi and the relevant literature review

目的 探讨淋巴结内痣(nodal nevi,NN)的临床病理学特征及鉴别诊断要点。方法 收集上海市静安区中心医院2018年至2019年诊断的2例NN患者,回顾性分析其临床病理学特征,行HE染色及免疫组化染色进行观察分析,并复习相关文献。结果 患者均为女性,年龄分别为48岁和50岁,均无恶性黑色素瘤病史,因乳腺癌行改良根治术后于腋窝淋巴结内发现NN。术后随访44~49个月,2例患者均未见复发及转移。镜下2例NN的痣细胞呈巢团状聚集,分别位于淋巴结被膜处及边缘窦内,病灶最大径分别为2 mm和2.5 mm,痣细胞形态温和,类似于皮肤的良性色素痣细胞,缺乏明显的异型性及核分裂象。免疫组化检测结果示S100均呈强阳性表达,SOX10、P16均呈阳性,Ki67阳性计数均<1%;HMB45、KP-1、CKpan均呈阴性。结论 NN是一种少见的良性淋巴结内黑色素细胞增生性病变,结合临床病史、组织病理学特征、免疫组化及分子检测结果有助于与淋巴结转移性癌及转移性恶性黑色素瘤相鉴别。

Objective To investigate the clinicopathological characteristics and differential diagnosis of nodal nevi(NN).Methods Two cases of NN diagnosed at Jing’an District Center Hospital of Shanghai from 2018 to 2019 were collected.The clinicopathological characteristics and follow-up date were retrospectively analyzed.The 2 cases were analyzed by histopathologic evaluation and immunohistochemical staining,and the relevant literatures were reviewed.Results These 2 cases were female aged 48 years and 50 years without clinic history of malignant melanoma.Both were found NN in axillary lymph nodes after breast cancer modified radical mastectomy.There were no occurrences of recurrence or metastasis during the follow-up period of 44 to 49 months.Histologically,the nevus cells of these NN cases were arranged in the nest bulk in the capsule of the lymph node and within the marginal sinus.The largest lesions observed in the 2 cases were 2 mm and 2.5 mm in diameter.The morphology of nevus cells were uniform,and resembling cutaneous pigmented nevi without atypia and mitosis.In the 2 cases,immunohistochemistry showed strongly positive for S100,positive for SOX10 and P16,the Ki67 labeling index<1%,while negative for HMB45,KP-1 and Ckpan.Conclusion NN is a rare and benign melanocytic lesion in lymph node.The clinical history,histopathologic characteristics,immunohistochemical staining and molecular assay are advantageous in distinguishing diagnosis between metastatic carcinoma and metastatic melanoma.