Spitzoid melanocytic tumors / 中华皮肤科杂志

Clinical and histological features of Spitz nevi, atypical Spitz tumors and spitzoid melanoma overlap each other, making their identification challenging. Combined with clinical and histological features of spitzoid melanocytic tumors, this review summarizes research progress in their immunohistochemical features and application of fluorescence in situ hybridization in their identification.

Clinicopathological profile of hyperpigmented skin lesions- A prospective study

Introduction: Hyperpigmentation is one of the most common reac?on to inflammatory, benign and malignant lesions of the skin. These disorders comprise heterogeneous group of diseases of epidermal and dermal hyperpigmenta?on divided into various types according to e?ology and pathology. Correct diagnosis of these hyperpigmented lesions is linked to histopathologic examina?on of skin biopsies with clinical correla?on. Aim: To study the spectrum of hyperpigmented skin lesions with reference to age and sex distribu?on. Materials and Methods: This prospec?ve cohort study was conducted at Department of Pathology, at Alluri Sitaramaraju Academy of Medical Sciences, Eluru, Andhra Pradesh, India, which included 80 pa?ents who were clinically diagnosed with hyperpigmented skin lesions in all age groups from July 2014 to August 2016. Frequency and percentage sta?s?cs was used to present the results. Results: Out of 80 cases, 34 cases of inflammatory lesions, 23 cases of benign lesions and 23 cases of malignant lesions were reported. Among the post inflammatory lesions the majority were classical Lichen planus. Conclusion: Most common lesion was lichen planus and its variants with highest incidence in females and age group greater than 60 years. Histopathological diagnosis with clinical correla?on aids in effec?ve management of the pa?ents.

Pluralismo metodológico e interdisciplinaridade nas pesquisas psicanalíticas de René Spitz: fundamentos e estratégias / Methodological pluralism and interdisciplinarity in René Spitz's psychoanalytic research: foundations and strategies

O artigo aborda as pesquisas de René Spitz sobre o desenvolvimento das psicopatologias precoces infantis, enfatizando seus aspectos metodológicos e a maneira como o autor procura articular a investigação experimental e a perspectiva clínica e teórica da psicanálise. Os principais métodos e os procedimentos complementares de suas pesquisas empíricas são apresentados e discutidos, a partir da análise das publicações originais do autor. Críticas e debates que cercaram seus trabalhos à época são também revisitados e analisados. Em conclusão, argumenta-se que os trabalhos de Spitz, apesar de suas limitações, constituem um exemplo histórico significativo de como a psicanálise pode se beneficiar de uma perspectiva mais plural e interdisciplinar e suas pesquisas clínicas e empíricas.

This paperaddresses René Spitz's research on child development and early psychopathological disorders, emphasizing its methodological aspects and how the author seeks to articulate experimental research and the psychoanalytic clinical and theoretical perspective. The main methods and complementary procedures of his empirical research are presented and discussed, based on the analysis of the author's original publications. Criticism and debates that surrounded his works at the time are also revisited and analyzed. In conclusion, it is argued that Spitz's works, despite their limitations, constitute a significant historical example of how psychoanalysis can benefit from a more plural and interdisciplinary perspective in its clinical and empirical research.

The first case of vaginal angiomatoid Spitz nevus causing vaginal bleeding

Angiomatoid Spitz nevus is a variant of melanocytic nevus with prominent vasculature. Due to its pathologic features, angiomatoid Spitz nevus in the vaginal wall is extremely rare. A 42-year-old woman presented to the hospital with abnormal vaginal bleeding. Vaginal examination revealed a 2×2-cm well-demarcated tumor on the posterior wall of the vagina. The mass was successfully removed by complete excision and was diagnosed as angiomatoid Spitz nevus on pathologic examination. We present the first reported case of vaginal angiomatoid Spitz nevus, which caused vaginal bleeding. Although angiomatoid Spitz nevus has many histopathological similarities with malignant melanoma, precise histopathological diagnosis is important for preventing overtreatment.

Neoplasias melanocíticas spitzoides: estudio clínico-histopatológico de 62 lesiones en un hospital universitario chileno / Spitzoid melanocytic neoplasms: clinical-histopathological study of 62 lesions in a Chilean university hospital

INTRODUCCIÓN: Las neoplasias spitzoides son tumores melanocíticos con un espectro biológico variable, que constituyen un desafío diagnóstico. Los estudios en población latinoamericana son muy escasos, no contando con series chilenas. OBJETIVO: Caracterizar clínica e histopatológicamente a los pacientes con neoplasias spitzoides en el Hospital Clínico de la Universidad de Chile. METODOLOGÍA: Estudio retrospectivo, basado en revisión de fichas clínicas y biopsias de pacientes con diagnóstico confirmado de nevo de Spitz (NS), tumor de Spitz atípico y melanoma spitzoide, entre 1995-2018. Se analizó: edad, sexo, características clínicas e histopatológicas. RESULTADOS: Se estudiaron 62 neoplasias spitzoides. 39 mujeres (62,9%). Edad promedio de 18,9 (+14,3) años. Localización de lesiones: 8 (12,9%) cabeza, 6 (9,7%) tronco, 17 (27,4%) extremidades superiores y 22 (35,5%) extremidades inferiores; en 9 (14,5%) no se registró. Tamaño promedio 5,5 mm. Respecto al diagnóstico clínico: 21 (33,9%) nevo melanocítico, 16 (25,8%) nevo atípico, 12 (19,4%) NS, 7 (11,3%) lesiones vasculares, 3 (4,8%) melanoma y 3 (4,8%) otro. En cuanto al diagnóstico histopatológico: NS clásico 38 (61,3%), Nevo de Reed 9 (14,5%), NS desmoplásico 2 (3,2%), NS atípico 8 (12,9%) y melanoma spitzoide 5 (8,1%). CONCLUSIÓN: El presente estudio constituye la primera serie chilena de neoplasias spitzoides, según la literatura revisada. Destaca el mayor número de lesiones en mujeres y en extremidades, lo que ya había sido informado en otras series similares. Considerando la dificultad en el diagnóstico clínico preoperatorio, destaca un número mayor de sospecha de neoplasias spitzoides comparado a otros estudios.

INTRODUCTION: Spitzoid neoplasms are melanocytic tumors with a variable biological spectrum, which are a diagnostic challenge. There are few studies in Latin American population, not finding chilean series. OBJECTIVE: Clinically and histopathologically characterize patients with spitzoid neoplasms in the Hospital Clínico Universidad de Chile. METHODOLOGY: Retrospective study, based on re-view of clinical records and biopsies of patients with confirmed diagnosis of Spitz nevus (SN), atypical Spitz tumors and spitzoid melanoma (SM), between 1995-2018. It is analyzed: age, sex, clinical and histopathological characteristics. RESULTS: 62 spitzoid neoplasms were studied. 39 women (62.9%). Average age of 18.9 (+14.3) years. Location of injuries: 8 (12.9%) head, 6 (9.7%) trunk, 17 (27.4%) upper extremities and 22 (35.5%) lower extremities; in 9 (14.5%) it is not identified. Average size 5.5 mm. Clinical diagnosis: 21 (33.9%) melanocytic nevus, 16 (25.8%) atypical nevus, 12 (19.4%) NS, 7 (11.3%) vascular lesions, 3 (4.8%) melanoma and 3 (4.8%) other. Histopathological diagnosis: classic NS 38 (61.3%), Reed Nevus 9 (14.5%), desmoplastic SN 2 (3.2%), atypical SN 8 (12.9%) and SM 5 (8.1%). CONCLUSION: The present study appears in the first chilean series of spitzoid neoplasms, according to the literature reviewed. It highlights the greatest number of injuries in women and in the extremities, which had already been reported in other similar series. In the preoperative clinical diagnosis, a greater number of suspicion of spitzoid neoplasms stands out compared to other studies.

A rápida evolução clínica de um nevo de spitz: acompanhamento de três anos em criança / The fast clinical evolution of a spitz nevus: three-year follow-up of a child

RESUMO Objetivo: Descrever a evolução clínica do nevo de Spitz, desde sua característica inicial plana até o aparecimento de uma superfície irregular, nodular e avermelhada e a conduta perante essas alterações. Descrição do caso: Criança do sexo feminino, fototipo II, com um pequeno nevo congênito na perna esquerda e outros pequenos nevos adquiridos. Paciente passou por avaliações anuais clínicas e dermatoscópicas para controle entre 3 e 7 anos de idade, quando um desses nevos, localizado na coxa esquerda, apresentou crescimento rápido. A hipótese clínica foi nevo de Spitz, com indicação de remoção cirúrgica com margem de segurança e posterior análise anatomopatológica. Considerando a idade da paciente e os aspectos clínicos e histológicos, a lesão foi diagnosticada como nevo de Spitz. Comentários: Uma lesão de padrão dermatoscópico globular e menor que 5 mm permitia acompanhamento clínico, porém a hipercromia, a estética local, o crescimento rápido, a possibilidade de trauma na região e os riscos de transformação maligna na puberdade nortearam a decisão de remoção total e posterior acompanhamento para monitorar qualquer recidiva.

ABSTRACT Objective: To report the clinical evolution and handling of a Spitz nevus, from its initial flat feature to becoming an irregular, nodular, reddish lesion. Case description: Female child, phototype II, with a small congenital nevus on the left lower limb and other sustained small nevi. The patient went through annual clinical and dermoscopic evaluations between the ages of three and seven, period during which the nevi located on the left thigh grew rapidly. The clinical hypothesis was Spitz nevus, with indication of surgical removal with a safety margin and anatomopathological study. Considering patient's age and clinical/histological aspects, the diagnosis of Spitz nevus was confirmed. Comments: Initial globular pattern and size under 5 mm upon dermoscopy allowed clinical follow-up. However, onset of hyperchromia and rapid growing of the lesion, along with aesthetic concerns, possibility of trauma in the region, and risk of malignancy at puberty guided the decision of total resection and follow-up for recurrence.

Um capítulo húngaro da história da psicanálise: as contribuições de Ferenczi, Spitz e Balint para o estudo das formas passivas de adoecimento psíquico / A Hungarian chapter of the history of psychoanalysis: The contributions of Ferenczi, Spitz, and Balint to the study of passive forms of mental illness / Un capítulo húngaro de la historia de psicoanálisis: las contribuciones de Ferenczi, Spitz y Balint para el estudio de las formas pasivas de enfermedad psíquica / Un chapitre hongrois de l'histoire de la psychanalyse: les contributions de Ferenczi, Spitz et Balint pour l'étude des formes passives de maladie psychique

Na história da psicanálise, podem ser reconhecidas descrições de algumas formas de adoecimento psíquico que ganham a capacidade de enrijecer e crescer, gerando verdadeiras interrupções nos processos de saúde, com regressões intensas e desorganizações psíquicas graves. Constituem-se, desse modo, adoecimentos psíquicos marcados por descontinuidades severas nos processos de saúde. Em alguns casos, tais interrupções ocorrem de forma muito radical e bem no início da vida, isolando uma área do psiquismo, deixando-a deserta. Não será difícil reconhecer nessa argumentação as bases do pensamento de Ferenczi (mas também de Spitz e Balint) sobre o traumatismo precoce e sua descrição clínica das defesas passivas, com sensações de estar afundando e morrendo.

In the history of psychoanalysis, one may recognize some forms of psychic disorders which can stiffen and worsen. As such, they interrupt health processes by causing intense regressions and severe mental disorganization. Therefore, it leads to the development of mental illnesses, which will be marked by severe interruptions in health processes. In some cases, extremely radical interruptions may happen very early in life. As a result, an area of the psyche will be isolated and become desert. In this paper, the reader will have no problem in recognizing the foundation of Ferenczi's thinking on the early trauma and his clinical description of passive defenses, with sensations of sinking and dying. Spitz's and Balint's ideas have also inspired this study.

En la historia del psicoanálisis pueden ser reconocidas descripciones de algunas formas de adicción psíquica que tienen la capacidad de endurecer y crecer, generando verdaderas interrupciones en los procesos de salud, con regresiones intensas y desorganizaciones psíquicas graves. Se constituyen, de este modo, enfermedades psíquicas marcadas por discontinuidades severas en los procesos de salud. En algunos casos tales interrupciones ocurren de forma muy radical y bien al inicio de la vida, aislando un área del psiquismo, dejándola desierta. No será difícil reconocer en esta argumentación las bases del pensamiento de Ferenczi (pero también de Spitz y Balint) sobre el traumatismo precoz y su descripción clínica de las defensas pasivas, con sensaciones de estar hundiéndose y muriendo.

Dans l'histoire de la psychanalyse on peut reconnaitre des descriptions de certaines formes de maladie psychique qui acquièrent la capacité de s'endurcir et de s'accroître, générant des véritables interruptions dans les processus de santé, avec des régressions intenses et des perturbations psychologiques graves. Des maladies psychiques se constituent donc, marquées par de graves discontinuités dans les processus de santé. Dans certains cas, ces interruptions se produisent de forme très radicale et dans les premières années de la vie, en isolant une zone de la psyché, la laissant déserte. Ce ne sera pas difficile de reconnaître dans cet raisonnement le fondement de la pensée de Ferenczi (mais aussi celle de Spitz et de Balint) sur le traumatisme précoce et sa description clinique des défenses passives, avec sensations de naufrage et de mort.

A Case of Hyalinizing Spitz Nevus: A Rare Variant in the Spectrum of Spitz Nevus / 대한피부과학회지

Hyalinizing Spitz nevus was first introduced in 1994 by Suster. It is considered a rare variant in the spectrum of Spitz nevus, with only a dozen cases having been reported to date. Herein we report a case of a 28-year-old Korean woman who had a brown papular lesion on the left palm, which was diagnosed as hyalinizing Spitz nevus. Upon histopathological investigation, discohesive growth patterns of nevus cells in a hyalinized stroma were noted. Immunohistochemical stains showed positive reactivity of nevus cells with S-100 protein and vimentin, but negative stains with HMB-45 and CD68. This case demonstrates a rare variant of Spitz nevus located on an unusual site, and calls for awareness in the diagnosis of cutaneous lesions that histologically exhibit a prominent hyalinized stroma.

Spitz Nevus with Atypical Clinical Features in a Baby / 대한피부과학회지

No abstract available.

Polypoid Spitz Nevus: Aided by Dermoscopic Examination / 대한피부과학회지

Spitz nevus is a benign melanocytic nevus, common in children or young adults, and it has histological features that are confused with those of malignant melanoma. Polypoid Spitz nevus is the benign counterpart of polypoid malignant melanoma. A 22-year-old woman presented with a solitary 1.5×1.5 cm-sized firm polypoid erythematous nodule on the left thigh. On dermoscopy, pink to yellowish lagoons intermingled by white fibrous septa were found but milky red globules or irregular linear vessels were not found. Therefore, melanoma almost could be ruled out cautiously. Histopathology showed symmetrical, well-circumscribed, polypoid architecture with predominant dermal nests of spindle cells. Immunohistochemically, the nevus cells were strongly positive for S-100 protein and negative for HMB-45. Thus, the diagnosis of polypoid Spitz nevus was made. Herein, we report a case of polypoid Spitz nevus that was differentiated from polypoid melanoma by histopathologic and dermoscopic findings.

Differentiation of Desmoplastic Spitz Nevus from Similar Conditions / 대한피부과학회지

No abstract available.

Dermatoscopia do nevo de Spitz pigmentado / Dermatoscopy of the pigmented Spitz nevus

O nevo de Spitz pigmentado consiste em uma lesão melanocítica benigna com características peculiares. Geralmente, melanoma é considerado no diagnóstico diferencial desta lesão, bem como o nevo de Reed. A dermatoscopia representa uma parte relevante da abordagem diagnóstica e, portanto, ela permite um estudo mais eficiente dessas lesões dermatológicas. O presente relato de caso é sobre uma paciente com dois nevos de Spitz pigmentados de localização no tronco e história familial de melanoma, no qual a dermatoscopia associada à histopatologia foram cruciais para o diagnósticos das lesões.

The Spitz Nevus on the Areola / 대한피부과학회지

No abstract available.

Adult Onset Atypical Spitz Nevus / 대한피부과학회지

Atypical Spitz's nevus is a rare spitzoid melanocytic proliferations with an uncertain malignant potential. Atypical Spitz's nevus have overlapping features of both Spitz nevi and spitzoid melanoma, and consequently, generate controversies with diagnosis and management. Herein, we report a case of atypical Spitz's nevus developing on the lower right leg of a 46-year-old man. Histologically, the lesion shows numerous uniform nests of spindle cells and epithelioid cells in the dermis. The lesion had a high Ki-index, prominent cellular density, but not enough to consider a diagnosis of melanoma. The nevus was removed by total excisions. No recurrences or metastases were detected during the follow-up period of 6 months.

A Case of Spitzoid Melanoma with Lymph Node Metastasis in a Child

The distinction of a spitz nevus from a melanoma can be difficult and in some cases, impossible. A misdiagnosed spitz nevus can metastasize and lead to fatal outcomes, especially in children. A 5-yr-old girl presented with a 1-yr history of a solitary pinkish nodule on her left hand. On physical examination, she had a palpable left axillary lymph node. We performed biopsy and checked 3 sentinel lymph nodes (SLN) on her axillary area. The biopsy specimen showed multiple variably sized and shaped nests with large spindle or polygonal cells and SLN biopsy showed 3 of 3 lymph nodes that were metastasized. Under the diagnosis of spitzoid melanoma, she was treated with excision biopsy and complete left axillary lymph nodes were dissected. She received interferon-alpha2b subcutaneously at a dose of 8 MIU per day, 3 times weekly for 12 months, and shows no recurrence.

A Case of Atypical Spitz Nevus / 대한피부과학회지

A 6-year-old boy presented with a fast-growing, 0.8x0.7 cm-sized, dome-shaped, erythematous nodule on the back. Histopathologically, the lesion showed a spitzoid melanocytic proliferation from the dermo-epidermal junction to the reticular dermis. Melanocytes arranged in nests were epithelioid and spindle-shaped with abundant eosinophilic cytoplasm. The histopathological and clinical features were consistent with atypical Spitz nevus in that they showed no Kamino body, prominent cellular density, more than three mitoses per high power field, a high Ki-67 level, large size, and the lesion was located at an unusual location. Herein, we report a case of an atypical Spitz nevus on the back of a 6-year-old boy.

Immunohistochemical Study of the Expression of Astrocyte Elevated Gene-1 (AEG-1) in Malignant Melanoma, Spitz Nevus and Dysplastic Nevus / 대한피부과학회지

BACKGROUND: The astrocyte elevated gene-1 (AEG-1) was cloned as a novel HIV-1 and tumor necrosis factor-alpha-induced transcript from primary human fetal astrocytes. It has been reported that the AEG-1 expression is elevated in subsets of breast cancer, glioblastoma multiforme and melanoma cells, and AEG-1 cooperates with Ha-ras to promote the transformation of immortalized melanocytes. AEG-1 is thought to play a role in promoting cancer development and/or its maintenance. OBJECTIVE: The aim of this study is to determine whether AEG-1 is related to the pathogenesis of melanoma and other melanocytic lesions. METHODS: The nine biopsy specimens each of melanoma, dysplastic nevus, Spitz nevus and compound nevus were studied using immunohistochemical staining. The expressions of AEG-1 were evaluated using an immunostaining-intensity-distribution index. RESULTS: The expression of AEG-1 was significantly higher in the melanoma and dysplastic nevus than in the compound nevus. The expression was also significantly higher in the melanoma than in the Spitz nevus. CONCLUSION: AEG-1 may be related to the pathogenesis of both dysplastic nevus and melanoma, but it may not be related to Spitz nevus.

Immunohistochemical Study of the Expression of Astrocyte Elevated Gene-1 (AEG-1) in Malignant Melanoma, Spitz Nevus and Dysplastic Nevus / 대한피부과학회지

BACKGROUND: The astrocyte elevated gene-1 (AEG-1) was cloned as a novel HIV-1 and tumor necrosis factor-alpha-induced transcript from primary human fetal astrocytes. It has been reported that the AEG-1 expression is elevated in subsets of breast cancer, glioblastoma multiforme and melanoma cells, and AEG-1 cooperates with Ha-ras to promote the transformation of immortalized melanocytes. AEG-1 is thought to play a role in promoting cancer development and/or its maintenance. OBJECTIVE: The aim of this study is to determine whether AEG-1 is related to the pathogenesis of melanoma and other melanocytic lesions. METHODS: The nine biopsy specimens each of melanoma, dysplastic nevus, Spitz nevus and compound nevus were studied using immunohistochemical staining. The expressions of AEG-1 were evaluated using an immunostaining-intensity-distribution index. RESULTS: The expression of AEG-1 was significantly higher in the melanoma and dysplastic nevus than in the compound nevus. The expression was also significantly higher in the melanoma than in the Spitz nevus. CONCLUSION: AEG-1 may be related to the pathogenesis of both dysplastic nevus and melanoma, but it may not be related to Spitz nevus.

Acral Pigmented Spitz Nevus That Clinically Mimicked Acral Lentiginous Malignant Melanoma

Pigmented Spitz nevus is a benign melanocytic skin lesion with distinct clinical features and it is frequently found on the extremities. However, it rarely occurs on acral area of the body, and such a case has not yet been fully documented. We present a case of acral pigmented Spitz nevus occurring on the foot, and this mimicked acral lentiginous malignant melanoma. Clinicians should be well aware of this entity and its possible clinical presentations. Since acral pigmented Spitz nevus is benign in nature, making the correct diagnosis is important to avoid unnecessary mutilating or excessive surgery.

The Expression of HSP105 in Spitz Nevus and Malignant Melanoma / 대한피부과학회지

BACKGROUND: Spitz nevus and malignant melanoma have common features clinically and histologically, and in some cases it is impossible to distinguish between the two. Heat shock proteins (HSPs) serve to protect cells, and are activated by cell injury. Some HSPs are shown to be elevated in many types of cancers. Previous studies have reported the expression of heat shock protein in association with melanoma; however, a similar relationship with Spitz nevi has never been investigated. OBJECTIVE: This study was designed to measure the expression pattern of HSP 105 in both Spitz nevi and melanomas. METHODS: The specimens of 4 of Spitz nevi and 10 of malignant melanomas were analyzed for heat shock protein 105 expression through immunohistochemical staining. RESULTS: Immunohistochemical examination of HSP 105 showed strong expression in malignant melanoma specimens. On the other hand, weak expression was observed in Spitz nevus specimens. The degree of expression of HSP 105 showed a statistically significant difference (p<0.05). CONCLUSION: These findings provide the possibility of using HSP 105 as a effective marker for differentiating between Spitz nevi and malignant melanomas. In support of this, HSP 105 is considered to be a tumor-associated antigen of malignant melanoma.