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.

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.

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.

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.

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.

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.

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.

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.

Angiomatoid Spitz Nevus

Spitz nevus is a variant of melanocytic nevus which is histopathologically defined as large spindle and/or epithelioid cells. Angiomatoid Spitz nevus is a rare histologic variant of desmoplastic Spitz nevus characterized by prominent vasculature. We present a case of angiomatoid Spitz nevus, celluar type, that has not been reported before. We provide another example to show the remarkable diversity of Spitz nevus.

Critérios histopatológicos para diagnóstico de melanoma maligno cutâneo: análise comparativa de sua freqüência em lesões benignas e melanomas de pequena espessura (< 2 mm) / Histopathological criteria for cutaneous malignant melanoma: comparative analysis between benign and thin malignant lesions (< 2 mm)

INTRODUÇÃO: A histopatologia convencional continua sendo o padrão-ouro no diagnóstico dos melanomas cutâneos, apesar do progresso da imuno-histoquímica e da biologia molecular. Os critérios microscópicos existentes para esse diagnóstico são numerosos, porém nenhum deles é específico para se afirmar que uma determinada lesão é maligna quando ele está presente, ou é benigna na sua ausência. Alguns critérios têm uma relevância maior para o diagnóstico em relação a outros. OBJETIVO: Este estudo propõe uma análise daqueles critérios considerados mais importantes, comparando sua presença em lesões melanocíticas benignas e melanomas. MATERIAL E MÉTODOS: Foram estudadas 33 lesões melanocíticas benignas (nevo de Spitz: 13; nevo de Reed: 6; nevo displásico: 6; nevo congênito: 3; nevo adquirido: 3; nevo combinado: 1; nevo recorrente: 1), bem como 101 casos de melanomas extensivo/superficiais: 25 intra-epidérmicos e 76 invasivos de pequena espessura (< 2 mm). RESULTADOS: Alguns critérios mostraram alta freqüência em lesões benignas, apresentando pouca especificidade, enquanto outros tiveram menor positividade nas benignas, e alta freqüência nas malignas, mostrando sua maior especificidade e importância no diagnóstico dos melanomas. CONCLUSÃO: Os cinco critérios que mostraram diferenças estatisticamente significativas na comparação com as lesões benignas foram (em ordem decrescente de freqüência): 1. proliferação linear de células isoladas na camada basal; 2. início e fim da lesão com células isoladas; 3. melanócitos na camada granular; 4. disseminação pagetóide extensa; 5. nucléolos grandes, irregulares ou múltiplos. Os melanomas de pequena espessura não apresentam parte dos critérios considerados mais importantes, como falta de maturação, necrose e mitoses profundas.

INTRODUCTION: Conventional histopathology has been considered as the gold standard in the diagnosis of cutaneous malignant melanoma, despite the progress of molecular biology and immunohistochemistry. There are many microscopic criteria for diagnosis of melanoma, however there is not a single one that can be useful to define malignancy. AIM: Our purpose is to analyse the criteria considered more important to the diagnosis of melanoma, comparing their presence in benign melanocytic lesions and melanomas. MATERIAL AND METHODS: We studied 33 benign melanocytic lesions (Spitz nevi, 13; Reed nevi, 6; dysplastic nevi, 6; congenital nevi, 3; acquired nevi, 3; combined nevus, 1; recurrent nevus, 1) and 101 extensive/superficial melanomas (25 in situ and 76 invasive up to 2 mm thickness). RESULTS: Some criteria showed high frequency in benign lesions, showing low-specificity, while others had low-positivity in the benign and high-frequency in malignant lesions, consequently high-specificity and greater importance in the melanoma diagnosis. CONCLUSION: The five criteria that presented statistically significant difference after comparison with benign lesions were: 1. linear proliferation of a single layer cells in basal layer; 2. single cells at periphery; 3. cells in the granular layer; 4. extensive pagetoid array; and 5. large, irregular and/or multiple nucleoli . Thin melanomas usually do not show many of important criteria, like lack of cell maturation, necrosis and deep mitoses.