摘要
目的总结Spitz样肿瘤的临床及组织病理特征。方法回顾2005年1月至2020年1月西京皮肤医院确诊的320例Spitz样肿瘤患者的临床及病理资料。结果320例患者中,男141例,女179例,年龄0~65(12.5±11.7)岁,病程1个月至30年;其中,Spitz痣307例,不典型Spitz肿瘤(AST)8例,Spitz痣样黑素瘤(SM)5例。皮损多为单发,可见于头面部、躯干和四肢,边界均清楚。307例Spitz痣皮损以黑色(132例,43.0%)和红色(108例,35.1%)为主,多数色素均匀(262例,85.3%)且表面平滑(272例,88.6%)。Spitz痣存在特殊临床亚型,11例(3.6%)发生在斑痣上,11例(3.6%)呈簇发性,6例(2.0%)播散性,7例(2.3%)结节性,1例(0.3%)为瘢痕疙瘩样。Spitz痣特征性病理表现包括表皮内痣细胞呈Paget样扩散(123例,40.1%),真表皮交界处出现Kamino小体(74例,24.1%),痣细胞呈水平带状(177例,57.8%)及楔形分布(118例,38.4%),痣细胞巢周围出现裂隙(177例,57.8%),可见生理性核分裂象(117例,38.1%),核染色质均细腻。根据特殊组织病理表现,Spitz痣又分为色素性上皮样Spitz痣(9例,2.9%)、结缔组织增生性Spitz痣(13例,4.2%)、血管瘤样Spitz痣(8例,2.6%)、疣状Spitz痣(12例,3.9%)、黏液样Spitz痣(10例,3.3%)、晕痣样Spitz痣(4例,1.3%)等。4例AST皮损为黑色,7例色素均匀,3例皮损表面粗糙;特征病理表现包括细胞均有轻度至中度的异型性,均可见核分裂象(7例为2~6个/mm2),5例核染色质粗糙。3例SM皮损呈红色,4例色素不均匀,3例表面粗糙;特征病理表现包括黑素细胞呈Paget样扩散(3例),瘤细胞呈无极性浸润性生长且均未见成熟现象,均有明显异型性,并可见病理性核分裂象(3例,>6个/mm2),核染色质均粗糙且核膜明显着色。结论Spitz样肿瘤的临床及组织病理表现具有特征性,Spitz痣的临床及病理亚型繁多,AST同时具有Spitz痣和黑素瘤的临床及组织学特征。
Objective To analyze clinical and pathological features of 320 cases of Spitzoid tumors.Methods Clinical and pathological data were collected from 320 patients with Spitzoid tumors in Department of Dermatology,Xijing Hospital from January 2005 to January 2020,and retrospectively analyzed.Results The 320 patients included 141 males and 179 females,aged 0-65(12.5±11.7)years,and their course of disease ranged from 1 month to 30 years.Among them,there were 307 patients with Spitz nevi,8 with atypical Spitz tumors and 5 with Spitzoid melanoma.Most skin lesions were solitary,and occurred on the head,face,trunk and limbs,with clear boundaries.Among the 307 patients with Spitz nevi,the skin lesions were mainly black(132 cases,43.0%)and red(108 cases,35.1%)in color,most of which were uniformly pigmented(262 cases,85.3%)with smooth surfaces(272 cases,88.6%).There were several special clinical subtypes of Spitz nevi,including Spitz nevus arising in a nevus spilus(11 cases,3.6%),agminated Spitz nevus(11 cases,3.6%),disseminated Spitz nevus(6 cases,2.0%),nodular Spitz nevus(7 cases,2.3%)and keloid?like Spitz nevus(1 case,0.3%).Characteristic histopathological manifestations of Spitz nevi included pagetoid spread of epidermal nevus cells(123 cases,40.1%),Kamino bodies at the dermo?epidermal junction(74 cases,24.1%),horizontal band?like distribution of nevus cells(177 cases,57.8),wedge?shaped distribution of nevus cells(118 cases,38.4%),fissures around nevus cell nests(177 cases,57.8%),physiological mitotic figures(117 cases,38.1%),and fine nuclear chromatin(307 cases,100%).According to the special histopathological manifestations,Spitz nevi were divided into pigmented epithelioid Spitz nevus(9 cases,2.9%),desmoplastic Spitz nevus(13 cases,4.2%),hemangiomatous Spitz nevus(8 cases,2.6%),verrucous Spitz nevus(12 cases,3.9%),mucoid Spitz nevus(10 cases,3.3%),halo?like Spitz nevus(4 cases,1.3%),etc.Among the 8 cases of atypical Spitz tumors,4 skin lesions were black,7 were uniformly pigmented,and 3 had rough surfaces;the character
作者
刘芳
王江潮
刘宇
王雷
付萌
高天文
刘玲
Liu Fang;Wang Jiangchao;Liu Yu;Wang Lei;Fu Meng;Gao Tianwen;Liu Ling(Department of Dermatology,Xijing Hospital,The Fourth Military Medical University,Xi′an 710032,China;Department of Dermatology,Yellow River Hospital of Sanmenxia,Sanmenxia 472000,Henan,China)
出处
《中华皮肤科杂志》
CAS
CSCD
北大核心
2021年第1期33-41,共9页
Chinese Journal of Dermatology
基金
西京医院学科助推计划(XJZT18ML64、XJZT19MJ18)。
