Difference between revisions of "Spitz nevus"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Spitz_nevus_-_high_mag.jpg | |||
| Width = | |||
| Caption = Spitz nevus. [[H&E stain]]. | |||
| Micro = nests of cells (spindle, epithelioid or spindle/epithelioid) - in both dermis and epidermis - nests are vertically arranged ("hanging bananas"), +/-hyperkeratosis, +/-hypergranulosis, +/-[[acanthosis]] (thick stratum spinosum), Kamino bodies - dense eosinophilic bodies (rare in melanoma) | |||
| Subtypes = | |||
| LMDDx = [[malignant melanoma]], [[pigmented spindle cell nevus of Reed]] | |||
| Stains = HMB-45 -ve deep aspect, Ki-67 usu. low | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[skin]] - typically face or extremity | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = children and adolescents | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = uncommon | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = benign | |||
| Other = | |||
| ClinDDx = [[melanoma]], other [[melanocytic lesions]] | |||
}} | |||
'''Spitz nevus''', also known as '''epithelioid and spindle cell nevus''', is an uncommon [[melanocytic lesion]] that can be difficult to differentiate from [[malignant melanoma]]. | |||
==General== | |||
*May be very difficult to differentiate from [[melanoma]]. | |||
Epidemiology: | |||
*Children & adolescents. | |||
Treatment: | |||
*Complete excision.<ref name=pmid12140468>{{Cite journal | last1 = Gelbard | first1 = SN. | last2 = Tripp | first2 = JM. | last3 = Marghoob | first3 = AA. | last4 = Kopf | first4 = AW. | last5 = Koenig | first5 = KL. | last6 = Kim | first6 = JY. | last7 = Bart | first7 = RS. | title = Management of Spitz nevi: a survey of dermatologists in the United States. | journal = J Am Acad Dermatol | volume = 47 | issue = 2 | pages = 224-30 | month = Aug | year = 2002 | doi = | PMID = 12140468 }}</ref> | |||
==Gross== | |||
*Usually face ''or'' extremity.<ref name=Ref_Derm449>{{Ref Derm|449}}</ref> | |||
==Microscopic== | |||
Features:<ref name=Ref_WMSP499>{{Ref WMSP|499}}</ref> | |||
*Architecture: | |||
**Nests of cells (spindle, epithelioid or spindle/epithelioid) - in both dermis and epidermis. | |||
***Nests are vertically arranged, i.e. the long axis of the nests are perpendicular to the skin surface. | |||
****Nest arrangement/orientation described as "cluster of bananas". | |||
*+/-Hyperkeratosis (more keratin, i.e. thick stratum corneum). | |||
*+/-Hypergranulosis (thick stratum granulosum). | |||
*+/-[[Acanthosis]] (thick stratum spinosum). | |||
*Kamino bodies (also written ''Camino bodies'') - dense eosinophilic bodies.<ref name=PMC2797485>{{Cite journal | last1 = Kirkwood | first1 = John M. | last2 = Jukic | first2 = Drazen | last3 = Averbook | first3 = Bruce J. | last4 = Sender | first4 = Leonard S. | title = Melanoma in Pediatric, Adolescent, and Young Adult Patients | journal = Semin Oncol. | volume = 36 | issue = 5 | pages = 419-31 | month = October | year = 2009 | doi = | PMID = | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797485/?tool=pmcentrez |PMC = 2797485 }}</ref> | |||
**Kamino bodies are rare in melanoma. | |||
**Pathogenesis uncertain - probably represent aggregates of basement membrane material.<ref name=pmid9855349>{{Cite journal | last1 = Skelton | first1 = HG. | last2 = Miller | first2 = ML. | last3 = Lupton | first3 = GP. | last4 = Smith | first4 = KJ. | title = Eosinophilic globules in spindle cell and epithelioid cell nevi: composition and possible origin. | journal = Am J Dermatopathol | volume = 20 | issue = 6 | pages = 547-50 | month = Dec | year = 1998 | doi = | PMID = 9855349 }}</ref> | |||
***The classic teachng is Kamino bodies are apoptotic cells; however, this is disputed by evidence.<ref name=pmid9855350>{{Cite journal | last1 = Wesselmann | first1 = U. | last2 = Becker | first2 = LR. | last3 = Bröcker | first3 = EB. | last4 = LeBoit | first4 = PE. | last5 = Bastian | first5 = BC. | title = Eosinophilic globules in spitz nevi: no evidence for apoptosis. | journal = Am J Dermatopathol | volume = 20 | issue = 6 | pages = 551-4 | month = Dec | year = 1998 | doi = | PMID = 9855350 }}</ref> | |||
Notes: | |||
*'''Never''' in the setting of [[solar elastosis]].<ref>Jakubovic, H. 16 July 2010.</ref> | |||
**If there is solar elastosis -- it's melanoma. | |||
DDx: | |||
*[[Malignant melanoma]] - so-called ''Spitzoid melanoma''. | |||
*[[Pigmented spindle cell nevus of Reed]]. | |||
===Images=== | |||
<gallery> | |||
Image:Spitz_nevus_-_low_mag.jpg | Spitz nevus - low mag. (WC) | |||
Image:Spitz_nevus_-_intermed_mag.jpg | Spitz nevus - intermed. mag. (WC) | |||
Image:Spitz_nevus_-_high_mag.jpg | Spitz nevus - high mag. (WC) | |||
</gallery> | |||
www: | |||
*[http://www.drmihm.com/cases/case.cfm?CaseID=51 Spitz nevus - collection of images (drmihm.com)]. | |||
*[http://alf3.urz.unibas.ch/pathopic/e/getpic-fra.cfm?id=006734 Spitz nevus with arrow to camino body (unibas.ch)]. | |||
==IHC== | |||
*HMB-45 -ve at deep aspect. | |||
*Ki-67 low. | |||
==See also== | |||
*[[Melanocytic lesions]]. | |||
*[[Malignant melanoma]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | |||
[[Category:Melanocytic lesions]] | |||
Latest revision as of 20:44, 23 February 2018
| Spitz nevus | |
|---|---|
| Diagnosis in short | |
 Spitz nevus. H&E stain. | |
|
| |
| LM | nests of cells (spindle, epithelioid or spindle/epithelioid) - in both dermis and epidermis - nests are vertically arranged ("hanging bananas"), +/-hyperkeratosis, +/-hypergranulosis, +/-acanthosis (thick stratum spinosum), Kamino bodies - dense eosinophilic bodies (rare in melanoma) |
| LM DDx | malignant melanoma, pigmented spindle cell nevus of Reed |
| Stains | HMB-45 -ve deep aspect, Ki-67 usu. low |
| Site | skin - typically face or extremity |
|
| |
| Clinical history | children and adolescents |
| Prevalence | uncommon |
| Prognosis | benign |
| Clin. DDx | melanoma, other melanocytic lesions |
Spitz nevus, also known as epithelioid and spindle cell nevus, is an uncommon melanocytic lesion that can be difficult to differentiate from malignant melanoma.
General
- May be very difficult to differentiate from melanoma.
Epidemiology:
- Children & adolescents.
Treatment:
- Complete excision.[1]
Gross
- Usually face or extremity.[2]
Microscopic
Features:[3]
- Architecture:
- Nests of cells (spindle, epithelioid or spindle/epithelioid) - in both dermis and epidermis.
- Nests are vertically arranged, i.e. the long axis of the nests are perpendicular to the skin surface.
- Nest arrangement/orientation described as "cluster of bananas".
- Nests are vertically arranged, i.e. the long axis of the nests are perpendicular to the skin surface.
- Nests of cells (spindle, epithelioid or spindle/epithelioid) - in both dermis and epidermis.
- +/-Hyperkeratosis (more keratin, i.e. thick stratum corneum).
- +/-Hypergranulosis (thick stratum granulosum).
- +/-Acanthosis (thick stratum spinosum).
- Kamino bodies (also written Camino bodies) - dense eosinophilic bodies.[4]
Notes:
- Never in the setting of solar elastosis.[7]
- If there is solar elastosis -- it's melanoma.
DDx:
- Malignant melanoma - so-called Spitzoid melanoma.
- Pigmented spindle cell nevus of Reed.
Images
Spitz nevus - low mag. (WC)
Spitz nevus - intermed. mag. (WC)
Spitz nevus - high mag. (WC)
www:
IHC
- HMB-45 -ve at deep aspect.
- Ki-67 low.
See also
References
- ↑ Gelbard, SN.; Tripp, JM.; Marghoob, AA.; Kopf, AW.; Koenig, KL.; Kim, JY.; Bart, RS. (Aug 2002). "Management of Spitz nevi: a survey of dermatologists in the United States.". J Am Acad Dermatol 47 (2): 224-30. PMID 12140468.
- ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 449. ISBN 978-0443066542.
- ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 499. ISBN 978-0781765275.
- ↑ Kirkwood, John M.; Jukic, Drazen; Averbook, Bruce J.; Sender, Leonard S. (October 2009). "Melanoma in Pediatric, Adolescent, and Young Adult Patients". Semin Oncol. 36 (5): 419-31. PMC 2797485. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797485/.
- ↑ Skelton, HG.; Miller, ML.; Lupton, GP.; Smith, KJ. (Dec 1998). "Eosinophilic globules in spindle cell and epithelioid cell nevi: composition and possible origin.". Am J Dermatopathol 20 (6): 547-50. PMID 9855349.
- ↑ Wesselmann, U.; Becker, LR.; Bröcker, EB.; LeBoit, PE.; Bastian, BC. (Dec 1998). "Eosinophilic globules in spitz nevi: no evidence for apoptosis.". Am J Dermatopathol 20 (6): 551-4. PMID 9855350.
- ↑ Jakubovic, H. 16 July 2010.