Difference between revisions of "Spitz nevus"
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'''Spitz nevus''', also known as ''epithelioid and spindle-cell nevus''', is an uncommon [[melanocytic lesion]] that can be difficult to differentiate from [[malignant melanoma]]. | {{ 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== | ==General== | ||
Revision as of 01:23, 6 December 2013
| 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]
- Apoptotic cells.
- Kamino bodies are rare in melanoma.
Notes:
- Never in the setting of solar elastosis.[5]
- 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/.
- ↑ Jakubovic, H. 16 July 2010.