Amelanotic melanoma: a detailed morphologic analysis with clinicopathologic correlation of 75 cases
Amelanotic melanoma: a detailed morphologic analysis with clinicopathologic correlation of 75 cases
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DOI：
10.1111/j.1600-0560.2011.01808.x
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发表时间：
2012-01-01
影响因子：
1.7
通讯作者：
Meehan, Shane A.
中科院分区：
文献类型：
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作者：
Cheung, Wang L.;Patel, Rishi R.;Meehan, Shane A.
无色素性黑色素瘤在临床上和显微镜下都有不同的外观。在这里，我们提出了我们的经验与75例无色素性黑色素瘤临床定义为一个非色素性病变和组织病理学作为一个肿瘤缺乏显着的黑化。我们评估了显微镜下的特征，如形态学，有丝分裂计数，核小体和太阳能弹性组织变性的存在。我们的无色素性黑色素瘤表现出以下形态：上皮样（72%），梭形（18.7%）或促结缔组织增生（5.3%）。此外，我们获得了大多数病例（74/75; 98.7%）的患者信息和临床表现以及40%（30/75）病例的随访数据。男性中的大多数无色素性黑色素瘤见于躯干（13/45; 29%）、头颈部（12/45; 26.7%）和下肢（13/45; 29%），女性中的大多数无色素性黑色素瘤见于下肢（12/30; 40%）、上肢（10/30; 33.3%）和头颈部（6/30; 20%）。此外，我们发现有丝分裂指数的增加与生存率降低相关（p < 0.026），而其他病理特征，如核变性或日光性弹性组织变性的生存率没有差异。此外，在有可用组织的病例中，所有无黑色素性黑色素瘤均表达小眼球相关转录因子和酪氨酸酶，这表明肿瘤细胞分别保留了黑色素细胞谱系和黑色素形成酶。由于无色素性黑色素瘤的发生和黑色素瘤标志物的表达与色素性黑色素瘤相似，我们认为无色素性黑色素瘤代表黑色素瘤的一种亚型，而不是低分化或去分化黑色素瘤。
Amelanotic melanoma can have a varied appearance both clinically and microscopically. Here, we present our experiences with 75 cases of amelanotic melanoma defined clinically as a non-pigmented lesion and histopathologically as a tumor lacking significant melanization. We evaluated microscopic features such as morphology, mitotic count, nuclear atypia and presence of solar elastosis. Our amelanotic melanomas exhibited the following morphology: epitheloid (72%), spindled (18.7%) or desmoplastic (5.3%). In addition, we obtained patient information and clinical presentations on most of the cases (74/75; 98.7%) and follow-up data on 40% (30/75) of the cases. The majority of amelanotic melanomas in men were found on the trunk (13/45; 29%), head and neck (12/45; 26.7%), and lower limb (13/45; 29%) and in women were found on the lower limb (12/30; 40%), upper limb (10/30; 33.3%) and head and neck (6/30; 20%). In addition, we found that an increase in mitotic index correlated with worse survival (p < 0.026), whereas there were no differences in survival for other pathological features, such as nuclear atypia or solar elastosis. Furthermore, in cases with available tissue, all amelanotic melanoma expressed microphthalmia-associated transcription factor and tyrosinase, suggesting that the tumor cells retained melanocytic lineage and an enzyme in melanin formation, respectively. As the occurrence of amelanotic melanoma and the expression melanoma markers were similar to pigmented melanoma, we favor that amelanotic melanoma represents a subtype of melanoma rather than poorly differentiated or de-differentiated melanoma.