Use of Fluorescence In situ Hybridization (FISH) to Distinguish Intranodal Nevus From Metastatic Melanoma
Use of Fluorescence In situ Hybridization (FISH) to Distinguish Intranodal Nevus From Metastatic Melanoma
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DOI：
10.1097/pas.0b013e3181c805c4
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发表时间：
2010-02-01
影响因子：
5.6
通讯作者：
Bastian, Boris C.
中科院分区：
文献类型：
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作者：
Dalton, M. A. J. Scott R.;Gerami, Pedram;Bastian, Boris C.
随着黑色素瘤患者前哨淋巴结活检的增加，病理学家经常在淋巴结中发现形态平淡的小黑色素细胞沉积，有时不能轻易归类为良性淋巴结痣或黑色素瘤。由于大多数黑色素瘤具有特征性的染色体畸变，可用于与良性痣的区分，因此我们采用荧光原位杂交（FISH）技术，结合6号染色体和I号染色体3个区域的标记，对组织病理学诊断为转移性黑色素瘤或淋巴结痣的黑素细胞小灶前哨淋巴结标本进行染色体畸变检测。采用FISH分析了41例患者的59份组织样本（24例淋巴结转移，17例淋巴结痣和相应原发性黑色素瘤的IS）。24例被诊断为转移性黑色素瘤的病例中有20例（83%）显示FISH异常。在4例阴性病例中，3例是明确的黑色素瘤转移，而1例在复查时组织病理学上是模棱两可的。在17个结节痣中，1个（6%）也显示FISH畸变，其余为阴性。阳性病例中存在多种畸变，其中一些在相应的原发肿瘤中也发现，表明该病例代表了一种由组织形态学错误分类的看似平淡的黑色素瘤转移。我们的数据表明，FISH是传统方法的有用辅助工具，用于诊断淋巴结中组织病理学不明确的黑色素细胞沉积。
With the increase in sentinel lymph node biopsies in melanoma patients, pathologists are frequently confronted with small deposits of morphologically bland melanocytes in the node, which occasionally cannot be readily classified as benign nodal nevi or melanoma. As most melanomas harbor characteristic chromosomal aberrations which can be used to distinguish them from benign nevi, we used fluorescence in-situ hybridization (FISH) with markers for 3 regions on chromosome 6 and I on chromosome I I to determine the presence of chromosomal aberrations in sentinel lymph node specimens with small foci of melanocytes that had been diagnosed as metastatic melanoma or nodal nevi by histopathology. Fifty-nine tissue samples from 41 patients (24 lymph node metastases, 17 with nodal nevi, and IS of the available corresponding primary melanomas) were analyzed by FISH. Twenty of 24 (83%) cases diagnosed as metastatic melanoma showed aberrations by FISH. Of the 4 negative cases, 3 were unequivocal melanoma metastases, whereas 1 on re-review was histopathologically equivocal. Of the 17 nodal nevi, 1 (6%) also showed aberrations by FISH, whereas the remainder was negative. Multiple aberrations were present in the positive case, some of which were also found in the corresponding primary tumor, suggesting that this case represents a deceptively bland melanoma metastasis that had been misclassified by histomorphology. Our data indicate that FISH is a useful adjunct tool to traditional methods in the diagnostic workup of deposits of melanocytes in lymph nodes that are histopathologically ambiguous.