Histopathological patterns of melanoma metastases in sentinel lymph nodes
Histopathological patterns of melanoma metastases in sentinel lymph nodes
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DOI：
10.1136/jcp.57.1.64
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发表时间：
2004-01-01
影响因子：
3.4
通讯作者：
Ghazarian, DM
中科院分区：
文献类型：
--
作者：
Murray, CA;Leong, WL;Ghazarian, DM
前哨淋巴结活检（SLNB）是皮肤黑色素瘤（CM）分期和治疗的重要组成部分。医学文献仅提供了关于黑色素瘤前哨淋巴结（SLN）组织学的有限信息。这份报告详细介绍了特定的组织学模式，黑色素瘤转移的前哨淋巴结（SLNs），并强调了一些关键因素，在评估SLNs为melanoma.Methods：从1998年6月至2002年5月的281 SLNB例，79例连续SLN活检阳性转移CM进行了回顾性分析。结果：阳性SLN的中位直径为17 mm（5 ~ 38 mm）。SLN的中位转移灶为2个（范围：1 - 11），最大转移灶的中位大小为1.1 mm（范围：0.05 - 24）。S-100和HMB-45染色阳性率分别为100%和92%。86%、5%和9%的转移性黑色素瘤细胞为上皮样、梭形和混合型。转移灶最常（86%）发现于SLN的包膜下区域。结论：S100染色比HMB-45染色敏感（100%v92%），但HMB-45染色有助于区分良性痣细胞和黑色素瘤。被膜下区域是SLN评估的关键，因为86%的病例中包含转移瘤。囊下间隙的评估不应受到烧灼伪影或SLN切除不完全的影响。
Aims: Sentinel lymph node biopsy (SLNB) is an important component in the staging and treatment of cutaneous melanoma ( CM). The medical literature provides only limited information regarding melanoma sentinel lymph node (SLN) histology. This report details the specific histological patterns of melanoma metastases in sentinel lymph nodes (SLNs) and highlights some key factors in evaluating SLNs for melanoma.Methods: From 281 SLNB cases between June 1998 and May 2002, 79 consecutive cases of SLN biopsies positive for metastases from CM were retrospectively reviewed. The important characteristics of the SLNs and the metastatic foci are described.Results: The median size of positive SLNs was 17 mm ( range, 5 - 38). SLNs had a median of two metastatic foci ( range, 1 - 11), with the largest foci being a median of 1.1 mm in size ( range, 0.05 - 24). S-100 and HMB-45 staining was positive in 100% and 92% of the detected metastatic foci, respectively. The metastatic melanoma cells were epithelioid, spindled, and mixed in 86%, 5%, and 9% of cases. Metastatic foci were most often ( 86%) found in the subcapsular region of the SLN. Benign naevic cells were found coexisting in 14% of positive SLNs.Conclusions: Staining for S100 is more sensitive than HMB-45 ( 100% v 92%), but HMB-45 staining helped to distinguish benign naevic cells from melanoma. The subcapsular region was crucial in SLN evaluation, because it contained the metastases in 86% of cases. Evaluation of the subcapsular space should not be compromised by cautery artefacts or incomplete excision of the SLN.