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A 11-year-old girl with a brownish-black nodule / Niña de 11 años con nodulo negro-parduzco
Pathologic Anatomy Service,
Gaetano Rummo General Hospital,
Benevento
Italia
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Historia Clínica
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A 11-year-old girl with a brownish-black nodule of the right pre-auricular region; history of recent changes/enlargement.
Niña de 11 años con nódulo negro-parduzco de la región pre-auricular derecha, con historia reciente de cambios de crecimiento.
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Comentarios
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El 10/7/2006 1:21, Igor Santos Costa dijo:
Nevo penetrante profundo.
El 10/7/2006 6:13, Eduardo Solís dijo:
Saludos a todos, yo lo llamaría "nevus azul epitelioide", aunque sea una lesión afín (o dentro del mismo espectro) al diagnóstico emitido por el Dr. Santos Costa ("nevus penetrante profundo").
El 10/7/2006 8:00, Antonio Perasole (Castelfranco Veneto, Italy) dijo:
Proliferazione nodulare atipica a cellule fusate in nevo congenito versus nevo blu cellulato a cellule fusate. Grazie del bel caso Gerardo e saluti a tutta i gli amici della lista!.
El 10/7/2006 9:08, Julián José Ahijado González dijo:
Me parece que puede tratarse de un NEVUS FUSOCELULAR PLEXIFORME. Un saludo a tod@s , ¡en especial a los campeones italianos!
El 10/7/2006 12:58, Victor Prieto dijo:
Por lo que se ve en las fotos se trata de un nevus azul epitelioide ("nevus penetrante profundo"). Se deberia considerar la posibilidad de un sindrome de Carney
El 10/7/2006 13:22, Bayardo Flores dijo:
Pienso que podría ser una lesión compuesta, de una parte de una lesión epidérmica que tiene el aspecto de una Hiperplasia Verrucosa (Nevo Epidérmico)y de una componente intradérmica profunda que parece ser un Nevo Azul Celular, lo que no podría decir cual es la lesión inicial o si ambas aparecieron simultáneamente. Saludos
El 10/7/2006 15:08, Ricardo Drut dijo:
Melanocitoma epiteloide pigmentado (ver Histopathology 45:433,2004, especialmente página 444). Considerar la posiblidad de complejo de Carney.
El 10/7/2006 19:37, Jairo Mesa Cock dijo:
Yo veo un nevus intradermico, posiblemente congenito. Un saludo, Jairo Mesa Cock Manizales, Colombia
El 11/7/2006 13:57, Horacio dijo:
El 11/7/2006 14:44, Romualdo Correia Lins Filho dijo:
Concordo com o Dr. Ricardo Drut: Melanocitoma epitelióide pigmentado, descrito pelos Drs. Zembowicz, Carney e Mihm como uma entidade provisória de baixo grau englobando casos de melanoma do tipo animal e nevo azul epitelióide. A ocorrência de uma única lesão torna pouco provável a associação com o complexo de Carney. Abraços Romualdo
El 11/7/2006 17:24, Dr Eze dijo:
Lentiginous Melanocytic Nevus. The lentiginous junctional pattern of melanocytic hyperplasia is typically associated with an active, growing phase.
El 12/7/2006 2:59, Victor Leonel Argueta Sandoval dijo:
La lesión es pigmentada de celularidad que no afecta la epidermis, esta se observa en dermis. Mi diagnóstico es NEVO AZUL TIPO CELULAR.
El 12/7/2006 13:01, Victor Linares dijo:
Considero que se trata de un Melanocitoma epitelioide pigmentado Saludos
El 12/7/2006 15:17, Esther Contreras Valerio dijo:
Se identifican melanocitos epiteliodes con melanófacos que afectan al parecer fibras de músculo estriado y le producen atrofia así que me parece un Nevu Azul Epiteliode profundo,lo dificil es valorar si te trata de un Melanoma verdadero porque también se han descrito Melanocitomas epiteliodes en niños. Yo tuve la oportunidad de ver un Melanoma en un niño que se produjo en el pie enviado por un cirujano pediatra así que al parecer es raro pero si se pueden dar melanomas en niños. Saludos. ESther. Nota: en realidad la macro demuestra un nódulo, así que si la biopsia es del nódulo unicamente podría ser un Melanocitoma epiteliode.
El 14/7/2006 15:27, Lucía Deidamia Blanco Autilio dijo:
Es un nevo penetrante profundo... Se ha hecho inmunohistoquimica?? S-100 y HMB 45 serían de mucha aayuda...aunque esta ultima no permitiría diferenciarlo de un melanoma... Saludos a ARGENTINA!!!
El 14/7/2006 17:06, Juan María LOIZAGA dijo:
Mi opinión es también que se trata de un NEVUS PENTRANTE PROFUNDO ya que veo abundante melanina tanto en células superficiales como profundas. El diagnóstico diferencial se plantea con el nevus azul celular, pero no veo y no nos han enseñado en las microfotografías, los típicos nidos de células claras.
El 16/7/2006 0:02, Jesús Pérez García dijo:
Nevo Azul epiteliode profundo.
Hacer un comentario a este caso
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Diagnóstico
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Melanocytic tumor of uncertain malignant potential (MELTUMP), with features of combined Spitz and blue nevus (blitz nevus/epithelioid blue nevus/pigmented epithelioid melanocytoma)
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Comentario del Autor
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As seen in most fields of human pathology (1), melanocytic skin lesions are capable of showing features which can be placed along a clinical, histopathologic, and and bio-molecular spectrum ranging from undisputable benignity to overt malignancy; a rare subset of lesions with 'intermediate' features can be therefore found along this spectrum. Elder and Xu (2) divide these 'intermediate' neoplasms into two categories, namely: 'superficial atypical melanocytic proliferations of uncertain significance' (SAMPUS) and 'melanocytic tumors of uncertain malignant potential' (MELTUMP). The latter group can be differentiated from the former one by showing expansile nodules ('tumors') within the dermis; therefore, Spitz tumors, 'atypical' deep penetrating nevi, 'atypical' cellular blue nevi, and some 'nevoid' neoplasms are good examples of MELTUMP. A conceptual approach to MELTUMP could be considering them as very low-grade malignant neoplasms with 'bland' histopathologic features and metastatic potential limited to the regional lymph nodes (3,4). The common (although not invariable) absence of further dissemination beyond the regional lymph nodes has even raised the question about true malignant nature of the lymph node 'implants' from these neoplasms (5-7); at present, however, we have no convincing scientific data which can allow to really challenge the clinicopathologic dogma of the metastasis as an unequivocal sign of malignancy (8).
The present case is characterized by a large and slightly asymmetrical melanocytic proliferation with no pagetoid aggression of the epidermis, a regular 'interstitial' streaming of cells at the lateral edges, and a 'pushing' deep growth. The junctional and dermal proliferation is mainly made up by a regular commistion of large spindle cells with abundant eosinophilic cytoplasms (definitional for a 'spitzoid' lesion) and deeply pigmented dendritic melanocytes (identifying a 'blue nevus-like' component within the lesion). Areas of 'solid' cellular proliferation can be found together with areas showing some hyalinized collagen bundles. Despite the high cellularity, virtually no mitotic figures are encountered. The overall features are not enough to render a diagnosis of malignancy, but the large size of the lesion, together with its high cellularity are features which prompt to place it into the MELTUMP category.
The regular admixture of large spindle and/or epithelioid melanocytes with dendritic melanocytes has been variously referred to as 'epithelioid blue nevus' (9) or 'blitz nevus' (10). The majority of epithelioid blue nevi are detected as multiple elements associated with other cutaneous lesions (lentigines and myxoid neurofibromas) in the clinical context of a Carney (myxoma) syndrome (9). Cases of epithelioid blue nevus in Carney complex did not metastasize to date. However, they cannot be morphologically distinguished from cases of metastasizing epithelioid blue nevus and from animal-type melanoma, thereby justifying their inclusion into a unique category designated 'pigmented epithelioid melanocytoma' (11). The lack of reliable microscopic criteria which can allow to predict the biologic behavior of pigmented epithelioid melanocytoma must prompt to place it into the MELTUMP category.
A 'diagnostic' sentinel lymph node biopsy can be proposed in cases of MELTUMP, but the management is best decided case by case, also on the basis of a true informed consent approach (2). In the present case, because of the peculiar location of the neoplasm, a clinical and echotomographic
follow-up of both the surgical scar and the cervical lymph nodes has been scheduled.
ACKNOWLEDGMENT
The Author thanks Dr. Lorenzo Cerroni, Dept. of Dermatology, Medical University of Graz, Austria, for reviewing the microscopic slides and the text of the present report.
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Bibliografía
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1. Soyer HP, Massone C, Ferrara G, Argenziano G. Limitations of histopathologic analysis in the recognition of melanoma: a plea for a combined diagnostic approach of histopathologic and dermoscopic evaluation. Arch Dermatol. 2005 Feb;141(2):209-211. 2. Elder DE, Xu X. The approach to the patient with a difficult melanocytic lesion. Pathology. 2004 Oct;36(5):428-434. 3. Barnhill RL, Argenyi ZB, From L, Glass LF, Maize JC, Mihm MC Jr, Rabkin MS, Ronan SG, White WL, Piepkorn M. Atypical Spitz nevi/tumors: lack of consensus for diagnosis, discrimination from melanoma, and prediction of outcome. Hum Pathol. 1999 May;30(5):513-520. 4. Casso EM, Grin-Jorgensen CM, Grant-Kels JM. Spitz nevi. J Am Acad Dermatol. 1992 Dec;27(6 Pt 1):901-913. 5. LeBoit PE. What do these cells prove? Am J Dermatopathol. 2003 Aug;25(4):355-356. 6. Cerroni L. A new perspective for spitz tumors? Am J Dermatopathol. 2005 Aug;27(4):366-367. 7. Wick MR. Melanocytic lesions with features of Spitz nevus. Hum Pathol. 2006 Jul;37(7):779-780. 8. Urso C, Borgognoni L, Saieva C, Ferrara G, Tinacci G, Begliomini B, Reali UM. Sentinel lymph node biopsy in patients with "atypical Spitz tumors." A report on 12 cases. Hum Pathol. 2006 Jul;37(7):816-823. Epub 2006 May 19. 9. Carney JA, Ferreiro JA. The epithelioid blue nevus. A multicentric familial tumor with important associations, including cardiac myxoma and psammomatous melanotic schwannoma. Am J Surg Pathol. 1996 Mar;20(3):259-272. 10. Groben PA, Harvell JD, White WL. Epithelioid blue nevus: neoplasm Sui generis or variation on a theme? Am J Dermatopathol. 2000 Dec;22(6):473-488. 11. Zembowicz A, Carney JA, Mihm MC. Pigmented epithelioid melanocytoma: a low-grade melanocytic tumor with metastatic potential indistinguishable from animal-type melanoma and epithelioid blue nevus. Am J Surg Pathol. 2004 Jan;28(1):31-40.
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NOTA:
Esto es un foro médico profesional, que no tiene como objetivo ofrecer consejo médico o de salud. Los mensajes enviados a este foro solicitando estos consejos, no serán atendidos. La información científica ofrecida está refrendada por las referencias y bibliografía correspondientes y de su veracidad son responsables sus autores. La participación en este Foro es gratuita.
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Última Modificación: 2006/07/16 21:30:53 GMT+1
