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结膜原发性获得性黑变病:现在是提出新术语的时间吗?

Jakobiec FA

期刊名称:AJO 美国眼科学杂志

卷期:第161-2卷(2016年)2期

关键词:

摘要

 目的:回顾一组被诊断分类为 “原发性获得性黑变”案例。设计:带有组织病理和免疫组织化学插图的另一种诊断模式的课题和提案的文献综述。

方法:描述标准苏木精 - 伊红染色切片和MART-1免疫组织化学染色,溴甲基后马托品-45(HMB-45),小眼球相关转录因子(MITF),以及用于计算增殖指数的Ki-6.
结果:“黑变病”是一个不适当和误导性的术语,因为它不区分结膜上皮内黑色素生产过剩(“色素”)和上皮内黑素细胞增殖。建议采纳“上皮内黑素细胞增生”作为组织病理学诊断术语。非典型增生的特点是扩大细胞组件(树突,细胞体和胞核)的臃肿树突状黑色素细胞或无树突上皮黑素细胞。非典型多角形或上皮细胞变形性骨炎细胞可能达到较高的水平甚至超过了基底层的上皮细胞。免疫组织化学限定黑色素细胞增殖或蜂窝形状(树枝状或非枝晶)(MART-1,HMB-45)的程度或识别黑素细胞的细胞核(MITF)。上皮内黑素细胞非典型增殖代表了表现正常的树枝状黑素细胞的增殖(畸形增生或早期肿瘤),总体仍局限于基础/基底膜区。上皮内非增殖性黑素细胞色素沉着标志着通常是小数量的结膜基部的树状黑色素细胞合成增加了黑色素的总量转化为周围的角质细胞。
结论:如果有关于非典型的任何问题,应对平结膜黑色素细胞紊乱术前和术后活检进行免疫组化评估。基于对参与的细胞类型和他们的架构模式分析为前提的预测能更清晰的进行微观描述性诊断。这种做法有利于更好识别何时进行介入治疗。准确的早期诊断可防止不必要的后续手术。
PURPOSE:To review the diagnostic categories of a group of conditions referred to as "primary acquired melanosis."DESIGN:Literature review on the subject and proposal of an alternative diagnostic schema with histopathologic and immunohistochemical illustrations.
METHODS:Standard hematoxylin-eosin-stained sections and immunohistochemical stains for MART-1, HMB-45, microphthalmia-associated transcription factor (MiTF), and Ki-67 for calculating the proliferation index are illustrated.
RESULTS:"Melanosis" is an inadequate and misleading term because it does not distinguish between conjunctival intraepithelial melanin overproduction ("hyperpigmentation") and intraepithelial melanocytic proliferation. It isrecommended that "intraepithelial melanocytic proliferation" be adopted for histopathologic diagnosis. Atypical proliferations are characterized either by bloated dendritic melanocytes with enlarged cell components (dendrites, cell bodies, and nuclei) or by epithelioid melanocytes without dendrites. Atypical polygonal or epithelioid pagetoid cells may reach higher levels of the epithelium beyond the basal layer. Immunohistochemistry defines the degree of melanocytic proliferation or the cellular shape (dendritic or nondendritic) (MART-1, HMB-45) or identifies the melanocytic nuclei (MiTF). Intraepithelial melanocytic proliferation without atypia represents increased numbers of normal-appearing dendritic melanocytes (hyperplasia or early neoplasia) that generally remain confined to the basal/basement membrane region. Intraepithelial nonproliferative melanocytic pigmentation signifies the usually small number of conjunctival basal dendritic melanocytes that synthesize increased amounts of melanin that is transferred to surrounding keratinocytes.
CONCLUSION:All pre- and postoperative biopsies of flat conjunctival melanocytic disorders should be evaluated immunohistochemically if there is any question regarding atypicality. This should lead to a clearer microscopic descriptive diagnosis that is predicated on an analysis of the participating cell types and their architectural patterns. This approach is conducive to a better appreciation of features indicating when to intervene therapeutically. An accurate early diagnosis should forestall unnecessary later surgery.
 

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