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Herzum A, Occella C, Vellone VG, Gariazzo L, Pastorino C, Ferro J, Sementa A, Mazzocco K, Vercellino N, Viglizzo G. Paediatric Spitzoid Neoplasms: 10-Year Retrospective Study Characterizing Histological, Clinical, Dermoscopic Presentation and FISH Test Results. Diagnostics (Basel) 2023; 13:2380. [PMID: 37510125 PMCID: PMC10378405 DOI: 10.3390/diagnostics13142380] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Spitzoid lesions are a wide tumour class comprising Spitz nevus (SN), atypical Spitz tumour (AST) and Spitz melanoma (SM). MATERIALS AND METHODS We conducted a single-centre-based retrospective survey on all histologically diagnosed spitzoid lesions of paediatric patients (1-18 years) of the last 10 years (2012-2022). Histopathological reports and electronic records of patients were used to retrieve relevant data regarding patients' features, clinical and dermatoscopical aspects of lesions when recorded, and FISH tests when present. RESULTS Of 255 lesions, 82% were histologically benign, 17% atypical, 1% malignant. Clinically, 100% of SM were large (≥6 mm) and raised; AST were mainly large (63%), raised (98%), pink (95%). Small (≤5 mm), pigmented, flat lesions correlated with benign histology (respectively 90%, 97%, 98% SN) (p < 0.0001). Dermatoscopical patterns were analysed in 100 patients: starburst pattern correlated with benign histology (26% SN (p = 0.004)), while multicomponent pattern correlated with atypical/malignant lesions (56% AST, 50% SM (p = 0.0052)). Eighty-five lesions were subjected to fluorescence in situ hybridization (FISH): 34 (71% AST; 29% SN) were FISH-positive; 51 (63% SN; 37% AST) were FISH-negative (p = 0.0038). DISCUSSION This study confirmed predominant benign histology (82%) of paediatric spitzoid lesions, thus detecting 17% AST and 1% SM, highlighting the need for caution in handling spitzoid lesions. CONCLUSION Until AST are considered potentially malignant proliferations and no reliable criteria are identified to distinguish them, the authors suggest a prudent approach, especially in children.
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Affiliation(s)
- Astrid Herzum
- Dermatology Unit, U.O.C. Dermatologia e Centro Angiomi, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5-16147 Genova, Italy
| | - Corrado Occella
- Dermatology Unit, U.O.C. Dermatologia e Centro Angiomi, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5-16147 Genova, Italy
| | - Valerio Gaetano Vellone
- Pathology Unit, U.O.C. Anatomia Patologica, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5-16147 Genova, Italy
| | - Lodovica Gariazzo
- Dermatology Unit, U.O.C. Dermatologia e Centro Angiomi, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5-16147 Genova, Italy
| | - Carlotta Pastorino
- Dermatology Unit, U.O.C. Dermatologia e Centro Angiomi, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5-16147 Genova, Italy
| | - Jacopo Ferro
- Dermatology Unit, U.O.C. Dermatologia e Centro Angiomi, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5-16147 Genova, Italy
| | - Angela Sementa
- Pathology Unit, U.O.C. Anatomia Patologica, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5-16147 Genova, Italy
| | - Katia Mazzocco
- Pathology Unit, U.O.C. Anatomia Patologica, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5-16147 Genova, Italy
| | - Nadia Vercellino
- Dermatology Unit, U.O.C. Dermatologia e Centro Angiomi, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5-16147 Genova, Italy
| | - Gianmaria Viglizzo
- Dermatology Unit, U.O.C. Dermatologia e Centro Angiomi, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5-16147 Genova, Italy
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Gerami P, Benton S, Zhao J, Zhang B, Lampley N, Roth A, Boutko A, Olivares S, Busam KJ. PRAME Expression Correlates With Genomic Aberration and Malignant Diagnosis of Spitzoid Melanocytic Neoplasms. Am J Dermatopathol 2022; 44:575-580. [PMID: 35503885 PMCID: PMC11010723 DOI: 10.1097/dad.0000000000002208] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Spitzoid melanocytic neoplasms are a diagnostically challenging class of lesions in dermatopathology. Recently, molecular assays and immunohistochemical markers have been explored as ancillary methods to assist in the diagnostic workup. Specifically, preferentially expressed antigen in melanoma (PRAME) immunohistochemistry is a nuclear stain commonly positive in melanomas, but not in nevi. This study investigates PRAME immunoreactivity (≥75% positive nuclear staining in tumor cells) in a set of 59 spitzoid melanocytic neoplasms with known clinical outcomes. We compared PRAME status with (1) the clinical outcomes, (2) the morphologic diagnoses, and (3) the status of TERT promoter mutation. Regarding clinical outcomes, 3 cases developed metastatic disease, of which 2 expressed diffusely positive PRAME staining. Of the 56 cases that did not show evidence of metastasis, 6 expressed diffusely positive PRAME staining. Morphologically, diffusely positive PRAME staining was seen in 7 of 21 cases (33.3%) diagnosed as melanoma and only 1 benign tumor 1 of 38 (2.6%). There were 4 of 8 cases with a TERT promoter mutation which were diffusely PRAME-positive compared with 4 of 51 cases without TERT promoter mutation ( P = 0.001). Our results show a statistically significant correlation between PRAME expression and the diagnosis, outcome, and TERT promoter mutation status of atypical spitzoid melanocytic neoplasms, suggesting immunohistochemistry for PRAME can help support a suspected diagnosis. However, because of occasional false-positive and negative test results, correlation with the clinical and histologic findings as well as results from other tests is needed for the interpretation of diagnostically challenging spitzoid melanocytic neoplasms.
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Affiliation(s)
- Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sarah Benton
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jeffrey Zhao
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Bin Zhang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Nathaniel Lampley
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Andrew Roth
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Anastasiya Boutko
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Shantel Olivares
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
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Mito JK, Weber MC, Corbin A, Murphy GF, Zon LI. Modeling Spitz melanoma in zebrafish using sequential mutagenesis. Dis Model Mech 2022; 15:276442. [PMID: 36017742 PMCID: PMC9438928 DOI: 10.1242/dmm.049452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/13/2022] [Indexed: 01/13/2023] Open
Abstract
Spitz neoplasms are a diverse group of molecularly and histologically defined melanocytic tumors with varying biologic potentials. The precise classification of Spitz neoplasms can be challenging. Recent studies have revealed recurrent fusions involving multiple kinases in a large proportion of Spitz tumors. In this study, we generated a transgenic zebrafish model of Spitz melanoma using a previously identified ZCCHC8-ROS1 fusion gene. Animals developed grossly apparent melanocytic proliferations as early as 3 weeks of age and overt melanoma as early as 5 weeks. By 7 weeks, ZCCHC8-ROS1 induced a histologic spectrum of neoplasms ranging from hyperpigmented patches to melanoma. Given the swift onset of these tumors during development, we extended this approach into adult fish using a recently described electroporation technique. Tissue-specific expression of ZCCHC8-ROS1 in adults led to melanocyte expansion without overt progression to melanoma. Subsequent electroporation with tissue-specific CRISPR, targeting only tp53 was sufficient to induce transformation to melanoma. Our model exhibits the use of sequential mutagenesis in the adult zebrafish, and demonstrates that ZCCHC8-ROS1 induces a spectrum of melanocytic lesions that closely mimics human Spitz neoplasms. Summary: We describe the first animal model of Spitz neoplasms and demonstrate its use for modeling sequential mutagenesis and its potential for studying melanocyte development in vivo.
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Affiliation(s)
- Jeffrey K Mito
- Stem Cell Program and Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA 02215, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA 02215, USA
| | - Margaret C Weber
- Stem Cell Program and Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA 02215, USA
| | - Alexandra Corbin
- Stem Cell Program and Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA 02215, USA
| | - George F Murphy
- Department of Pathology, Brigham and Women's Hospital, Boston, MA 02215, USA
| | - Leonard I Zon
- Stem Cell Program and Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA 02215, USA.,Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA 02138, USA.,Howard Hughes Medical Institute, Harvard Medical School, Boston, MA 02215, USA
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Bonometti A, Berti E. Reticulohistiocytoses: a revision of the full spectrum. J Eur Acad Dermatol Venereol 2020; 34:1684-1694. [PMID: 31955466 DOI: 10.1111/jdv.16214] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 12/31/2019] [Indexed: 12/11/2022]
Abstract
Reticulohistiocytoses (RH) are rare and clinically heterogeneous histiocytic disorders of dermatological interest. Three clinical entities with superimposable histopathological features are currently considered, namely solitary reticulohistiocytoma, diffuse/generalized reticulohistiocytosis and multicentric reticulohistiocytosis. Although in the last decade, RH studies have only minimally progressed, histiocytosis research has advanced considerably: the prognostic and therapeutic importance of the clinical subclassification of histiocytosis patients as well as of the detection of genetic alterations in the genes of the ERK pathway has been highlighted. According to these insights, we previously reported the presence of molecular alteration RH and described a subset of patients with disseminated multisystem involvement lacking arthritis. In the present review, we aim to update and revise the knowledge regarding RH. We first reviewed their histopathological, immunophenotypical and ultrastructural features, discussed their histopathological differential diagnosis with other conditions characterized by infiltrates made of oncocytic or epithelioid cells (with special regard to Destombes-Rosai-Dorfman disease) and finally summarized the molecular landscape of RH. We therefore tried to adjust the clinical subclassification of Langerhans cell histiocytosis to the clinical phenotypes of RH, outlining five clinically different groups of patients. Finally, we reconsidered the clinical workflow to the evaluation of RH patients, in light of the 5 different clinical groups and discussed the different therapeutic approaches and the possible role of target inhibitors.
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Affiliation(s)
- A Bonometti
- Unit of Anatomic Pathology, Department of Molecular Medicine, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy
| | - E Berti
- Unit of Dermatology, IRCCS Ca' Granda - Maggiore Policlinico Hospital Foundation, University of Milan, Milan, Italy
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5
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Sainz-Gaspar L, Sánchez-Bernal J, Noguera-Morel L, Hernández-Martín A, Colmenero I, Torrelo A. Nevo de Spitz y otros tumores spitzoides en la infancia. Parte 1: aspectos clínicos, histológicos e inmunohistoquímicos. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:7-19. [DOI: 10.1016/j.ad.2019.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/03/2019] [Indexed: 11/25/2022] Open
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Sainz-Gaspar L, Sánchez-Bernal J, Noguera-Morel L, Hernández-Martín A, Colmenero I, Torrelo A. Spitz Nevus and Other Spitzoid Tumors in Children —Part 1: Clinical, Histopathologic, and Immunohistochemical Features. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abstract
Melanoma is an aggressive malignancy arising from melanocytes in the skin and rarely in extracutaneous sites. The understanding of pathology of melanoma has evolved over the years, with the initial classifications based on the clinical and microscopic features to the current use of immunohistochemistry and genetic sequencing. The depth of invasion and lymph node metastasis are still the most important prognostic features of melanoma. Other important prognostic features include ulceration, lymphovascular invasion, mitosis, and tumor-infiltrating lymphocytes. This article reviews the pathology of melanoma and its precursor lesions, along with the recent advances in pathologic diagnosis of melanoma.
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Affiliation(s)
- Asmita Chopra
- Department of Surgery, Division of Surgical Oncology, University of Pittsburgh, Room A-422, Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
| | - Rohit Sharma
- Department of Surgery, Marshfield Medical Center, 1000 North Oak Avenue, Marshfield, WI 54449, USA
| | - Uma N M Rao
- Department of Pathology, University of Pittsburgh School of Medicine, Section of Bone/Soft Tissue, Melanoma Pathology, UPMC Presbyterian Shadyside, Room WG2.9, 5230 Centre Avenue, Pittsburgh, PA 15232, USA
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Nestin Expression in Spitzoid Lesions: An Immunohistochemical Characterization With Clinical and Dermoscopic Correlations. Appl Immunohistochem Mol Morphol 2019; 27:430-435. [DOI: 10.1097/pai.0000000000000653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kiavash K, Bluth MH, Thompson AD. An Update Regarding the Molecular Genetics of Melanocytic Neoplasms and the Current Applications of Molecular Genetic Technologies in Their Diagnosis and Treatment. Clin Lab Med 2019; 38:385-399. [PMID: 29776637 DOI: 10.1016/j.cll.2018.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Molecular genetic technologies are used to aid in diagnosis and treatment of borderline melanocytic tumors as an adjuvant to the gold standard histopathologic evaluation. A specific set of fluorescence in situ hybridization probes is widely used to aid in diagnosing challenging melanocytic lesions. New melanoma probe cocktails have revealed increased sensitivity and specificity in ambiguous melanocytic cases. Array comparative genomic hybridization is a more complex technology used for the work-up of diagnostically problematic Spitzoid melanocytic proliferations. Cutting-edge technologies, including next-generation sequencing and cell-free nucleic acid analysis, are promising biomarker applications for mutation detection towards personalized patient management.
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Affiliation(s)
- Katrin Kiavash
- Department of Pathology, Wayne State University, 4160 John R Street, Detroit, MI 48201, USA; Department of Pathology and Laboratory Medicine, Detroit Medical Center University Laboratories, 4160 John R Street, Detroit, MI 48201, USA
| | - Martin H Bluth
- Department of Pathology, Wayne State University, 4160 John R Street, Detroit, MI 48201, USA; Department of Pathology, Wayne State University, School of Medicine, 540 East Canfield Street, Detroit, MI 48201, USA; Pathology Laboratories, Michigan Surgical Hospital, 21230 Dequindre Road, Warren, MI 48091, USA
| | - Andrew David Thompson
- Department of Pathology, Wayne State University, 4160 John R Street, Detroit, MI 48201, USA; Department of Pathology and Laboratory Medicine, Detroit Medical Center University Laboratories, 4160 John R Street, Detroit, MI 48201, USA.
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10
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Ma SA, O'Day CP, Dentchev T, Takeshita J, Ridky TW, Seykora JT, Chu EY. Expression of p15 in a spectrum of spitzoid melanocytic neoplasms. J Cutan Pathol 2019; 46:310-316. [PMID: 30666677 DOI: 10.1111/cup.13424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/17/2018] [Accepted: 01/14/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Accurate classification of spitzoid melanocytic lesions is difficult due to overlapping clinical and histopathologic features between Spitz nevi, atypical Spitz tumors (ASTs), and spitzoid melanomas. Expression of p16 (CDKN2A) has been used as a marker of spitzoid lesions. However, its expression may be variable. p15 is a tumor suppressor encoded by CDKN2B, loss of which has been recently shown to promote transition from nevus to melanoma. We sought to determine whether p15 is a useful immunohistochemical marker to distinguish Spitz nevi from spitzoid melanomas and to compare p15 and p16 staining in this population. METHODS Immunohistochemistry for p15 and p16 was performed on Spitz nevi (n = 19), ASTs (n = 41), and spitzoid melanomas (n = 17). Immunoexpression was categorized by a four-tiered system: 0 (negative), 1+ (weak), 2+ (moderate), 3+ (strong). RESULTS 3+/strong p15 staining was observed in 68.4% of Spitz nevi, 34.2% of ASTs, and 17.7% of spitzoid melanomas. By contrast, we observed 3+ p16 staining in roughly equivalent percentages of Spitz nevi (57.9%), ASTs (56.1%), and spitzoid melanomas (58.8%). CONCLUSION These data illustrate that p15 may be more useful than p16 as a biomarker to help distinguish benign from malignant spitzoid lesions.
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Affiliation(s)
- Sophia A Ma
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Conor P O'Day
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tzvete Dentchev
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Junko Takeshita
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biostatistics Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Todd W Ridky
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John T Seykora
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Y Chu
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Plexiform Atypical Spitz Tumor With Rosette-Like Giant Cells: A Histologic and Immunohistochemical Study on a Case Suggesting Ganglioneuroblastic Differentiation: Review of the Literature and Considerations on Histogenesis. Am J Dermatopathol 2018; 40:903-907. [DOI: 10.1097/dad.0000000000001184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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