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Giubellino A, He Y, Munro SA, Zhou Y, Song KY, Plaza JA, Torres-Cabala CA, Nelson AC. Gene Expression Profile of Benign, Intermediate, and Malignant Spitz and Spitzoid Melanocytic Lesions. Cancers (Basel) 2024; 16:1798. [PMID: 38791877 PMCID: PMC11119593 DOI: 10.3390/cancers16101798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/19/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
Spitz and Spitzoid lesions represent one of the most challenging melanocytic neoplasms in dermatopathology. Nosologic classification has been more recently improved by the discovery of novel molecular drivers, particularly translocations. In the current study, we aimed to use an unbiased approach to explore the gene expression profile of a group of melanocytic Spitz and Spitzoid melanocytic lesions ranging from benign lesions to melanoma, including intermediate lesions such as SPARK nevi and atypical Spitz tumors/melanocytomas. Using unsupervised analysis of gene expression data, we found some distinct hierarchical clusters of lesions, including groups characterized by ALK and NTRK translocations. Few non-ALK translocated tumors demonstrated increased ALK expression, confirmed by immunohistochemistry. Spitz tumors with overlapping features of dysplastic nevi, so-called SPARK nevi, appear to have a common gene expression profile by hierarchical clustering. Finally, weighted gene correlation network analysis identified gene modules variably regulated in subtypes of these cases. Thus, gene expression profiling of Spitz and Spitzoid lesions represents a viable instrument for the characterization of these lesions.
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Affiliation(s)
- Alessio Giubellino
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA; (Y.H.); (Y.Z.); (K.Y.S.); (A.C.N.)
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | - Yuyu He
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA; (Y.H.); (Y.Z.); (K.Y.S.); (A.C.N.)
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | - Sarah A. Munro
- Minnesota Supercomputing Institute, Minneapolis, MN 55455, USA;
| | - Yan Zhou
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA; (Y.H.); (Y.Z.); (K.Y.S.); (A.C.N.)
| | - Kyu Young Song
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA; (Y.H.); (Y.Z.); (K.Y.S.); (A.C.N.)
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jose A. Plaza
- Department of Pathology, The Ohio State University Wexner Medical Center (OOSUWMC), Columbus, OH 43210, USA;
| | | | - Andrew C. Nelson
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA; (Y.H.); (Y.Z.); (K.Y.S.); (A.C.N.)
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
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Chatzopoulos K, Syrnioti A, Linos K. Spitz Melanocytic Tumors: A Fascinating 75-Year Journey. Genes (Basel) 2024; 15:195. [PMID: 38397186 PMCID: PMC10887813 DOI: 10.3390/genes15020195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024] Open
Abstract
Over the last 75 years, our understanding of Spitz lesions has undergone substantial evolution. Initially considered a specific type of melanoma, the perception has shifted towards recognizing Spitz lesions as a spectrum comprising Spitz nevi, Spitz melanocytomas, and Spitz melanomas. Spitz lesions are known for posing a significant diagnostic challenge regarding the distinction between benign neoplasms displaying atypical traits and melanomas. A comprehensive understanding of their molecular basis and genomic aberrations has significantly improved precision in classifying and diagnosing these challenging lesions. The primary aim of this review is to encapsulate the current understanding of the molecular pathogenesis and distinct clinicopathologic characteristics defining this intriguing set of tumors.
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Affiliation(s)
- Kyriakos Chatzopoulos
- Department of Pathology, Aristotle University, 54636 Thessaloniki, Greece; (K.C.); (A.S.)
| | - Antonia Syrnioti
- Department of Pathology, Aristotle University, 54636 Thessaloniki, Greece; (K.C.); (A.S.)
| | - Konstantinos Linos
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Hillen LM, Vandyck HLD, Leunissen DJG, de Greef BTA, Bosisio FM, zur Hausen A, van den Oord J, Winnepenninckx V. Integrative histopathological and immunophenotypical characterisation of the inflammatory microenvironment in spitzoid melanocytic neoplasms. Histopathology 2021; 78:607-626. [PMID: 32970867 PMCID: PMC7894529 DOI: 10.1111/his.14259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 12/14/2022]
Abstract
AIMS The role of inflammation in conventional cutaneous melanoma has been extensively studied, whereas only little is known about the inflammatory microenvironment and immunogenic properties of spitzoid melanocytic neoplasms. The composition of infiltrating immune cells and the architectural distribution of the inflammation, in particular, are still obscure. This is the first study, to our knowledge, to systematically characterise the inflammatory patterns and the leucocyte subsets in spitzoid melanocytic lesions. METHODS AND RESULTS We examined 79 spitzoid neoplasms including banal Spitz naevi (SN, n = 50), atypical Spitz tumours (AST, n = 17) and malignant Spitz tumours (MST, n = 12) using histopathological analysis and immunohistochemistry. Spitzoid melanocytic lesions showed a high frequency (67.1%, n = 53 of 79) of inflammation. Four inflammatory patterns were identified according to architectural composition, distribution and intensity of inflammation. The majority of the inflammatory infiltrate corresponded to CD3+ /CD8+ T lymphocytes (56.1%), followed by CD3+ /CD4+ T cells (35.7%) and CD68+ histiocytes (20.3%). CD3+ /TIA-1+ cytotoxic T lymphocytes constituted 3.7% of inflammatory cells. Rarely, CD3+ / granzyme B+ cytotoxic T lymphocytes (2.7%) and CD138+ plasma cells (0.5%) were detected in the infiltrating immune cells. There was no significant difference in the inflammatory cellular composition among the spitzoid melanocytic subgroups (SN versus AST versus MST). CONCLUSION Our findings demonstrate that Spitz tumours are highly immunogenic lesions. Inflammation with the presence of lymphocytic aggregates predominated in SN, but was not distinctive for this melanocytic category. A strong and intense inflammation was suggestive of an underlying malignancy. The infiltrating cytotoxic T lymphocyte subsets in Spitz tumours deserve further investigation in larger study cohorts to elucidate prognostic and immuno-oncological therapeutic relevance.
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Affiliation(s)
- Lisa M Hillen
- Department of PathologyGROW School for Oncology and Developmental BiologyMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Hendrik L D Vandyck
- Department of PathologyGROW School for Oncology and Developmental BiologyMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Daphne J G Leunissen
- Department of PathologyGROW School for Oncology and Developmental BiologyMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Bianca T A de Greef
- Department of Clinical Epidemiology and Medical Technology AssessmentMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Francesca M Bosisio
- Laboratory for Translational Cell and Tissue Research (TCTR)University of LeuvenKULLeuvenBelgium
| | - Axel zur Hausen
- Department of PathologyGROW School for Oncology and Developmental BiologyMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Joost van den Oord
- Laboratory for Translational Cell and Tissue Research (TCTR)University of LeuvenKULLeuvenBelgium
- Department of PathologyUniversity HospitalsLeuvenBelgium
| | - Véronique Winnepenninckx
- Department of PathologyGROW School for Oncology and Developmental BiologyMaastricht University Medical CenterMaastrichtthe Netherlands
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Hillen LM, Geybels MS, Spassova I, Becker JC, Gambichler T, Garmyn M, Zur Hausen A, van den Oord J, Winnepenninckx V. A digital mRNA expression signature to classify challenging Spitzoid melanocytic neoplasms. FEBS Open Bio 2020; 10:1326-1341. [PMID: 32431053 PMCID: PMC7327909 DOI: 10.1002/2211-5463.12897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/21/2020] [Accepted: 05/15/2020] [Indexed: 12/19/2022] Open
Abstract
Spitzoid neoplasms are a challenging group of cutaneous melanocytic proliferations. They are characterized by epithelioid and/or spindle-shaped melanocytes and classified as benign Spitz nevi (SN), atypical Spitz tumors (AST), or malignant Spitz tumors (MST). The intermediate AST category represents a diagnostically challenging group since on purely histopathological grounds, their benign or malignant character remains unpredictable. This results in uncertainties in patient treatment and prognosis. The molecular properties of Spitzoid lesions, especially their transcriptomic landscape, remain poorly understood, and genomic alterations in melanoma-associated oncogenes are typically absent. The aim of this study was to characterize their transcriptome with digital mRNA expression profiling. Formalin-fixed paraffin-embedded samples (including 27 SN, 10 AST, and 14 MST) were analyzed using the NanoString nCounter PanCancer Pathways Panel. The number of significantly differentially expressed genes in SN vs. MST, SN vs. AST, and AST vs. MST was 68, 167, and 18, respectively. Gene set enrichment analysis revealed upregulation of pathways related to epithelial-mesenchymal transition and immunomodulatory-, angiogenesis-, hormonal-, and myogenesis-associated processes in AST and MST. A molecular signature of SN vs. MST was discovered based on the top-ranked most informative genes: NRAS, NF1, BMP2, EIF2B4, IFNA17, and FZD9. The AST samples showed intermediate levels of the identified signature. This implies that the gene signature can potentially be used to distinguish high-grade from low-grade AST with a larger study cohort in the future. This combined histopathological and transcriptomic methodology is promising for prospective diagnostics of Spitzoid neoplasms and patient management in dermatological oncology.
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Affiliation(s)
- Lisa M Hillen
- Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Milan S Geybels
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Ivelina Spassova
- Department for Translational Skin Cancer Research (TSCR), German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Jürgen C Becker
- Department for Translational Skin Cancer Research (TSCR), German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany.,Deutsches Krebsforschungsinstitut (DKFZ), Heidelberg, Germany
| | - Thilo Gambichler
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Marjan Garmyn
- Laboratory of Dermatology, Department of Oncology and Department of Dermatology, University Hospitals Leuven, University of Leuven KUL, Leuven, Belgium
| | - Axel Zur Hausen
- Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Joost van den Oord
- Department of Pathology, University Hospitals of Leuven, University of Leuven KUL, Leuven, Belgium.,Laboratory Translational Cell and Tissue Research, University of Leuven, KU, Leuven, Belgium
| | - Véronique Winnepenninckx
- Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
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Hillen LM, Van den Oord J, Geybels MS, Becker JC, Zur Hausen A, Winnepenninckx V. Genomic Landscape of Spitzoid Neoplasms Impacting Patient Management. Front Med (Lausanne) 2018; 5:344. [PMID: 30619857 PMCID: PMC6300473 DOI: 10.3389/fmed.2018.00344] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/23/2018] [Indexed: 12/27/2022] Open
Abstract
Spitzoid neoplasms are a distinct group of melanocytic proliferations characterized by epithelioid and/ or spindle shaped melanocytes. Intermediate forms that share features of both benign Spitz nevi (SN) and Spitz melanoma, i.e., malignant Spitz tumor (MST) represent a diagnostically and clinically challenging group of melanocytic lesions. A multitude of descriptive diagnostic terms exist for these ambiguous lesions with atypical Spitz tumor (AST) or Spitz tumor of uncertain malignant potential (STUMP) just naming two of them. This diagnostic gray zone creates confusion and high insecurity in clinicians and in patients. Biological behavior and clinical course of this intermediate group still remains largely unknown, often leading to difficulties with uncertainties in clinical management and prognosis. Consequently, a better stratification of Spitzoid neoplasms in benign and malignant forms is required thereby keeping the diagnostic group of AST/STUMP as small as possible. Ancillary diagnostic techniques such as immunohistochemistry, comparative genomic hybridization, fluorescence in situ hybridization, next generation sequencing, micro RNA and mRNA analysis as well as mass spectrometry imaging offer new opportunities for the distinct diagnosis, thereby allowing the best clinical management of Spitzoid neoplasms. This review gives an overview on these additional diagnostic techniques and the recent developments in the field of molecular genetic alterations in Spitzoid neoplasms. We also discuss how the recent findings might facilitate the diagnosis and stratification of atypical Spitzoid neoplasms and how these findings will impact the diagnostic work up as well as patient management. We suggest a stepwise implementation of ancillary diagnostic techniques thereby integrating immunohistochemistry and molecular pathology findings in the diagnosis of challenging ambiguous Spitzoid neoplasms. Finally, we will give an outlook on pending future research objectives in the field of Spitzoid melanocytic lesions.
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Affiliation(s)
- Lisa M Hillen
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Joost Van den Oord
- Laboratory for Translational Cell and Tissue Research, Department of Pathology, KU Leuven, Leuven, Belgium
| | - Milan S Geybels
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Jürgen C Becker
- Institute for Translational Skin Cancer Research, German Cancer Consortium (DKTK), Partner Site Essen, University Hospital Essen, Essen, Germany
| | - Axel Zur Hausen
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Véronique Winnepenninckx
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
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