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Intradermal Spitz nevus differentiated from reticulohistiocytic granuloma by immunoreactivity to S-100 protein.

A firm, dark reddish, smooth surfaced nodule on the forearm of a 16-year-old boy was diagnosed as a Spitz nevus with the aid of a strong positive reactivity to S-100 protein. Histological examination revealed an intradermal epithelioid cell tumor with prominent multinucleated giant cells, suggesting the diagnosis of reticulohistiocytic granuloma. However, immunoperoxidase staining of the tumor cells showed strong positive reactivity to S-100 protein and vimentin; it was negative for lysozyme and alpha-1 antitrypsin. Although a few melanosomes in the tumor cells seen in electron microscopic examination provided crucial proof for the diagnosis of Spitz nevus, the positive reactivity to S-100 protein in ordinary formalin-fixed, paraffin-embedded tissues proved to be very useful in the differentiation of Spitz nevus from tumors of histiocytic origin, especially those of the mononuclear phagocytic system.

Adolescent↗

Nevus cells observed in the sebaceous glands.

Of sebaceous gland-containing specimens of melanocytic nevi, a total of 79 specimens from 70 cases of nevocellular nevus (consisting of 10 cases of compound nevus and 60 of intradermal nevus), four cases of juvenile melanoma and three of blue nevus were examined light-microscopically in detail for the presence or absence of nevus cells or dermal melanocytes in the sebaceous glands. As a result, clusters of cells that appeared to be nevus cells were found in the sebaceous glands of specimens from a total of three cases, that is, two cases of nevocellular nevus i.e. compound nevus, and one of the cases of juvenile melanoma. Two cases were infantile and one case was the age of puberty. The origin of the nevus cells found in the sebaceous glands is discussed.

Adolescent↗

Pigmented lesion of the oral cavity with eight years follow-up.

A 27 year old white female with a pigmented lesion on the anterior portion of the mandibular gingival is described. A prophylactic excisional biopsy was performed in conjunction with a gingival graft. A gingival graft was performed to accelerate the healing process and reduce post operative discomfort. An intradermal nevus was diagnosed. The number of documented oral nevi in the literature now exceeds 200 and approximately half of them are histologically of the intradermal type. If early detection of thin oral melanomas is to be achieved, all pigmented oral cavity lesions should be viewed with suspicion.

Adult↗

Nevi, other than dysplastic and Spitz nevi.

Cutaneous nevi are common lesions that develop by proliferation of melanocyte-derived cells. The majority develop as junction nevi from melanocytes at the epidermo-dermal junction. Cells from this proliferation pass into the underlying dermis forming compound nevi. Later junctional melanocytic activity ceases, leaving an intradermal nevus. A minority of nevi, mainly blue nevi, arise from intradermal melanocytes. Histological variants of melanocytic nevi exist and can be the source of difficult diagnostic problems. Nevi are important as clinical and histological simulators of cutaneous melanoma, as precursor lesions for melanoma (although the actual chance of malignant transformation of an individual nevus is low) and as cosmetic problems (mainly large congenital nevi). Cutaneous nevi are to be separated clinically and histologically from melanomas that are comprised of nevocyte-like cells (minimal deviation melanoma).

Adult↗

[Corymbiform nevus cell nevus].

There is a wide morphological variety in the appearance of melanocytic nevi. We report a case of a 77-year-old woman with a pedunculated, lobulated intradermal nevus on her trunk. For this grape-like clinical variant, we propose the term "corymbiform nevus".

Aged↗

[Is the presence of horny pseudocysts in the histological picture of nevus cell nevi a sign for a benign lesion?].

Among 2203 nevus cell nevi, 1333 cases showed horny pseudocysts in the histological picture (60.5%). In 1234 out of 1674 cases (73.7%) horny pseudocysts occurred in intradermal nevi. In 332 cases of malignant melanoma, horny pseudocysts did not appear at all. We concluded that the horny pseudocyst if a common histological feature in cases of intradermal nevus but is at least extremely rare in malignant melanoma. Therefore the horny pseudocyst may play an important part as a histological guide for a benign lesion in cases of borderline nevus cell nevi with initial signs of malignant transformation.

Cysts↗

Immunohistochemical and electron microscopic observations of nevic corpuscle.

Nevic corpuscle in the pigmented nevus was studied under light microscopy in comparison with Meissner corpuscle of the human sole skin in order to determine its ontogenesis. No nerve fibers within nevic corpuscle but coiled fibers in Meissner corpuscle could be demonstrated by Bodian stain. Presence of S-100 protein in the pigmented nevus and Meissner corpuscle was observed under light microscopy utilizing peroxidase-antiperoxidase immunohistochemical staining. S-100 protein was more evident in nevic corpuscles than in Types A and B intradermal nevus cells. Meissner corpuscle showed moderate stainability for S-100 protein. Ultrastructural study revealed that the nevic corpuscle was composed of the laminated cells with flattened cytoplasmic processes but lacked peripheral nerve endings such as axons, characteristically shown in Meissner corpuscle. No melanogenic activity of nevic corpuscle was observed. These morphological and histochemical findings of nevic corpuscle did not enable us to give definite conclusion on its ontogenesis.

Female↗

Dermal duct tumor.

A dermal duct tumor which clinically resembled an intradermal nevus and developed on the lower back of a 59-year-old woman is described. The diagnosis could only be reached by microscopic examination. The dermal duct tumor appears to originate from cells with differentiation towards the intradermal portion of the eccrine sweat duct.

Female↗

Hypopigmented common blue nevus.

Blue nevus is a benign pigmented lesion of dermal melanocytes with a number of histologic and clinical variants, of which the major types are the common blue nevus, cellular blue nevus and combined nevus. This study describes 9 cases of hypopigmented blue nevus (HBN), a variant of common blue nevus in which there is minimal identifiable melanin pigment. We also discuss the usefulness of the immunoperoxidase stain HMB-45 in relation to the diagnosis of HBN and the lesions with which it may be histologically confused, namely common intradermal nevus, dermatofibroma, neurofibroma, dermal scar and desmoplastic malignant melanoma. The HMB-45 stain was found to be uniformly positive in all 9 cases of HBN, in contrast to the other dermal lesions which have been reported as either negative or showing only focal positivity. The physical distribution and age range of the patients in this study was similar to the age and sites for common BN, supporting the relationship between the 2 lesions. The occurrence of HBN in predominantly young adults indicates that this lesion is not a phenomenon due to ageing or degenerative change, and should be regarded as a variant of common blue nevus.

Adolescent↗

"Triggered trap": nevoid malignant melanoma.

Nevoid malignant melanoma probably represents an early form of nodular malignant melanoma in which there is little proliferation of melanocytes in the epidermis and a dermal proliferation that mimics some features of a compound or intradermal nevus, which is difficult to recognize as being due to malignant melanoma. The lesions can contain either small nevoid cells or larger cells that resemble those in Spitz's nevi. Overall the lesions are symmetrical, have minimal proliferation in the epidermis, and often have dispersion of cells at the base. The lesions with small nevoid cells are particularly difficult to distinguish from common intradermal or compound melanocytic nevi. Reactivity of the intradermal component for HMB-45 antigen, without antigen retrieval, or for Ki-67 antigen can show that the dermal cells have an immature phenotype and, in combination with histological criteria, can support a diagnosis of nevoid malignant melanoma.

Adult↗

Leptomeningeal malignant melanoma arising in neurocutaneous melanocytosis: a case report.

A rare case of histology-proved giant congenital melanocytic nevus (GCMN) with symptomatic leptomeningeal melanocytosis is reported. A 26-year-old man had had a large patch of pigmented nevus over his back and left arm since birth. He had begun to have seizures as well as symptoms and signs of increased intracranial pressure about six months before admission. Serial computed tomography of brain showed hydrocephalus, diffuse leptomeningeal enhancement and multiple well-enhanced, rapid-growing nodules on the surface of the cerebellum and left parietal lobe. Magnetic resonance imaging (MRI) revealed T1 shortening of leptomeninges on precontrast T1 weighted imaging. Skin biopsy was done twice and showed intradermal nevus. Biopsy on one of the intracranial nodules revealed malignant melanoma arising in the melanocytosis. He died one year after the onset of neurologic symptoms. For early diagnosis of neurocutaneous melanocytosis, we suggest 1) MRI, and 2) leptomeningeal biopsy in patients with suspected leptomeningeal malignant melanoma.

Adult↗

Distribution of laminin and collagen type-IV in benign and malignant lesions of melanocytic origin.

Using antisera for two specific basement membrane (b.m.) antigens such as laminin and collagen type-IV, together with electron microscopy, we have shown that fully antigenic b.m. and morphologically typical basal lamina (b.l.) are associated with normal and transformed cells of the melanocyte lineage in different ways. Thus, while b.m. and b.l. surround individual choroidal melanocytes, intradermal nevus cells and cells of blue nevi are not detectable at the periphery of resting and proliferating epidermal melanocytes. They have a low degree of expression with a heterogeneous pattern of distribution in primary and metastatic melanoma. This heterogeneity is present within single metastases and among autologous metastases. These findings indicate that the presence of b.m. can be an additional marker for cells of the melanocyte lineage and should be considered when applying serological means for the detection and control of neoplasms of melanocytic origin.

Basement Membrane↗