Biopsy Pathology of Melanocytic Disorders

455 Pages·1992·14.27 MB·English

by  W. J. Mooi MD, T. Krausz MD, MRCPath (auth.)

Biopsy Pathology of
Melanocytic Disorders
BIOPSY PATHOLOGY SERIES
General Editors
Professor Leonard S. Gottlieb, MD, MPH
Mallory Institute of Pathology,
Boston, USA
Professor A. Munro Neville, PhD, DSc, MD, FRC Path.
Ludwig Institute for Cancer Research,
London, UK
Professor F. Walker, MD, PhD, FRC Path.
Department of Pathology,
University of Aberdeen, UK
Other titles in the series
1. Biopsy Pathology of the Small Intestine
F. D. Lee and P. G. Toner
2. Biopsy Pathology of the Liver
R. S. Patrick and]. O'D. McGee
3. Brain Biopsy
]. H. Adams, D. I. Graham and D. Doyle
4. Biopsy Pathology of the Lymphoreticular System
D. H. Wright and P. G. Isaacson
5. Biopsy Pathology of Muscle
M. Swash and M. S. Schwartz
6. Biopsy Pathology of Bone and Bone Marrow
B. Frisch, S. M. Lewis, R. Burkhardt and R. Bartl
7. Biopsy Pathology of the Breast
]. Sloane
8. Biopsy Pathology of the Oesophagus, Stomach and Duodenum
D. W. Day
9. Biopsy Pathology of the Bronchi
E. M. McDowell and T. F. Beals
10. Biopsy Pathology in Colorectal Disease
I. C. Talbot and A. B. Price
11. Biopsy Pathology and Cytology of the Cervix
D. V. Coleman and D. M. D. Evans
12. Biopsy Pathology of the Liver (2nd edn)
R. S. Patrick and]. O'D. McGee
13. Biopsy Pathology of the Pulmonary Vasculature
C. A. Wagenvoort and W. ]. Mooi
14. Biopsy Pathology of the Endometrium
C. H. Buckley and H. Fox
15. Biopsy Pathology of Muscle (2nd edn)
M. Swash and M. S. Schwartz
16. Biopsy Pathology of the Skin
N. Kirkham
17. Biopsy Pathology of Melanocytic Disorders
W. ]. Mooi and T. Krausz
Biopsy Pathology of
Melanocytic Disorders
W. J. MOOI
MD
Head of Department of Pathology;
Head of Division of Tumour Biology
The Netherlands Cancer Institute
Amsterdam
The Netherlands
and
T. KRAUSZ
MD, MRCPath
Senior Lecturer and Consultant
Histopathology and Cytopathology
Royal Postgraduate Medical School
Hammersmith Hospital
London
UK
With a Foreword by
J. G. AZZOPARDI
MD, FRCPath
Emeritus Professor of Oncology
Royal Postgraduate Medical School
University of London
Honorary Consultant Pathologist
Hammersmith Hospital
London
u
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I
SPRINGER-SCIENCE+BUSINESS MEDIA, B.V.
First edition 1992
© 1992 W.J. Mooi and T. Krausz
Originally published by Chapman & Hall in 1992
Softcover reprint of the hardcover 1st edition 1992
Typeset in 10/12 Palatino by Best-set Typesetter Ltd, Hong Kong
ISBN 978-0-412-32350-8 ISBN 978-1-4899-6908-8 (eBook)
DOI 10.1007/978-1-4899-6908-8
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Contents
Colour plates appear in Chapter 13
Preface X
Foreword xiii
1 Melanin and melanocytes 1
1.1 Embryology 3
1.2 Light microscopy 4
1.3 Biochemistry of melanin synthesis 8
1.4 Electron microscopy 10
2 Biopsy, tissue processing and histological investigation 17
2.1 Skin biopsy of a pigmented lesion: clinical considerations 17
2.2 Macroscopical description and dissection of skin biopsy 19
specimens
2.3 Dissection of lymphadenectomy specimens 20
2.4 Dissection of other specimens containing metastases 21
2.5 Tissue processing and staining methods 21
2.6 Electron microscopy 26
2.7 Other techniques in the diagnosis of malignancy 27
2.8 Histological investigation and description 27
2.9 Criteria for diagnosis: usefulness and limitations 28
3 Cutaneous pigmented lesions not related to melanocytic 36
naevi
3.1 Generalized and regional hyperpigmentation 36
3.2 Ephelis (freckle) 38
3.3 Solar lentigo (senile lentigo, 'liver spot') 39
3.4 Cafe-au-lait spot 40
3.5 Becker's naevus (pigmented hairy epidermal naevus) 41
3.6 Xeroderma pigmentosum 42
3.7 Reactive pigmentation and melanocyte colonization of 43
tumours
vi Contents
3.8 Pigmented dermatofibrosarcoma protuberans (Bednar 51
tumour)
4 Common acquired melanocytic naevi 56
4.1 Lentigo simplex (simple lentigo, naevoid lentigo) 57
4.2 Junctional naevus 61
4.3 Compound naevus 64
4.4 Intradermal naevus 74
4.5 Halo naevus (Sutton's naevus, leukoderma acquisitum 85
centrifugum)
4.6 Balloon cell naevus 90
4.7 Cockarde naevus 93
4.8 Deep penetrating naevus 93
4.9 Recurrent naevus after incomplete removal 97
('pseudomelanoma')
4.10 'Active' naevi (so-called 'hot naevi') 99
4.11 Vulvar naevi 100
5 Cutaneous blue naevi and related lesions 106
5.1 Common blue naevus 107
5.2 Cellular blue naevus 113
5.3 Plaque-type blue naevus 125
5.4 Target blue naevus 125
5.5 Combined naevus 126
5.6 Mongolian spot, Ota's and Ito's naevus, and related 130
lesions
6 Congenital melanocytic naevi 136
6.1 Clinical features 136
6.2 Pathological features 138
6.3 The distinction between congenital and acquired naevi 150
6.4 Malignant transformation of congenital naevi 152
6.5 Subtypes of congenital naevus 152
6.6 Meningeal melanocytic lesions associated with congenital 154
naevi (neurocutaneous melanosis)
6.7 Placental naevus cell aggregates 154
7 Spitz naevus, desmoplastic Spitz naevus and pigmented 157
spindle cell naevus
7.1 Terminology 157
7.2 Clinical features 158
7.3 Histological features 160
Contents vii
7.4 Differential diagnosis 172
7.5 Desmoplastic Spitz naevus 175
7.6 Pigmented spindle cell naevus ('Reed's pigmented spindle 178
cell tumour')
8 Dysplastic naevus 186
8.1 Familial melanoma and the dysplastic naevus syndrome 188
8.2 Sporadic dysplastic naevus syndrome and solitary 190
dysplastic naevus
8.3 Clinical features 192
8.4 Pathological features 192
8.5 Histological criteria for the diagnosis 201
8.6 Dysplastic naevi vs in situ melanoma 204
8.7 Additional diagnostic techniques 206
8.8 Histological grading of dysplastic naevi to identify 207
dysplastic naevi associated with high risk
8.9 Histological evidence of dysplastic naevi_as precursors of 208
melanoma
8.10 Conclusion 210
9 Cutaneous melanoma 215
9.1 Macroscopical appearance 217
9.2 Histological diagnosis 219
9.3 Clinicopathological subtyping of melanoma 233
9.4 Superficial spreading melanoma 237
9.5 Nodular melanoma 239
9.6 Lentigo maligna and lentigo maligna melanoma 240
9.7 Acrallentiginous melanoma 246
9.8 Spindle cell melanoma 250
9.9 Desmoplastic and neurotropic melanoma 253
9.10 Borderline and minimal deviation melanoma 260
9.11 Balloon cell melanoma 270
9.12 Intradermal melanoma arising in intradermal naevus 273
9.13 Malignant blue naevus 274
9.14 Congenital melanoma; materno-fetal metastasis 274
9.15 Childhood melanoma 275
9.16 Melanoma arising in congenital naevus 275
9.17 Multiple melanoma 277
9.18 Primary and metastatic melanoma simulating other 281
neoplasms
9.19 Cutaneous and generalized melanosis in metastatic 294
melanoma
viii Contents
10 Prognostic factors in cutaneous melanoma 304
10.1 Clinical and pathological tumour stage 305
10.2 Site, sex and age 305
10.3 Levels of invasion 308
10.4 Tumour thickness 309
10.5 Mitotic rate, and related prognostic index 313
10.6 Ulceration 313
10.7 Satellites 314
10.8 Regression 316
10.9 Vascular invasion 317
10.10 Pre-existent naevus 318
10.11 Dermal inflammatory infiltrate 318
10.12 Cytological features 318
10.13 Late recurrence of melanoma 320
10.14 Prognosis of metastatic melanoma 320
10.15 Metastatic melanoma with unknown primary 322
11 Extracutaneous melanocytic lesions 331
11.1 Eye and orbital cavity 333
11.2 Nasal cavity and paranasal sinuses 344
11.3 Labial mucosa, oral cavity, and oropharynx 345
11.4 Larynx 349
11.5 Oesophagus 350
11.6 Lower respiratory tract 351
11.7 Gallbladder 353
11.8 Anal canal and rectum 353
11.9 Genitourinary tract 356
11.10 Lymph node 362
11.11 Melanoma of soft tissues (clear cell sarcoma) 366
11.12 Central nervous system 369
11.13 Adrenal gland 374
11.14 Miscellaneous sites 374
12 Other extracutaneous melanotic lesions 384
12.1 Conjunctiva 385
12.2 Labial and oral melanotic lesions 385
12.3 Salivary gland 386
12.4 Dermatopathic lymphadenopathy 386
12.5 Endocrine organs and neuroendocrine tumours 387
12.6 Melanotic schwannoma and neurofibroma 387
12.7 Other pigmented tumours of the nervous system 392
12.8 Tumours of uveal pigment epithelium 394
Contents ix
12.9 Pigmented neuroectodermal tumour of infancy ('melanotic 394
progonoma')
12.10 Pigmented tumours of the genital tract 398
13 Cytological diagnosis of melanoma 404
13.1 Methods 405
13.2 Microscopic features: general remarks 408
13.3 Epithelioid-cell melanoma 410
13.4 Spindle cell melanoma 413
13.5 Melanomas of mixed cell type 415
13.6 Uveal melanomas 415
13.7 Cytological features of melanoma in specimens other than 416
FNA
Index 421