Histomorphologic Assessment and Interobserver Diagnostic Reproducibility of Atypical Spitzoid Melanocytic Neoplasms With Long-term Follow-up

被引：130

作者：

Gerami, Pedram ^{[1
,2
]}

Busam, Klaus ^{[5
]}

Cochran, Alistair ^{[6
]}

Cook, Martin G. ^{[16
,17
]}

Duncan, Lyn M. ^{[9
]}

Elder, David E. ^{[10
]}

Fullen, Douglas R. ^{[12
,13
]}

Guitart, Joan ^{[1
,2
]}

LeBoit, Philip E. ^{[7
,8
]}

Mihm, Martin C., Jr. ^{[9
]}

Prieto, Victor G. ^{[14
,15
]}

Rabkin, Michael S. ^{[11
]}

Scolyer, Richard A. ^{[18
,19
]}

Xu, Xiaowei ^{[10
]}

Yun, Sook Jung ^{[20
]}

Obregon, Roxana ^{[1
]}

Yazdan, Pedram ^{[1
]}

Cooper, Chelsea ^{[1
]}

Weitner, Bing Bing ^{[3
,4
]}

Rademaker, Alfred ^{[3
,4
]}

Barnhill, Raymond L. ^{[6
]}

机构：

[1] Northwestern Univ, Dept Dermatol, Chicago, IL 60611 USA

[2] Northwestern Univ, Robert H Lurie Canc Ctr, Chicago, IL 60611 USA

[3] Northwestern Univ, Dept Prevent Med, Feinberg Sch Med, Chicago, IL 60611 USA

[4] Northwestern Univ, Robert H Lurie Comprehens Canc Ctr, Feinberg Sch Med, Chicago, IL 60611 USA

[5] Mem Sloan Kettering Canc Ctr, Dept Pathol, New York, NY 10021 USA

[6] Univ Calif Los Angeles, Med Ctr, Dept Pathol & Lab Med, Los Angeles, CA 90024 USA

[7] Univ Calif San Francisco, Dept Pathol, San Francisco, CA 94140 USA

[8] Univ Calif San Francisco, Dept Dermatol, San Francisco, CA 94143 USA

[9] Massachusetts Gen Hosp, Pathol Serv, Boston, MA 02114 USA

[10] Univ Penn, Dept Pathol, Philadelphia, PA 19104 USA

[11] Rabkin Dermatopathol Lab PC, Tarentum, PA USA

[12] Univ Michigan, Med Ctr, Dept Pathol, Ann Arbor, MI 48109 USA

[13] Univ Michigan, Med Ctr, Dept Dermatol, Ann Arbor, MI 48109 USA

[14] Univ Texas MD Anderson Canc Ctr, Dept Pathol, Sect Dermatopathol, Houston, TX 77030 USA

[15] Univ Texas MD Anderson Canc Ctr, Dept Dermatol, Houston, TX 77030 USA

[16] Royal Surrey Cty Hosp, Dept Histopathol, Guildford, Surrey, England

[17] Univ Surrey, Div Clin Med, Guildford GU2 5XH, Surrey, England

[18] Melanoma Inst Australia, Royal Prince Alfred Hosp, Sydney, NSW, Australia

[19] Univ Sydney, Sydney, NSW 2006, Australia

[20] Chonnam Natl Univ, Sch Med, Dept Dermatol, Kwangju, South Korea

来源：

AMERICAN JOURNAL OF SURGICAL PATHOLOGY | 2014年 / 38卷 / 07期

关键词：

melanoma; atypical Spitz tumor; Spitz tumor; Spitz nevus; spitzoid melanoma; interobserver; TUMORS;

D O I：

10.1097/PAS.0000000000000198

中图分类号：

R36 [病理学];

学科分类号：

100104 ;

摘要：

Predicting clinical behavior of atypical Spitz tumors remains problematic. In this study, we assessed interobserver agreement of diagnosis by 13 expert dermatopathologists for atypical Spitz tumors (n = 75). We determined which histomorphologic features were most heavily weighted for their diagnostic significance by the experts and also which histomorphologic features had a statistically significant correlation with clinical outcome. There was a low interobserver agreement among the experts in categorizing lesions as malignant versus nonmalignant (kappa = 0.30). The histomorphologic features that were given the most diagnostic significance by the experts were: consumption of the epidermis, atypical mitoses, high-grade cytologic atypia, and mitotic rate. Conversely, the histomorphologic features that most correlated with disease progression were: frequent mitoses, deep mitoses, asymmetry, high-grade cytologic atypia, and ulceration. The presence and/or pattern of pagetoid spread, consumption of the epidermis, and lymphoid aggregates demonstrated no association with clinical behavior. The results support the assertion that there is a lack of consensus in the assessment of atypical Spitz tumors by expert dermatopathologists. Importantly, many features used to distinguish conventional melanoma from nevi were not useful in predicting the behavior of atypical Spitz tumors. This study may provide some guidance regarding histologic assessment of these enigmatic tumors.

引用

页码：934 / 940

页数：7

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