Difference between revisions of "Pigmented spindle cell nevus"

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#redirect [[Melanocytic lesions]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Pigmented_spindle_cell_nevus_-_2_-_high_mag.jpg
| Width      =
| Caption    = Pigmented spindle cell nevus. [[H&E stain]].
| Synonyms  = Pigmented spindle cell nevus of Reed, Reed nevus
| Micro      = nests of heavily pigmented spindle cells at dermal-epidermal junction, no epithelioid cells
| Subtypes  =
| LMDDx      = [[malignant melanoma]], [[Spitz nevus]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      = dark brown/back, usu. 3-6 mm
| Grossing  =
| Site      = [[skin]] - usu. lower extremity, back, shoulder
| Assdx      =
| Syndromes  =
| Clinicalhx = classically women - teens and 20s
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = good
| Other      =
| ClinDDx    = other [[melanocytic lesions]]
| Tx        =
}}
'''Pigmented spindle cell nevus''', also '''pigmented spindle cell nevus of Reed''' and '''Reed nevus''',<ref name=pmid21997694/> is an uncommon benign [[melanocytic lesion]].
 
==General==
*Benign.
*Uncommon.
*Women (M:F = 1:1.4<ref name=pmid8463457/>).
*Usually 20s or teens.
 
Note:
*It was previously considered a variant of [[Spitz nevus]].<ref name=pmid21605093>{{cite journal |author=Webber SA, Siller G, Soyer HP |title=Pigmented spindle cell naevus of Reed: a controversial diagnostic entity in Australia |journal=Australas. J. Dermatol. |volume=52 |issue=2 |pages=104–8 |year=2011 |month=May |pmid=21605093 |doi=10.1111/j.1440-0960.2011.00743.x |url=}}</ref>
==Gross==
Features:<ref name=pmid8463457>{{Cite journal  | last1 = Sau | first1 = P. | last2 = Graham | first2 = JH. | last3 = Helwig | first3 = EB. | title = Pigmented spindle cell nevus: a clinicopathologic analysis of ninety-five cases. | journal = J Am Acad Dermatol | volume = 28 | issue = 4 | pages = 565-71 | month = Apr | year = 1993 | doi =  | PMID = 8463457 }}</ref>
*Dark brown/black.
*Typically 3-6 mm.
**Mostly under 7 mm.<ref name=pmid21997694/>
 
Location:
*Usually extremities (75% in one series<ref name=pmid8463457/>) - typically lower extremities.
*Back.
*Shoulder region.
 
==Microscopic==
Features:<ref name=Ref_WMSP500>{{Ref WMSP|500}}</ref>
*Nests of heavily pigmented spindle cells at dermal-epidermal junction - '''key feature'''.
**Nevoid cells in epidermis & dermis - form "basket weave" pattern.
*Well-circumscribed lesion.
 
Notes:
*No epithelioid nevus cells.
 
DDx:
*[[Spitz nevus]].
*[[Malignant melanoma]].
 
===Images===
<gallery>
Image:Pigmented_spindle_cell_nevus_-_low_mag.jpg | PSCN - low mag. (WC)
Image:Pigmented_spindle_cell_nevus_-_2_-_intermed_mag.jpg | PSCN - intermed. mag. (WC)
Image:Pigmented_spindle_cell_nevus_-_2_-_high_mag.jpg | PSCN - high mag. (WC)
</gallery>
www:
*[http://www.histopathology-india.net/Reed.htm Reed nevus - collection (histopathology-india.net)].
 
==IHC==
Features:<ref name=pmid21997694>{{Cite journal  | last1 = Díaz | first1 = A. | last2 = Valera | first2 = A. | last3 = Carrera | first3 = C. | last4 = Hakim | first4 = S. | last5 = Aguilera | first5 = P. | last6 = García | first6 = A. | last7 = Palou | first7 = J. | last8 = Puig | first8 = S. | last9 = Malvehy | first9 = J. | title = Pigmented spindle cell nevus: clues for differentiating it from spindle cell malignant melanoma. A comprehensive survey including clinicopathologic, immunohistochemical, and FISH studies. | journal = Am J Surg Pathol | volume = 35 | issue = 11 | pages = 1733-42 | month = Nov | year = 2011 | doi = 10.1097/PAS.0b013e318229cf66 | PMID = 21997694 }}</ref>
*Cyclin D1 ~12% of cells (range 1-40%) vs. ~42% of cells (range 1-95%) in melanoma.
*Ki-67 ~1% of cells (range 0-5%) vs. ~13% (range 1-40%) in melanoma.
 
==Sign out==
<pre>
SKIN LESION, RIGHT POSTERIOR NECK, EXCISION:
- PIGMENTED SPINDLE CELL NEVUS OF REED.
-- COMPLETELY EXCISED (CLEARANCE ~ 1 MM).
</pre>
 
===Micro===
The sections show spindled pigmented melanocytes in nests confined to the epidermis.
The lesion is symmetrical in its architecture and pigment distribution. There is no
pagetoid spread of melanocytes in the epidermis. No significant nuclear atypia is
identified. No mitotic activity is appreciated. Melanophages are present in the superficial
dermis. The lesion is completely excised in the plane of section.
 
==See also==
*[[Melanocytic lesions]].
*[[Spitz nevus]].
*[[Malignant melanoma]].
 
==References==
{{Reflist|2}}
 
[[Category:Diagnosis]]
[[Category:Melanocytic lesions]]

Latest revision as of 23:50, 25 June 2014

Pigmented spindle cell nevus
Diagnosis in short

Pigmented spindle cell nevus. H&E stain.
Synonyms Pigmented spindle cell nevus of Reed, Reed nevus
LM nests of heavily pigmented spindle cells at dermal-epidermal junction, no epithelioid cells
LM DDx malignant melanoma, Spitz nevus
Gross dark brown/back, usu. 3-6 mm
Site skin - usu. lower extremity, back, shoulder
Clinical history classically women - teens and 20s
Prevalence uncommon
Prognosis good
Clin. DDx other melanocytic lesions

Pigmented spindle cell nevus, also pigmented spindle cell nevus of Reed and Reed nevus,[1] is an uncommon benign melanocytic lesion.

General

  • Benign.
  • Uncommon.
  • Women (M:F = 1:1.4[2]).
  • Usually 20s or teens.

Note:

Gross

Features:[2]

  • Dark brown/black.
  • Typically 3-6 mm.
    • Mostly under 7 mm.[1]

Location:

  • Usually extremities (75% in one series[2]) - typically lower extremities.
  • Back.
  • Shoulder region.

Microscopic

Features:[4]

  • Nests of heavily pigmented spindle cells at dermal-epidermal junction - key feature.
    • Nevoid cells in epidermis & dermis - form "basket weave" pattern.
  • Well-circumscribed lesion.

Notes:

  • No epithelioid nevus cells.

DDx:

Images

  • PSCN - low mag. (WC)

  • PSCN - intermed. mag. (WC)

  • PSCN - high mag. (WC)

www:

IHC

Features:[1]

  • Cyclin D1 ~12% of cells (range 1-40%) vs. ~42% of cells (range 1-95%) in melanoma.
  • Ki-67 ~1% of cells (range 0-5%) vs. ~13% (range 1-40%) in melanoma.

Sign out

SKIN LESION, RIGHT POSTERIOR NECK, EXCISION:
- PIGMENTED SPINDLE CELL NEVUS OF REED.
-- COMPLETELY EXCISED (CLEARANCE ~ 1 MM).

Micro

The sections show spindled pigmented melanocytes in nests confined to the epidermis. The lesion is symmetrical in its architecture and pigment distribution. There is no pagetoid spread of melanocytes in the epidermis. No significant nuclear atypia is identified. No mitotic activity is appreciated. Melanophages are present in the superficial dermis. The lesion is completely excised in the plane of section.

See also

References

  1. ↑ 1.0 1.1 1.2 Díaz, A.; Valera, A.; Carrera, C.; Hakim, S.; Aguilera, P.; García, A.; Palou, J.; Puig, S. et al. (Nov 2011). "Pigmented spindle cell nevus: clues for differentiating it from spindle cell malignant melanoma. A comprehensive survey including clinicopathologic, immunohistochemical, and FISH studies.". Am J Surg Pathol 35 (11): 1733-42. doi:10.1097/PAS.0b013e318229cf66. PMID 21997694.
  2. ↑ 2.0 2.1 2.2 Sau, P.; Graham, JH.; Helwig, EB. (Apr 1993). "Pigmented spindle cell nevus: a clinicopathologic analysis of ninety-five cases.". J Am Acad Dermatol 28 (4): 565-71. PMID 8463457.
  3. ↑ Webber SA, Siller G, Soyer HP (May 2011). "Pigmented spindle cell naevus of Reed: a controversial diagnostic entity in Australia". Australas. J. Dermatol. 52 (2): 104–8. doi:10.1111/j.1440-0960.2011.00743.x. PMID 21605093.
  4. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 500. ISBN 978-0781765275.
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