Yintoni i-Spitz Nevus?
I-Spitz nevus yintlobo eyahlukeneyo ye-melanocytic nevus eyakhiwe ngama-melanocytes amakhulu, i-epithelioid kunye ne-spindle-shaped, eyachazwa okokuqala nguDkt. Sophie Spitz ngo-1948. Yayiqanjwe ngokokuqala ngokuba yi-juvenile melanoma ngenxa yokufana kwayo kwehistology ne-melanoma, igama lishintshwe laba yi-Spitz nevus xa kwavela ukuba inani elikhulu lezi zifo liyi-benign nangona ibonakala ibi kwi-microscope.
I-Spitz nevi ithatha malunga ne-1% yezo zonke i-melanocytic nevi kubantwana kwaye ivame ukufumaneka kubaguli abangaphantsi kweminyaka engama-20, ngokufika okuphezulu kwi-nyanga zokuqala zokuphila. Nangona kunjalo, zingavela nanini na kuquka kubantu abadala. Ngokwenene, i-classic Spitz nevus ibonakala njenge-papule okanye i-nodule emsulwa, enobungakanani be-dome, emthubi okanye ebomvu — ivame ukuba ne-5 ukuya kwi-10 millimeters ububanzi — ebangela ngokukhawuleza kwaye ingakhula ngokukhawuleza kwiiveki ukuya kumaxesha ngaphambi kokuba iqinise.
Umbala ophakathi kokuthandabuzeka okanye obomvu uvela kwi-vascularity ephawulekayo ngaphakathi kwalesi sifo. Ezinye i-Spitz nevi zinepigment (mnyama ukuya kumnyama), kwaye ezi zinguqulelo ze-pigmented — ngamanye amaxesha zibizwa ngokuba yi-Reed nevi okanye i-pigmented spindle cell nevi — ziqhelekile kubantu abadala nakwiindawo eziphantsi. Indawo eqhelekileyo yi-ntliziyo, ngakumbi kwiimpundu, kulandele iindawo eziphantsi.
I-Spitz nevi ivame ukuba yodwa, nangona iinguqulelo ezixhaphakileyo (ezibanjwe) okanye ezahlukeneyo zikhona. Ubungqina be-clinical be-Spitz nevi abukwazanga ukuxhalabisa ngengozi ethile kodwa kumngcipheko wokuxilongwa — ukufana kwayo kwe-clinical kunye ne-histologic ne-melanoma kwenza ukuba ukwahlula ngokucacileyo kube enye yeendawo eziphikisanayo kakhulu kwi-dermatopathology.
Kutheni i-Spitz Nevi Zifana ne-Melanoma
Ukwahluka kwe-histologic phakathi kwe-Spitz nevi kunye ne-melanoma kube ngumthombo wokuphikisana kokuxilongwa kangaphezu kweminyaka esixhenxe. Ngaphantsi kwe-microscope, i-Spitz nevi ibonisa ezininzi zeempawu ezihambelana ne-malignancy: ama-epithelioid amakhulu kunye ne-spindle cells anokuphuma okuninzi kunye ne-nucleoli ephawulekayo; ukungahambelani kwezakhiwo kunye ne-melanocytes ezibekwe kwiindawo ezinkulu, ezihlanganisiweyo; ukusasazeka kwe-melanocytes phezulu kwi-epidermis (umsebenzi oqhelekileyo ohambelana ne-melanoma in situ); umphumo ophakamileyo, ngakumbi kwiindawo ezikhulayo ngokukhawuleza kubaguli abancinci; kunye nokungena okujolise kwi-dermis. Ezi mpawu, zibonwa ngokwahlukana okanye ngokubambisana, ziya kukhupha umngcipheko omkhulu we-melanoma kwiimeko ezithile.
Okwahlukileyo i-classic Spitz nevus kwi-melanoma kwi-histology kuquka ubungakanani obuphakathi kunye nokuchaneka kwesifo; ukuvuthwa ngokujolise (ama-cell aba mncinci kwaye angafani kwiindawo ezijulileyo); ubukho be-Kamino bodies (i-eosinophilic globules kwi-dermo-epidermal junction); i-cleavage artifacts ezikufutshane ne-melanocyte nests; kunye nokungabikho kwe-mitotic atypical deep. Ingxaki kukuba ezi mpawu ezahlukeneyo zihlala zifihlekile kwaye zikhona kwi-spectrum — phakathi kwe-classic Spitz nevus ebonakalayo kunye ne-melanoma ecacileyo kukhona indawo emnyama yezi zifo ezibangelwa ngababukeli abaninzi abaqeqeshiweyo. Ezi zifo eziphikisanayo zifumene amagama ahlukeneyo kuquka i-atypical Spitz tumor (AST), i-spitzoid melanocytic tumor ye-malignant potential engaziwayo (STUMP), kunye ne-spitzoid melanocytic neoplasm ye-significance engaziwayo. Ukuphila kwale ndawo emnyama kunemiphumo emikhulu kwi-management yomguli.
I-Spitz Nevi Kubantwana vs. Kubantu Abadala
Ubudala bomguli bunomphumo omkhulu kwi-diagnosis, prognosis, kunye nolawulo lwe-Spitz nevi. Kubantwana, ngakumbi abo bangaphantsi kweminyaka engama-12, i-classic Spitz nevi ziqhelekile, zaziwa kakuhle, kwaye ziyi-benign. Ukubonakala okuqhelekileyo — i-papule emthubi okanye ebomvu, enobungakanani be-dome, ebusweni okanye kwiindawo eziphantsi zomntwana omncinci — ibonakala ngokucacileyo kwaye ibonisa ukhuseleko kwi-pathology.
Nokuba lezi zifo ze-Spitz zentlalontle zibonisa iimpawu ezikhathazayo ze-histologic (ukusasazeka, mitoses, ubungakanani obukhulu), iimpumelelo zihlala zikhona. I-spitzoid melanoma yeentsana ezingenaminyaka yokuphila iyinto engaqhelekanga — abanye abaphandi baphikisa ukuba ayikho ngokupheleleyo okanye iyancipha kakhulu.!! Le prognosis elungileyo kubantwana ibonisa indlela yokulawula ethambileyo: abaninzi be-pediatric dermatologists kunye ne-pathologists bayavuma ukususa ngokupheleleyo kunye nokubona i-classic Spitz nevi kubantwana abancinci.
Kubantu abadala, umphakathi wokuxilongwa utshintsha kakhulu. I-Spitz nevi iba ngaphezulu kokuba zinqabile ngexesha lokukhula, ngelixa i-melanoma iba ngaphezulu, iguqula umngcipheko we-pretest ukuya kwi-malignancy. I-lesion ye-spitzoid kumntu omdala — ngakumbi ophakathi kweminyaka engama-40 — ibonakala ngathi iyimela ye-spitzoid melanoma kunokuba ibe yi-benign Spitz nevus.!!
Ngaphezu koko, indlela ye-biological ye-atypical spitzoid tumors kubantu abadala ayiqinisekanga njengakubantwana, kunye nomngcipheko onomsebenzi (nangona usenokuphakama) weziphumo ezibi kuquka i-sentinel lymph node positivity kunye ne-metastasis engathandekiyo. Ngoko ke, ulawulo lwezifo ze-spitzoid kubantu abadala lujolise kakhulu, kunye nemida yokususa engaphezulu kunye nokusebenzisa rhoqo i-sentinel lymph node biopsy kwi-tumors ezihlukeneyo.
Ukwahlula kunye ne-Atypical Spitz Tumor Controversy
Ukwahlula kwe-Spitz nevi kuxhomekeke kakhulu kwi-histopathological examination emva kwe-biopsy, ebandakanya ukuhlolwa kwe-clinical kunye ne-dermoscopic. I-Dermoscopy ye-classic Spitz nevi ibonisa iimpawu ezithile: i-starburst pattern (ukuhamba kwe-radial okanye i-pseudopods ezibekwe ngokufanayo emaphethelweni) iyahluka kakhulu kwi-Spitz nevi, ngakumbi kwiinguqulelo ezinepigment. Ezinye iimpawu ze-dermoscopic ziquka i-globular pattern (i-brown globules ezihambelanayo), i-homogeneous pattern, kunye ne-atypical pattern enezinto ezininzi.
I-dotted vessel pattern (i-red dots ezibekwe ngokufanayo) ivame ukufumaneka kwi-Spitz nevi ezingekho ne-pigment. Kwi-histopathology, i-dermatopathologist eqeqeshiweyo ikwazi ngokuvamile ukuhlukanisa i-classic Spitz nevus kwi-melanoma. Nangona kunjalo, isigaba se-atypical Spitz tumor (AST) simele enye yeendawo eziphikisanayo kakhulu kwi-pathology.
Ezi zifo zineempawu ezihluke kakhulu kune-classic Spitz nevus kodwa azinayo imigaqo eyaneleyo yokuxilongwa kwe-melanoma. Abaphandi abaninzi abajolise kwi-lesion efanayo bangafika kwiingxelo ezahlukeneyo — uphando lubonise ukungafani okukhulu phakathi kwabaphandi, abaninzi beclassifying i-lesion njenge-Spitz nevus ngelixa abanye beyibiza ngokuba yi-melanoma. Ukuhlolwa kwe-molecular kuphucule ukuchaneka kokuxilongwa: i-fluorescence in situ hybridization (FISH) ingafumanisa utshintsho lwechromosome oluhambelana ne-melanoma, i-comparative genomic hybridization (CGH) ibonisa ukunyuka kunye nokulahleka kwechromosome, kwaye i-gene expression profiling ibonelela ngolwazi olungaphezulu lokuxilongwa.
Ubukho be-homozygous loss ye-9p21 (CDKN2A), ukunyuka kwe-6p25 okanye 11q13, okanye i-chromosomal aberrations ezinzima zixhasa ukuxilongwa kwe-melanoma, ngelixa i-kinase fusions (BRAF, ROS1, ALK, NTRK, RET, MET) ngaphandle kwezinye i-aberrations zihlala zihlala kwi-tumors ze-Spitz. Nangona ezi ziphuculo, ukwahlula ngokucacileyo kusemngciphekweni kwiimeko ezithile.
Iindlela Zolawulo
Ulawulo lwe-Spitz nevi luxhomekeke kwiimeko ze-clinical, ubudala bomguli, kunye ne-histopathologic classification. Kwi-classic, encinane, i-papule emthubi kumntwana apho ukuxilongwa kwe-clinical kwe-Spitz nevus kukhulu, abanye abachwephesha baphakamisa ukulandelela kwe-clinical ngaphandle kwe-biopsy, ngakumbi ukuba le lesion ibonisa i-pattern ye-dermoscopic eqhelekileyo. Nangona kunjalo, abaninzi be-clinicians bakhetha ukwenza i-biopsy kwi-Spitz nevus ethathwa njengomngcipheko ukuze bafumane ukuxilongwa kwe-histologic okuqinisekileyo, ngakumbi kuba ukuxilongwa kwe-clinical kuphela akukwazi ukuthembeka ngokupheleleyo.
I-excisional biopsy — ukususa yonke le lesion ngemida emincinci — yindlela efanelekileyo ye-biopsy, njengoko i-biopsy engaphelelanga ingaboni iimpawu zokuxilongwa kwaye ingenza ukuba ukutolika kwe-histopathologic kube nzima. Kwi-classic Spitz nevi eziqinisekisiweyo ngeempawu ezikhuselekileyo kunye nemida engalunganga, akukho msebenzi ungekhoyo. Ukulandela rhoqo ukuze kulandelelwe ukubuya kuyacetyiswa, kunye ne-re-excision ukuba le lesion ibuyela.
Kwi-atypical Spitz tumors (ASTs), ulawulo luphikisana ngakumbi. Umnqweno wamanje we-ASTs kubantwana kunye neentsana uthanda ukususwa ngokupheleleyo ngemida ecacileyo (ngokuqhelekileyo i-5 millimeters) kunye nokulandela ngokusondeleyo kwe-clinical. I-sentinel lymph node biopsy (SLNB) ye-ASTs kubantwana iyaphikisana — nangona ukuya kwi-50% ye-ASTs ingabonisa i-sentinel node positivity, umphumo we-clinical we-node eziphilayo kwi-atypical spitzoid tumors kubantwana uhluke kwi-melanoma, kwaye i-node eziphilayo ezininzi azikhokeleki kwi-metastasis engathandekiyo okanye ukufa.
Abaninzi abachwephesha ngoku bacebisa ukuba bangakwenzi i-SLNB ye-ASTs kubantwana, bayigcine kwi-lesions ezineempawu ezikhathazayo ze-molecular okanye ze-histologic. Kubantu abadala, i-SLNB yenziwa rhoqo kwi-ASTs kuba umngcipheko weziphumo ezibi uphakamile kwaye umngcipheko we-pretest we-melanoma ukhula ngokuhamba kweminyaka. Kwi-lesion ethathwa njenge-spitzoid melanoma, ulawulo luhamba ngokweemigaqo yokwelashwa kwe-melanoma kuquka ukususwa kweendawo ezibanzi kunye nemida efanelekileyo kunye ne-sentinel lymph node biopsy.
Indlela i-AI Yokuhlola Izinwele Ezingasiza Ngayo
I-nodula ekhula ngokushesha, emnyama noma enombala ophuzi ebusweni bebantwana noma esikhumbeni sabantu abadala ibangela ukukhathazeka okuphuthumayo. I-Skinscanner inikeza ukuhlolwa kokuqala okusheshayo okusekelwe kwi-AI uma uthwebula isithombe salo msebenzi, ihlola izici zayo zokubukeka — ukuvumelana komumo, ukujolisa kombala, ukucaciswa kwemingcele, ubukhulu be-surface, nobukhulu — ngokumelene nezithombe ezihambisana ne-spitz nevi ezithokozisayo nezici ezikhombisa imisebenzi engajwayelekile noma i-melanoma. I-AI ingakwazi ukuqaphela ukuvezwa okujwayelekile kwe-Spitz nevus — i-papule emnyama, evumelanayo, enomumo wesigubhu — futhi ihlukanise phakathi kokubukeka okungajwayelekile, okungavumelani, okunezimpawu eziningi ezikhombisa i-melanoma.
Kwama-variant anombala, uhlelo luhlola ukuvumelana nokujwayeleka komfanekiso wombala. I-Skinscanner ibaluleke kakhulu njengethuluzi lokuhlola lokuqala kubazali ababona umkhiqizo omusha, okhula esikhumbeni somntwana wabo. Uhlelo lunikeza umongo ophuthumayo mayelana nalokho okungase kube yisithombe, kunciphisa ukukhathazeka uma izici zikhuthaza ngenkathi zikhuthaza ukuhlolwa kochwepheshe uma ukubukeka kungajwayelekile.
Kubantu abaqapha izithombe ezikhona ze-spitzoid, ukuthwebula izithombe okwenziwa ngochwepheshe kusiza ukuqopha ukuzinza noma ukushintsha ngokuhamba kwesikhathi — ulwazi olubalulekile ekwenzeni izinqumo zoclinical. I-Skinscanner ayifuni ukufaka esikhundleni sokuhlolwa kwe-dermoscopic kanye nokuhlolwa kwe-histopathologic, okuyizinto ezibalulekile ukuze kutholakale kahle izithombe ze-spitzoid. Noma iyiphi i-nodula emnyama, ekhula, noma eshintsha — ikakhulukazi uma ingavumelani, inemibala eminingi, noma inkulu kune-centimeter eyodwa — kufanele ihlolwe udokotela wezokwelapha. Kodwa i-Skinscanner isiza ukuhlanganisa ibhuloho phakathi kokubona isithombe nokuthola ukunakekelwa kochwepheshe.
