Spitz Nevus: I-Mole Engajwayelekile Engase Ifane Ne-Melanoma

I-Spitz nevus uhlobo oluhlukile lwe-melanocytic nevus olwakhiwe ngama-melanocytes amakhulu, ama-epithelioid kanye ne-spindle-shaped atholakala okokuqala nguDkt. Sophie Spitz ngo-1948. Okokuqala kwaziwa ngokuthi i-juvenile melanoma ngenxa yokufana kwayo kwe-histologic ne-melanoma, igama lishintshwe laba yi-Spitz nevus lapho kwavela khona ukuthi inqwaba yalezi zindawo iyabukeka kahle naphezu kokubukeka kwayo okukhathazayo ngaphansi kwe-microscope.

I-Spitz nevi ibalwa cishe ku-1% yazo zonke i-melanocytic nevi ezinganeni futhi ivame ukuhlolwa ezigulini ezingaphansi kweminyaka engama-20, ngokuhamba phambili eminyakeni yokuqala yokuphila. Nokho, zingavela nganoma yiliphi iviki kuhlanganisa nabantu abadala. Ngokwezokwelapha, i-classic Spitz nevus ibonakala njenge-papule noma i-nodule elula, enobumba, emnyama noma ebomvu — ivamise ukuba nendawo engama-5 kuya kwama-10 millimitha ububanzi — ebonakala ngokuphazima kweso futhi ingakhula ngokushesha ezinsukwini kuya ezinyangeni ngaphambi kokuzinza.

Umbala ophawulekayo obomvu noma ophuzi uvela ngenxa yokukhula kwe-vascularity ngaphakathi kwalesi sifo. Ezinye i-Spitz nevi zinezimpawu (zibomvu kuya kwinhlanga), futhi lezi zinguquko ezinemibala — kwesinye isikhathi zibizwa ngokuthi ama-Reed nevi noma ama-pigmented spindle cell nevi — zivame ukutholakala kubantu abadala nasezitheni eziphakeme. Indawo evame kakhulu ibuso, ikakhulukazi emaphashini, kulandela izitho.

I-Spitz nevi ivame ukuba yodwa, nakuba izinguquko ezivamile (ezihlanganisiwe) noma ezitholakalayo zikhona. Ukubaluleka kwezokwelapha kwe-Spitz nevi akukhona engozini ethile kodwa emkhakheni wezinkinga zokuhlola — ukufana kwabo kwezokwelapha ne-histologic ne-melanoma kwenza ukuhlukaniswa okucacile kube enye yezindawo eziphikisanayo kakhulu ku-dermatopathology.

Ukufana kwe-histologic phakathi kwe-Spitz nevi ne-melanoma kube umthombo wezinkinga zokuhlola isikhathi esingaphezu kweminyaka eyisixhenxe. Ngaphansi kwe-microscope, i-Spitz nevi ibonisa izici eziningi ezihlobene ne-pathologists nezinhlobonhlobo: ama-epithelioid amakhulu, ama-spindle cells anokwakheka okuningi kanye ne-nucleoli ephawulekayo; ukuhlela okungahleleki kwe-melanocytes okuhlelwe ezindaweni ezinkulu, ezihlangene; ukusabalala kwe-melanocytes phezulu kwi-epidermis (isici esivame ukuhlotshaniswa ne-melanoma in situ); ukusebenza okuphezulu kwe-mitotic, ikakhulukazi ezindaweni ezikhula ngokushesha ezigulini ezincane; kanye nokwandiswa okujulile kwi-dermis. Lezi zici, uma zibonwa ngokwehlukana noma ngokuhlanganyela, zingavusa ukukhathazeka okukhulu nge-melanoma kunoma iyiphi enye indawo.

Lokhu okwenza i-classic Spitz nevus ihluke kwe-melanoma ngokwe-histology kuhlanganisa ukujwayeleka kokubili nokuhlukaniswa kwesimo; ukujula (amaseli aba mancane futhi angajwayeleki ezindaweni ezijulile); ukuvela kwezinto ezihlukile ze-Kamino (ama-globules e-eosinophilic endaweni ye-dermo-epidermal); izimpawu zokuhlukanisa ezizungezile ama-melanocyte nests; kanye nokungabi khona kwe-mitotic atypical ejulile. Inkinga ukuthi lezi zici ezihlukanisayo zicashile futhi zikhona kumkhakha — phakathi kwe-classic Spitz nevus ecacile ne-melanoma ecacile kukhona indawo ephuzi yezindawo ezingenakuhlukaniswa ngokuqinisekile ngochwepheshe abanolwazi. Lezi zindawo eziphikisanayo ziye zathola amagama ahlukahlukene kuhlanganisa i-atypical Spitz tumor (AST), i-spitzoid melanocytic tumor enokungaqiniseki kokuphila (STUMP), kanye ne-spitzoid melanocytic neoplasm enokungaqiniseki. Ukuphila kwalesi sikhala esiphuzi kunemiphumela emikhulu kwezokwelapha ekuphathweni kweziguli.

Iminyaka yesiguli ithonya kakhulu ukuhlolwa, ukubikezela, nokuphathwa kwe-Spitz nevi. Ezinganeni, ikakhulukazi labo abangaphansi kweminyaka eyi-12, ama-classic Spitz nevi ajwayelekile, aqashelwa kahle, futhi avame ukuba nezinhloso ezinhle. Ukuboniswa okujwayelekile — i-papule elungile, eliqondile, elibomvu noma eliphuzi enebuso noma esithweni somntwana omncane — kubonakala ngokweqile futhi kuhlola kahle.

Noma ngabe lezi Spitz nevi ezinganeni zikhombisa izici ezikhathazayo ze-histologic (ukusabalala kwe-pagetoid, ama-mitoses, usayizi omkhulu), imiphumela ivame ukuba yinhle kakhulu. I-spitzoid melanoma yangempela ezinganeni ezingakafiki eminyakeni yokukhulelwa iyinto engajwayelekile kakhulu — abanye ochwepheshe baphikisa ukuthi ayikho ngokuphelele noma iyinto engajwayelekile kakhulu.!! Le mpumelelo enhle ezinganeni ikhulisa indlela yokuphatha ephusile: abanye abelaphi bezingane nabaphenyi bakhululekile ngokususa ngokuphelele okuphumelelayo nokubheka ama-classic Spitz nevi ezinganeni ezincane.

Kubantu abadala, umkhakha wokuhlola ushintsha kakhulu. I-Spitz nevi iba yincane kakhulu ngokukhula kweminyaka kanti i-melanoma iba yinkulu, ishintsha ithuba lokuhlola libheke ekubeni yingozi. I-lesion ye-spitzoid kumuntu omdala — ikakhulukazi oneminyaka engama-40 nangaphezulu — ivame ukuba yi-spitzoid melanoma kunokuba ibe yi-Spitz nevus elungile.!!

Ngaphezu kwalokho, ukuziphatha kwe-biological kwe-atypical spitzoid tumors kubantu abadala akuhleleki kahle njengasezinganeni, kunengozi ethile (nakuba isenjalo) yokuphuma okubi okuhlanganisa i-sentinel lymph node positivity kanye nokuqhamuka kancane. Ngakho-ke, ukuphathwa kwe-lesions ye-spitzoid kubantu abadala kuvame ukuba namandla, ngokuhlinzwa okubanzi kanye nokusetshenziswa okuphindaphindiwe kwe-sentinel lymph node biopsy kwe-tumors atypical.

Ukuxilongwa kwe-Spitz nevi kusekelwe kakhulu ekuhlolweni kwe-histopathological kulandela i-biopsy, kuhambisana nokuhlolwa kweklinikhi kanye ne-dermoscopic assessment. I-dermoscopy ye-classic Spitz nevi iveza amaphethini akhethekile: iphethini ye-starburst (ukugeleza kwe-radial noma ama-pseudopods ahlelwe ngendlela efanayo emaphethelweni) ikhethekile kakhulu ku-Spitz nevi, ikakhulukazi izinguqulo eziphekiwe. Amanye amaphethini e-dermoscopic afaka iphethini ye-globular (ama-globules amnyama ahlukaniswe kahle), iphethini elihlangene, kanye nephethini engajwayelekile enezici eziningi.

Iphethini ye-dotted vessel (amadoti abomvu ahlukaniswe kahle) ivamile ku-Spitz nevi engaphekile. Ku-histopathology, udokotela we-dermatopathologist onolwazi uvame ukuhlukanisa i-classic Spitz nevus ku-melanoma. Nokho, isigaba se-atypical Spitz tumor (AST) simele enye yezindawo eziphikisanayo kakhulu ku-pathology.

Lezi zifo zineziqu ezijwayelekile ezingajwayelekile kune-classic Spitz nevus kodwa azinayo imikhawulo eyanele yokuxilongwa okuqondile kwe-melanoma. Abahloli abahlukene abahlola lesi sifo bangafinyelela eziphethweni ezahlukene — izifundo zikhombisa umehluko omkhulu phakathi kwabahloli, abanye bechaza isifo njenge-Spitz nevus kanti abanye bakubiza ngokuthi i-melanoma. Ukuhlolwa kwemolekyuli kuthuthukisile ukunemba kokuxilongwa: i-fluorescence in situ hybridization (FISH) ingathola izinguquko zenombolo ye-chromosomal ezihlobene ne-melanoma, i-comparative genomic hybridization (CGH) ikhetha ukukhula nokulahleka kwe-chromosomal okubanzi, futhi i-gene expression profiling inikeza olunye ulwazi lokuxilonga.

Ukuphuma kwe-homozygous kwe-9p21 (CDKN2A), ukukhula kwe-6p25 noma i-11q13, noma izinguquko eziyinkimbinkimbi ze-chromosomal kusekela ukuxilongwa kwe-melanoma, kanti ama-kinase fusions ahlukanisiwe (BRAF, ROS1, ALK, NTRK, RET, MET) ngaphandle kwezinguquko ezengeziwe zihlukaniswa njenge-Spitz tumors. Naphezu kwalokhu kuthuthuka, ukuhlukaniswa okuqondile kusenokungabi khona kwezinye izifo.

Ukuphathwa kwe-Spitz nevi kuncike kumongo wekliniki, ubudala bomtholampilo, kanye ne-classification ye-histopathologic. Kwipapule encane, elula, ebomvu e-classic engumntwana lapho ukuxilongwa kwe-Spitz nevus kuqinisekisiwe, abanye ochwepheshe bakhuthaza ukuqapha kwekliniki ngaphandle kwe-biopsy, ikakhulukazi uma lesi sifo sikhombisa iphethini ye-dermoscopic ejwayelekile. Nokho, abaninzi bezokwelapha bakhetha ukuhlinza noma iyiphi i-Spitz nevus eyenziwe ngempela ukuze bathole ukuxilongwa kwe-histologic okuqondile, ikakhulukazi ngoba ukuxilongwa kwekliniki kuphela akukwazi ukuhlinzeka ngokuqinisekile.

I-biopsy ye-excisional — ukususa lesi sifo sonke ngemikhawulo emincane — iyindlela ethandwa yokuhlinza, njengoba i-biopsy engaphelele ingase ingathathi izici zokuxilonga futhi ingenza kube nzima ukuhumusha kwe-histopathologic. Ku-Spitz nevi ye-classic eqinisekisiwe nge-histologically enezici ezithokozisayo kanye nemikhawulo emibi, akukho okunye ukuphathwa okudingekayo. Ukuqhubeka okujwayelekile ukuze kuqaphe ukuvuselelwa kuyas recommended, ngokuhlinzwa kabusha uma lesi sifo sibuya.

Ku-atypical Spitz tumors (ASTs), ukuphathwa kuphikisana kakhulu. Ukuvumelana kwamanje kwe-ASTs ezinganeni nasezintsheni kukhuthaza ukuhlinzwa kabusha okuphelele ngemikhawulo ecacile (ngokuvamile imithathu emilimitha) kanye nokulandela ngokucophelela kwekliniki. I-sentinel lymph node biopsy (SLNB) ye-ASTs ezinganeni iyaphikiswa — nakuba kuze kube ngu-50% ye-ASTs kungase kubonakale i-sentinel node positivity, ukubaluleka kwekliniki kwezinhlayiya ezinhle ku-atypical spitzoid tumors ezinganeni kuhluke ku-melanoma, futhi iningi lezinhlayiya ezinhle aliholeli ekutheni kube nokuhlaselwa kude noma ukufa.

Abaningi ochwepheshe manje bakhuthaza ukungawenzi i-SLNB ejwayelekile ye-pediatric ASTs, begcina lokhu ezifo ezineziqu ezikhathazayo ze-molecular noma ze-histologic. Kubantu abadala, i-SLNB ivame ukwenziwa kakhulu ku-ASTs ngoba ubungozi beziphumo ezimbi buphakeme futhi amathuba okuhlola i-melanoma akhula ngokuhamba kweminyaka. Noma iyiphi i-lesion ehlukaniswe njenge-spitzoid melanoma, ukuphathwa kulandela imihlahlandlela yokwelashwa kwe-melanoma okuhlanganisa ukuhlinzwa okukhulu kwendawo enezikhala ezifanele kanye ne-sentinel lymph node biopsy.

I-nodule ekhula ngokushesha, ebomvu noma ephekiwe ebusweni bomntwana noma esikhumbeni somuntu omdala ibangela ukukhathazeka okuphuthumayo. I-Skinscanner inikeza ukuhlolwa kokuqala okusheshayo okuqhutshwa yi-AI uma uthatha isithombe salesi sifo, ihlola izici zaso zokubukeka — ukujwayeleka kwesimo, ukuvumelana kombala, ukucaciswa kwemikhawulo, ubuchwepheshe besikhumba, kanye nosayizi — ngokumelene namaphethini ahlobene ne-Spitz nevi ezinhle nezici ezikhathazayo eziphakamisa izifo eziningi ezingajwayelekile noma i-melanoma. I-AI ingakwazi ukuqaphela ukuveza okujwayelekile kwe-Spitz nevus — i-papule ebomvu, elula, enesimo esifana ne-dome — futhi ihlukanise kusuka kubukeka obungajwayelekile, obungafani, obunemibala eminingi obuphakamisa i-melanoma.

Kwizinguqulo eziphekiwe, uhlelo luhlola ukujwayeleka nokujwayeleka kwephatheni le-pigment. I-Skinscanner ibalulekile njengethuluzi lokuhlola lokuqala kubazali ababona isifo esisha, esikhulayo emntwaneni wabo. Uhlelo lunikeza umongo ophuthumayo mayelana nalokho lesi sifo singaba yinto, kunciphisa ukukhathazeka uma izici zikhuthazayo ngenkathi zikhuthaza ukuhlolwa kwezobuchwepheshe uma ukubukeka kungajwayelekile.

Kubantu abaqapha izifo ezikhona ze-spitzoid, ukuthwebula izithombe okuqhubekayo kusiza ukuqopha ukuzinza noma ushintsho ngokuhamba kwesikhathi — ulwazi olubalulekile lokwenza izinqumo eziphathelene nezokwelapha. I-Skinscanner ayithathi indawo yokuhlola kwe-dermoscopic kanye nokuhlolwa kwe-histopathologic, okuyizinto ezibalulekile zokuxilongwa okuqondile kwe-spitzoid lesions. Noma iyiphi i-nodule entsha, ekhula, noma eshintshayo ebomvu noma ephekiwe — ikakhulukazi eyingxenye engajwayelekile, enombala omningi, noma enkulu kune-centimeter eyodwa — kufanele ihlolwe udokotela wezokwelapha. Kodwa i-Skinscanner isiza ukuhlanganisa umgwaqo phakathi kokubona isifo nokuthola ukunakekelwa kwezobuchwepheshe.