Fleksural bölge yerleşimli nevüslerin dermoskopik ve histolojik özelliklerinin retrospektif incelenmesi
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Dosyalar
Tarih
2018
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Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Vücudun özel bölge olarak adlandırılan anatomik alanlarında görülen benign melanositik nevusların, diğer bölge nevuslarına göre daha atipik histopatolojik özellikler sergileyebildiği savunulmaktadır. Özel bölge nevüsü olarak adlandırılan bu nevüsler, akral bölgeler, saçlı deri, genital bölgeler, fleksural bölgelerde görülmektedir. Bu çalışmada fleksural alanlardan eksize edilen nevüslerin dermoskopik ve histopatolojik özellikleri değerlendirilmiştir. Çalışmada aksiller, meme, periumblikal, inguinal, mons pubis, skrotum, labium majus ve intergluteal alanlardan eksize edilmiş 75 melanositik nevüsün klinik, dermoskopik ve histopatolojik özellikleri değerlendirildi. Dermoskopik inceleme yapılırken lezyonların klinik fotoğrafları lokalizasyon anlaşılamayacak şekilde düzenlendi. Tüm lezyonlara ait preparatlar patolog tarafından önce anatomik lokalizasyon bilgisi verilmeden ve daha sonra lokalizasyon bilgisi verilerek iki kez değerlendirildi. Nevüslerin ortalama boyutu ise 0,86 cm tespit edildi. Nevüslerin %80'ni kahverengi ve tonlarındaydı. En sık görülen dermoskopik patern retiküloglobüler(%25,3) paterndi. Kırık ağ yapısı görülen 6 nevüs de meme yerleşimliydi. Nevüslerde en sık görülern dermoskopik özellikler düzensiz nokta(%60), asimetri(%56), eritem(%50,6), düzensiz globül(%48) şeklindeydi. Histopatolojik incelemede nevüslerin %50'sinde dermal ve yuva paterni görüldü. En sık görülen histopatolojik özellikler ise akantoz (%61,3), host reaksiyonu(%57,3), damarlanmada artış(%53,3), sitolojik atipi(%41,3) şeklindeydi. Her iki patoloji değerlendirmesindeki tanılar ve bunların dermoskopi tanıları birbirleriyle uyumluydu. Yani displastik nevüs veya erken melanom açısından önem taşıyan dermoskopik yapılar saptandığında tanı histopatolojik olarak da displastik nevüs olmuştur. Bu çalışmaya melanom tanısı almış lezyonlar dahil edilmemiştir. Diğer yandan konjenital nevüslerde görülebilen klasik dermoskopik özellikler de yine bu bölgelerde görülen konjenital nevüslerde benzer şekilde izlenmiştir. Fleksur yerleşimli nevüslerin değerlendirilmesinde lezyonun dermoskopik ve histopatolojik bulguların birlikte yorumlanması gerektiğini düşünmekteyiz. Hem dermoskopik hem histopatolojik açıdan atipik olan bir lezyonun, sadece fleksural anatomik bölgede yerleşmesinden dolayı gerçek anlamda atipik lezyon doğasında olmadığını ileri sürebilecek bir kanıt literatürde yoktur. Çalışmamızda fleksur yerleşimli nevüslerde, dermoskopik ve histopatolojik tanı uyumsuzluğuna sebep olabilecek bir özellik saptamadık.
It is asserted that benign nevi of anatomical locations so called special sites have more atypical characteristics compared to nevi of other sites.Called as special site nevi, these nevi are seen in acral sites, scalp, genital and flexural regions. In this study, nevi excised from flexural regions are assessed in terms of dermoscopy and histopathology. In this study, dermoscopic and histopathologic charecteristics of 75 melanocytic nevi excised from axillary , breast, periumbilical, inguinal, mons pubis, scrotum, intergluteal areas and labium majus were evaluated. In dermoscopic evaluations, clinical photographs of lesions were lined so that the observer did not have the localization knowledge of nevi. All pathology specimens were evaluated by pathologists two times firstly without the localization information and then with localization information. Average size of nevi was determined as 0,86 cm. %80 of nevi were in in brown and its tones.The most frequent pattern was reticulo-globular pattern ( %25,3) . All six nevi having broken-up network were localized in breasts. The most frequent dermoscopic charecteristics seen in nevi were irregular dots (%60), asymmetry (%56), erythema (%50,6), irregular globules ( %48) . In histopathologic examination , in %50 of nevi ,dermal and nest patterns were observed. The most frequent histopathologic charecteristics were acanthosis(%61,3 ), host reaction (%57,3) , increased vascularization (%53,3), cytologic atypia( %41,3). Nevi identifications based on two pathological evaluations were consistent with each other and with dermoscopic evaluation. In other words, when dermoscopic structures consistent with dyplastic nevi criteria and early melanoma criteria were found , histopathological examination was also consistent with dysplastic nevus. Lesions with melanoma diagnosis were excluded from the study. On the other hand, classical dermoscopic features seen in other sites congenital nevi were also observed in special site congenital site nevi. We think, evaluation of flexural sites localized nevi should be based on both of dermoscopic and histopathologic findings. There is no evidence in literature which can state that a lesion atypical in terms of dermoscopy and histopathology can be evaluated as not a truely atypical lesion just because of its flexural anatomic localization. In our study, we didn‟t detect any feature which may cause dermoscopic and histopathologic diagnostic inconsistency.
It is asserted that benign nevi of anatomical locations so called special sites have more atypical characteristics compared to nevi of other sites.Called as special site nevi, these nevi are seen in acral sites, scalp, genital and flexural regions. In this study, nevi excised from flexural regions are assessed in terms of dermoscopy and histopathology. In this study, dermoscopic and histopathologic charecteristics of 75 melanocytic nevi excised from axillary , breast, periumbilical, inguinal, mons pubis, scrotum, intergluteal areas and labium majus were evaluated. In dermoscopic evaluations, clinical photographs of lesions were lined so that the observer did not have the localization knowledge of nevi. All pathology specimens were evaluated by pathologists two times firstly without the localization information and then with localization information. Average size of nevi was determined as 0,86 cm. %80 of nevi were in in brown and its tones.The most frequent pattern was reticulo-globular pattern ( %25,3) . All six nevi having broken-up network were localized in breasts. The most frequent dermoscopic charecteristics seen in nevi were irregular dots (%60), asymmetry (%56), erythema (%50,6), irregular globules ( %48) . In histopathologic examination , in %50 of nevi ,dermal and nest patterns were observed. The most frequent histopathologic charecteristics were acanthosis(%61,3 ), host reaction (%57,3) , increased vascularization (%53,3), cytologic atypia( %41,3). Nevi identifications based on two pathological evaluations were consistent with each other and with dermoscopic evaluation. In other words, when dermoscopic structures consistent with dyplastic nevi criteria and early melanoma criteria were found , histopathological examination was also consistent with dysplastic nevus. Lesions with melanoma diagnosis were excluded from the study. On the other hand, classical dermoscopic features seen in other sites congenital nevi were also observed in special site congenital site nevi. We think, evaluation of flexural sites localized nevi should be based on both of dermoscopic and histopathologic findings. There is no evidence in literature which can state that a lesion atypical in terms of dermoscopy and histopathology can be evaluated as not a truely atypical lesion just because of its flexural anatomic localization. In our study, we didn‟t detect any feature which may cause dermoscopic and histopathologic diagnostic inconsistency.
Açıklama
Anahtar Kelimeler
Özel Bölge Nevüsü, Fleksural Nevüs, Dermoskopi, Dermatopatoloji, Special Site Nevus, Flexural Nevus, Dermoscopy, Dermatopathology
