Nevo de Spitz atípico versus melanoma spitzoide: el papel de la hibridación fluorescente in situ en el diagnóstico de lesiones melanocíticas ambiguas.

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Rev Asoc Colomb Dermatol. 2018; 26 : 1 (enero - marzo), 24-31

Nevo de Spitz atípico versus melanoma spitzoide: el papel de la hibridación fluorescente in situ en el diagnóstico de lesiones melanocíticas ambiguas.

Atypical Spitz nevus versus spitzoid melanoma: The role of fluorescent in situ hybridization for diagnosing ambiguous melanocytic tumors.
Autor(es): 
Catalina Santa-Vélez
catalinasantavelez@yahoo.com
Fellow de Dermatología Oncológica, Instituto Nacional de Cancerología-Universidad Militar Nueva Granada, Bogotá, D.C., Colombia.
Samuel Morales
Dermatopatológo, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia.
Tatiana Indira Roncancio
Laboratorio de Genética y Oncología Molecular, Grupo de Patología Oncológica, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia
Xavier Rueda-Lozada
Dermatólogo oncólogo, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia.
Resumen: 

Se presenta el caso de una paciente de 33 años de edad, con una lesión spitzoide de reciente aparición y con características atípicas. A pesar de presentar una arquitectura globalmente simétrica, se observó falta de maduración de los melanocitos hacia la dermis profunda con más de tres mitosis por campo de gran aumento y, en la inmunohistoquímica, se observó un alto índice de proliferación. A pesar de la dificultad diagnóstica, se consideró como diagnóstico diferencial un melanoma spitzoide y se decidió usar la hibridación fluorescente in situ (fluorescent in situ hybridization, FISH), la cual fue negativa para melanoma. Se hizo el diagnóstico final de nevo de Spitz atípico teniendo en cuenta el cuadro clínico, la histopatología, la inmunohistoquímica y el resultado de la FISH, el cual se caracteriza por su gran especificidad y sensibilidad pero cuya interpretación aún es difícil.

Palabras clave: 
melanoma, hibridización in situ fluorescente, nevo, melanocíticos, inestabilidad cromosómica, hibridación genómica comparativa

Summary: 

We present the case of a 33-year old female with a 4-month history of a pigmented spitzoid lesion on her left forearm. Pathology showed a symmetric spitzoid melanocytic tumor with certain atypical characteristics such as lack of maturation and multiple mitoses. Considering the differential diagnoses being atypical Spitz nevus versus spitzoid melanoma, fluorescent in situ hybridization (FISH) was performed with a negative result. Taking into account the clinical picture, the pathology, immunohistochemistry and the FISH results a final diagnosis of atypical Spitz nevus was made. FISH technique has a high specificity and sensitivity and it is being used in most skin cancer centers around the world, but its interpretation is still controversial and difficult.

Key words: 
Melanoma, fluorescence in situ hibridization, melanocytic, nevus, chromosomal instability, comparative genomic hybridization
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