Abstract：
Objective: To investigate the clinicopathological, immunohistochemical and molecular characteristics of cutaneous ALK-rearranged Spitz melanocytoma. Methods: Two cases of cutaneous ALK-rearranged Spitz melanocytoma from outside hospital consultations in Department of Pathology, Affiliated Cancer Hospital of Fudan University in August 2020 and in Shanghai Ackermann Medical Laboratory in June 2022 were collected. The clinicopathological features, immunophenotypes and molecular profiles of two patients with cutaneous Spitzoid melanocytic tumor harboring ALK-rearrangement were analyzed. The literatures were reviewed. Results: The study included an 8-year-old boy and an 11-year-old girl, who presented with a polypoid lesion in the skin of right thigh and left auricle measuring 1.0 cm and 1.2 cm, respectively. Histologically, they were composed of medium to large-sized epithelioid to plump spindle cells, arranged in nested, plexiform or fascicular patterns in the superficial dermis. The neoplastic cells had abundant eosinophilic cytoplasm with round to ovoid vesicular nuclei containing prominent eosinophilic nucleoli. One case showed mild to moderate nuclear pleomorphism and mitotic activity (average, 2/mm2). Immunohistochemically, the epithelioid and plump spindle cells showed diffuse and strong staining of S-100 protein, SOX10, and ALK (D5F3 and 1A4), but did not express HMB45, PNL2 and MiTF. ALK-rearrangement was detected by fuorescence in situ hybridization in both cases. Subsequent next generation sequence (NGS) analysis identified KANK1::ALK and TPM3:ALK fusions. At 34 and 14 months after surgical resection, both patients remained well with no signs of recurrence or metastasis. Conclusions: ALK-rearranged Spitz melanocytoma represents a morphologically and genetically distinct subset of Spitz melanocytoma, characterized clinically by predilection in children and adolescents, with Spitzoid morphology in plexiform pattern, positive immunohistochemical stains, and rearrangement of ALK. As some cases show atypical features and high mitotic activity, a distinction from Spitz melanoma is warranted.
目的： 探讨间变性淋巴瘤激酶（ALK）重排Spitz黑色素细胞瘤（ALK rearranged Spitz melanocytoma）临床病理、免疫组织化学及分子病理学特征。 方法： 收集复旦大学附属肿瘤医院病理科2020年8月院外会诊病例及上海阿克曼医学检验所2022年6月会诊病例，共2例皮肤ALK重排Spitz黑色素细胞瘤。回顾性分析其临床病理学资料，分别进行光镜观察、免疫组织化学标记和分子检测，并复习相关文献。 结果： 2例病例，男性和女性各1例，年龄分别为8岁和11岁。表现为右大腿和左耳廓皮肤息肉样新生物，最大径分别为1.0 cm和1.2 cm。镜下观察，肿瘤由中等偏大的上皮样至胖梭形细胞组成，在皮肤真皮浅层内呈巢状、丛状或束状排列。瘤细胞胞质丰富，嗜伊红色，核呈圆形或卵圆形，可见小核仁。例2瘤细胞显示轻至中度多形性，并可见核分裂象（平均2个/mm2）。免疫组织化学标记显示，瘤细胞弥漫表达S-100蛋白、SOX10和ALK（1A4和D5F3），不表达HMB45、PNL2和MiTF。荧光原位杂交检测显示均有ALK基因重排。二代测序分别检测出KANK1：：ALK融合和TPM3：：ALK融合基因。2例病例分别随访34和14个月，均无复发或转移。 结论： ALK重排Spitz黑色素细胞瘤是Spitz黑色素细胞瘤的一种少见分子亚型，好发于儿童和青少年，以具有Spitz样形态、丛状生长方式、弥漫表达ALK和ALK融合基因为特征。部分病例显示多形性和核分裂活性，需注意与Spitz黑色素瘤相鉴别。.
目的： 探讨间变性淋巴瘤激酶（ALK）重排Spitz黑色素细胞瘤（ALK rearranged Spitz melanocytoma）临床病理、免疫组织化学及分子病理学特征。 方法： 收集复旦大学附属肿瘤医院病理科2020年8月院外会诊病例及上海阿克曼医学检验所2022年6月会诊病例，共2例皮肤ALK重排Spitz黑色素细胞瘤。回顾性分析其临床病理学资料，分别进行光镜观察、免疫组织化学标记和分子检测，并复习相关文献。 结果： 2例病例，男性和女性各1例，年龄分别为8岁和11岁。表现为右大腿和左耳廓皮肤息肉样新生物，最大径分别为1.0 cm和1.2 cm。镜下观察，肿瘤由中等偏大的上皮样至胖梭形细胞组成，在皮肤真皮浅层内呈巢状、丛状或束状排列。瘤细胞胞质丰富，嗜伊红色，核呈圆形或卵圆形，可见小核仁。例2瘤细胞显示轻至中度多形性，并可见核分裂象（平均2个/mm2）。免疫组织化学标记显示，瘤细胞弥漫表达S-100蛋白、SOX10和ALK（1A4和D5F3），不表达HMB45、PNL2和MiTF。荧光原位杂交检测显示均有ALK基因重排。二代测序分别检测出KANK1：：ALK融合和TPM3：：ALK融合基因。2例病例分别随访34和14个月，均无复发或转移。 结论： ALK重排Spitz黑色素细胞瘤是Spitz黑色素细胞瘤的一种少见分子亚型，好发于儿童和青少年，以具有Spitz样形态、丛状生长方式、弥漫表达ALK和ALK融合基因为特征。部分病例显示多形性和核分裂活性，需注意与Spitz黑色素瘤相鉴别。.
摘要：
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