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c25t3P1 (case 780): The lesion is polypoid; a lentiginous and junctional component extends in the epidermis to the left away from the polypoid component. The epidermis is hyperplastic; over the polypoid portion, the patterns are verrucoid. In the polypoid portion, small nests of “epithelioid cells” are closely spaced in a typical vertical growth pattern. Thin band-like infiltrates of lymphoid cells outline the deep margin of the lesion; the pattern is level III.
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c25t3P2: To the left of the center of the field, the nests and fascicles of cells are loosely spaced in the widened papillary dermis. In this area, some of the fascicles “rain down” into the dermis. Also in this area, there is evidence of maturation from the superficial to the deep margin of the lesion. There is loss of cohesion in the fascicles that extend from the epidermis into the dermis.
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c25t3P3: Atypical epithelioid cells form closely spaced, small nests in the deeper portion of the lesion. The cells show moderate nuclear atypia. The band-like infiltrates have migrated into some of the nests of neoplastic cells to produce halo nevus-like patterns. In the nests, there is loss of cellular cohesion. Neoplastic cells in the lymphoid infiltrates have plump, rounded nuclei; they have dense nuclear chromatin. In these areas, the cytologic features are of a type commonly encountered in the dermal component of halo “nevus.” The pattern is level III.
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c25t3P4: In the vertical growth component, small nests of atypical cells are closely spaced. There areas of nuclear pleomorphism with scattered tumor giant cells. Halo nevus-like phenomena are represented at the deep margin. I wonder if, by some criteria, this lesion might qualify as Spitz nevus with halo nevus-like phenomena.
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c25t3P5: The polypoid portion is represented to the left. To the right, lentiginous and junctional patterns extend in the epidermis. There is upward migration of cells into the epidermis. In the junctional component, there is loss of cellular cohesion. To the left, the widened papillary dermis shows lamellar fibrosis. Lymphoid infiltrates are mild.
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c25t3P6: The patterns are Spitz nevus-like. Fascicles of cells rain down into the widened papillary dermis. There is loss of cellular cohesion in the nests and fascicles. The epidermis is hyperplastic in a pattern commonly seen in Spitz-like variants. Vessels are ectatic. On the other hand, there is cytologic atypia with nuclear pleomorphism.
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