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c28t3P1 (case 8570): The epidermis is hyperplastic with elongation of rete ridges. There are focal lentiginous and junctional patterns; just to the left of the center of field, the cells of the lentiginous and junctional component show loss of cellular cohesion. The patterns in the dermis, at this magnification, have a common nevus-like quality. There are nests and fascicles in the dermis; the nests of cells are darker near the lateral margins of the section. Perhaps, the cells are more heavily pigmented in this area; perhaps, the cells in the more central areas of the dermal component are more epithelioid. The lesion extends in the dermis, and the epidermis to the lateral margins.
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c28t3P2: At a higher magnification, the cells of the nests and fascicles near the left margin are small and dark. To the right of this area, the cells are more epithelioid; they have more abundant, pale acidophilic cytoplasm; the nuclei of the cells appear to be more widely spaced. The red arrows identify areas with an ill-defined micro-nodular quality. The perivascular spaces of the reticular dermis are relatively free of lymphoid infiltrates. The basic pattern resembles that of a common nevus, but there are deviations cytologically and histologically. In the lentiginous and junctional components the atypia is moderately severe, and the cells of the junctional components are loosely attached to their neighbors.
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c28t3P3: Nevoid qualities are again evident in this field. Micro-nodular patterns are not well developed. Some of the small nevus-like cells at the deep, advancing margin extend into the upper portion of the reticular dermis in nevus cell-like patterns. The dermis is relatively free of inflammation. There are focal lentiginous patterns. In the dermal component, near the dermal-epidermal interface, the neoplastic cells are larger; they have enlarged, hyperchromatic nuclei.
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c28t3P4: The degree of atypia in the dermal component is moderate. The nuclei are slightly enlarged, and show variations in size and outlines. Some of the cells are outlined by delicate membranes in nevus cell-like patterns. In this field, the pattern is mostly dermal.
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c28T3P5: There is moderate cytologic atypia; the cells are somewhat epithelioid in character. An occasional nucleus is enlarged with marginated chromatin, and with a central nucleolus. The cytologic features are common nevus cell-like.
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c28t3P6: In this area in the deeper portion of the dermal component, the nevus cell-like qualities are well developed; there is “maturation.”
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c28t3P7: Atypia is most advanced in the junctional nests; in addition, there two acidophilic bodies. If an observer accepted the two bodies as Kamino bodies and, in addition, promoted the “epithelioid” qualities, would he then favor the interpretation that this a Spitz variant? It would be a stretch.
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c28t3P8: Focally, the lentiginous component is represented; in it, the atypia is moderately severe. In the subjacent dermal component, the atypia is moderately severe with some degree of nuclear pleomorphism. The epithelioid qualities are somewhat more prominent in this same area. Near the bottom of this field, the cells are smaller and more nevus cell-like. This is a nevus cell-like MDM. It measured 0.57 mm in vertical dimensions. At the time of excision of the primary lesion, 2 satellite lesions were noted. A superficial femoral lymph node dissection was performed; the lesion had metastasized (solitary focus) to a regional lymph node. At 2 years, there was no evidence of disease.
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