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Article

Decoding the Spitz Puzzle: Histological Patterns and Diagnostic Challenges in Everyday Pathology Practice—A Single-Center Study

by
Iuliu Gabriel Cocuz
1,2,
Georgian-Nicolae Radu
2,*,
Maria Cătălina Popelea
2,3,
Raluca Niculescu
1,2,
Maria Elena Cocuz
4,5,
Adrian-Horațiu Sabău
1,2,
Andreea-Cătălina Tinca
1,2,
Andreea Raluca Cozac-Szoke
1,2,
Bogdan Pastor
2,
Diana Maria Chiorean
1,2,
Corina Eugenia Budin
1,6,
Irina Bianca Kosovski
1,7 and
Ovidiu Simion Cotoi
1,2
1
Pathophysiology Department, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
2
Clinical Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania
3
Histology Department, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
4
Fundamental Prophylactic and Clinical Disciplines Department, Faculty of Medicine, Transilvania University of Brasov, 500003 Brașov, Romania
5
Clinical Pneumology and Infectious Diseases Hospital of Brasov, 500174 Brasov, Romania
6
Pneumology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania
7
Clinical Laboratory Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania
*
Author to whom correspondence should be addressed.
Medicina 2025, 61(8), 1501; https://doi.org/10.3390/medicina61081501 (registering DOI)
Submission received: 20 June 2025 / Revised: 5 August 2025 / Accepted: 20 August 2025 / Published: 21 August 2025
(This article belongs to the Section Oncology)
Versions Notes

Abstract

Background and Objectives: Spitz tumors represent a diagnostic challenge in dermatopathology due to their large spectrum of morphological characteristics and overlap with malignant lesions, especially in pathology departments where molecular pathology is not available. Even though most Spitz lesions are benign, the uncertainty around their biological behavior necessitates an integrated approach in daily practice. The objective of our study was to evaluate the epidemiological, macroscopic, and histopathological characteristics of Spitz lesions in accordance with WHO Classification of Skin Tumours. Materials and Methods: We performed a retrospective, descriptive, and hypothesis-generating study on Spitz tumors diagnosed between 2018 and 2024 in the Clinical Pathology Department of the Mures Clinical County Hospital, Romania. We included 10 cases and analyzed their macroscopic characteristics (localization, shape, dimension, and color), microscopic characteristics (cellular types, cytologic atypia, pagetoid migration, mitoses, and the type of lesion), and immunohistochemical profile. Results: The study population was composed of young patients with an average age of 20.2 years old, with a slight predominance of female gender. Most lesions were Spitz nevi, intradermic, or compound, with a fusiform, epithelioid, or rhomboid cell shape. Pagetoid migration and cytological atypia were seen in fewer cases. The Ki 67 proliferation index was under 5% in all cases. The main limitation of this study involved the low number of cases and the lack of molecular testing, which limited the molecular characterization of Spitz tumors. Complete excision was performed in all cases. Conclusions: In the absence of molecular testing, our study emphasizes the importance of clinical–morphological assessment using immunohistochemistry in establishing a correct diagnosis in Spitz lesions. Our results confirm that most of the Spitz lesions were benign and provide a basis for future research with a multidisciplinary approach, including molecular testing.
Keywords: Spitz tumors; histopathology; immunohistochemistry; diagnostic challenges Spitz tumors; histopathology; immunohistochemistry; diagnostic challenges

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MDPI and ACS Style

Cocuz, I.G.; Radu, G.-N.; Popelea, M.C.; Niculescu, R.; Cocuz, M.E.; Sabău, A.-H.; Tinca, A.-C.; Cozac-Szoke, A.R.; Pastor, B.; Chiorean, D.M.; et al. Decoding the Spitz Puzzle: Histological Patterns and Diagnostic Challenges in Everyday Pathology Practice—A Single-Center Study. Medicina 2025, 61, 1501. https://doi.org/10.3390/medicina61081501

AMA Style

Cocuz IG, Radu G-N, Popelea MC, Niculescu R, Cocuz ME, Sabău A-H, Tinca A-C, Cozac-Szoke AR, Pastor B, Chiorean DM, et al. Decoding the Spitz Puzzle: Histological Patterns and Diagnostic Challenges in Everyday Pathology Practice—A Single-Center Study. Medicina. 2025; 61(8):1501. https://doi.org/10.3390/medicina61081501

Chicago/Turabian Style

Cocuz, Iuliu Gabriel, Georgian-Nicolae Radu, Maria Cătălina Popelea, Raluca Niculescu, Maria Elena Cocuz, Adrian-Horațiu Sabău, Andreea-Cătălina Tinca, Andreea Raluca Cozac-Szoke, Bogdan Pastor, Diana Maria Chiorean, and et al. 2025. "Decoding the Spitz Puzzle: Histological Patterns and Diagnostic Challenges in Everyday Pathology Practice—A Single-Center Study" Medicina 61, no. 8: 1501. https://doi.org/10.3390/medicina61081501

APA Style

Cocuz, I. G., Radu, G.-N., Popelea, M. C., Niculescu, R., Cocuz, M. E., Sabău, A.-H., Tinca, A.-C., Cozac-Szoke, A. R., Pastor, B., Chiorean, D. M., Budin, C. E., Kosovski, I. B., & Cotoi, O. S. (2025). Decoding the Spitz Puzzle: Histological Patterns and Diagnostic Challenges in Everyday Pathology Practice—A Single-Center Study. Medicina, 61(8), 1501. https://doi.org/10.3390/medicina61081501

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