皮脂腺痣并发基底细胞癌1例

患者女,65岁。右侧头面颈部皮疹65年,进行性加重2年。皮疹呈疣状,发于单侧,曾诊断为“疣状痣”,经组织病理检查,确诊为皮脂腺痣并发基底细胞癌     

皮脂腺痣伴多发基底细胞癌1例

皮脂腺痣是一种表皮、真皮及皮肤附属器所构成的器官样痣,临床上常见,通常出生即有,好发于头面部。皮脂腺痣可以伴发多种皮肤肿瘤,基底细胞癌是皮脂腺痣最常伴发的皮肤恶性肿瘤之一,但伴多发基底细胞癌患者并不常见,本文现报告1例。     

皮脂腺痣并发基底细胞癌二例

正临床资料病例1:患者,男,66岁。2015年10月因头皮斑块66年,近1年出现黑色斑点来诊。患者出生时,左枕部头皮即有数个黄豆大斑疹,淡黄色,无自觉症状,未予治疗。十几岁时斑疹聚集并形成斑块,表面光滑无毛发生长。之后的几十年无不适症状和明显变化。近1年无明显诱因皮损中央出现数个灰黑色丘疹。局部无痛痒、破溃、糜烂、渗出。既往体健,家族中无类似疾病史。体检:一般情况可,系统检查无异常。皮肤科检查:左枕部头皮见约5 cm×3 cm淡黄色斑块,质软,皮损中可见数个散在的绿豆大灰黑色丘疹(图1a)。组     

皮脂腺痣并发鳞状细胞癌1例

1 病历摘要 患者男,54岁.右颞部斑块54年,其上出现肿块3年,于2009年4月21日就诊于我科门诊.患者出生后不久发现右颞部有绿豆大黄色斑块,上无毛发,以后随年龄增长,皮损逐渐缓慢扩大,青春期时增大明显,因无明显自觉症状,故一直未治疗.3年前无意间发现头部黄色斑块处出现一黑褐色豆粒大结节,初起时结节表面光滑,以后逐渐增大、隆起,表面渐变粗糙、破溃、结痂,不久痂脱落愈合,未接受任何诊治.1个月前结节明显增大、破溃,且面积逐渐扩大,易出血.在当地医院反复抗感染及局部换药治疗无效,为进一步诊断与治疗来诊.既往史:体健,否认有肝炎、结核等传染病史.家族史:否认有遗传皮肤病及肿瘤病史.     

皮脂腺痣并发基底细胞癌1例

<正>临床资料患者女,53岁。因头皮斑块53年,近6个月破溃渗出来诊。患者出生时头皮有一块淡黄色斑片,表面粗糙伴有毛发缺失,未进行任何治疗。随年龄增长,斑片面积逐渐增大,形成橘黄色疣状斑块。近6个月皮损破溃渗出,并伴有轻微疼痛,遂来我科就诊。患者家族中无类似疾病患者,系统检查未     

皮脂腺痣并发乳头状汗管囊腺瘤和基底细胞癌1例

皮脂腺痣是一种由多种皮肤结构组成的错构瘤,可并发多种肿瘤[1-2].本病向肿瘤转化的概率为10% ～ 20%[3].现将我科诊治的1 例皮脂腺痣并发乳头状汗管囊腺瘤和基底细胞癌报告如下.     

皮脂腺痣并发基底细胞上皮瘤1例

1临床资料患者女,32岁。因头皮淡黄色斑块32年伴灰黑色隆起状肿物2年,于2016年8月6日就诊我院皮肤外科门诊。患者自述出生后不久头皮出现1个黄豆大淡黄色斑块,偶有瘙痒,未曾诊疗。青春期时皮损逐渐增大,就诊于当地医院,诊断为“皮脂腺痣”,未给予治疗。2年前淡黄色斑块周边出现1个灰黑色边缘隆起的圆形斑片,未予重视,斑片逐渐增大至直径1cm小结节。     

头皮黄色疣状斑块伴灰黑色结节——皮脂腺痣并发基底细胞癌

诊断:皮脂腺痣并发基底细胞癌. 皮损组织病理:表皮角化过度,表皮突延长,皮脂腺增生,且无对应之毛囊.真皮深部及皮下脂肪内可见汗腺:另见界限清楚的肿瘤团块,部分与表皮相连.肿瘤团块中及周围混有单个或巢状皮脂腺分化细胞.团块由基底样细胞组成,周边细胞排列成栅栏状,可见收缩间隙.     

皮脂腺痣并发乳头状汗管囊腺瘤及基底细胞癌

报告1例皮脂腺痣患者,曾接受数次肿块平皮面削除手术后复发,全部皮损经组织病理学检查,病理诊断为皮脂腺痣并发乳头状汗管囊腺瘤及基底细胞癌.故皮脂腺痣皮损应彻底切除,并送组织病理检查,而不宜简单进行削平.     

多发性皮脂腺痣1例

患儿女,3天。出生时头、面、颈部即见多发性黄红色斑块伴疣状或脑回状增生。诊断:泛发型皮脂腺痣。     

Ten cases of sebaceous carcinoma arising in nevus sebaceus

Although nevus sebaceus is known to develop various types of secondary neoplasms, it rarely causes carcinoma and only 14 cases of secondary sebaceous carcinoma have been reported. In this study, 10 cases of sebaceous carcinoma arising in nevus sebaceus were collected. The clinicopathological features and results of immunohistochemical examinations with adipophilin, perilipin and p53 were summarized. Sebaceous carcinoma arising in nevus sebaceous predominantly occurred on the scalp (8/10) of elderly women (mean age, 67.7 years). No case was associated with Muir–Torre syndrome. We found several pathological features of sebaceous carcinoma; that is, made up mainly of germinative cells, moderate nuclear atypia without pleomorphism and many mitoses (4–28/10 high‐power field). Adipophilin and perilipin antibodies highlighted lipid drops in the cytoplasm of the malignant cells in all cases. Overexpression of p53 was seen in all cases. In two cases there were coexisting benign‐looking sebaceous lesions at the periphery of the main cancer nodule, and in these lesions p53 showed low positivity compared with the clearly malignant area. There was co‐occurrence of another neoplasm in three cases with trichoblastoma, sebaceoma and syringocystadenoma papilliferum, respectively. All cases were treated by excision of the malignant lesion, with or without inclusion of the nevus sebaceus. In a follow‐up period of 1–7 years, there was no case of recurrence, lymph node metastases or distant metastases. With these specific pathological and immunohistochemical findings using adipophilin, perilipin and p53, we have to consider the possibility that there is a tendency to underdiagnose secondary sebaceous carcinomas in nevus sebaceus. These clinicopathological features of sebaceous carcinomas developing in the nevus sebaceus seem to indicate different biological entities from de novo sebaceous carcinoma.     

Sebaceous carcinoma arising in nevus sebaceus

A 53-year-old woman had had a pale-brown lesion on her right cheek and neck from birth. Since she was about 40 years old, part of the lesion had gradually elevated and increased in size. At the first examination, there was a huge mass measuring 110 x 70 x 35 mm on the right cheek. A wide local excision of the area including a superficial parotidectomy and submandibular lymph node dissection was performed, followed by full thickness skin grafting. Histological examination of the tumor revealed an invasive dermal neoplasm characterized by lobes that were composed of foamy cells stained with Sudan-IV mixed with many atypical cells showing remarkable variation in the shapes and sizes of their nuclei. The surrounding epithelial changes were consistent with nevus sebaceus. From these findings, the gigantic tumor was diagnosed as a sebaceous carcinoma arising in nevus sebaceus.     

皮脂腺痣并发毛母细胞瘤

报告1例皮脂腺痣并发毛母细胞瘤。患者女,39岁。出生即发现右侧耳周芝麻至粟粒大褐色丘疹。皮肤科检查:右侧耳前部可见条带状斑块,呈蜡样光泽,其上有结节,局部糜烂及结痂;右侧耳后部可见密集分布的蜡黄或棕褐色角化性丘疹或斑块,边界清楚。皮损组织病理检查:表皮突延伸,区域表皮长出多个原始的毛乳头样结构,周边细胞呈栅栏状排列;真皮层可见结节状的毛母细胞瘤以及大量皮脂腺结构,下方无毛囊。诊断:皮脂腺痣并发毛母细胞瘤。治疗:予手术切除。     

Secondary neoplasms arising from nevus sebaceus: A retrospective study of 450 cases in Taiwan

Nevus sebaceus is frequently associated with the development of secondary neoplasms. Incidences of malignant transformation vary among different reports and few data is available regarding Asian populations. We aimed to determine the characteristics of secondary tumors developing from nevus sebaceus in a Taiwanese population and to review the published work. Patients with clinically and histologically confirmed nevus sebaceus were identified from 1992 to 2012 in a medical center. Among the 450 cases of nevus sebaceus, 38 secondary neoplasms were noted, accounting for 8.5% of all cases. Benign tumors represented more than 80% of all tumors. Syringocystadenoma papilliferum (2.7%) was the most common benign tumor, followed by trichoblastoma (1.6%) and trichilemmoma (1.6%) whereas basal cell carcinoma (0.9%) was the most frequent malignant tumor on nevus sebaceus and its clinical features were not typical. All the malignant tumors on nevus sebaceus were noted only in adulthood and the mean age of those with basal cell carcinoma was significantly older than that of trichoblastoma (P = 0.028). Our study concludes that malignant transformation is rare in nevus sebaceus and occurs uniquely in adulthood. On the basis of the findings, prophylactic excision of nevus sebaceus can be elective during childhood but is strongly advocated at puberty due to the increased risk of malignant transformation with time.     

Tumors associated with nevus sebaceous

Background: Nevus sebaceus (NS) is a congenital hamartomatous lesion, usually involving the scalp or the face. Various benign and malignant neoplasms can develop in association with NS, the most common being trichoblastoma, syringocystadenoma papilliferum, viral warts and basal cell carcinoma (BCC). Patients and methods: We retrospectively examined the clinical and histopa‐thological records of 15 NS cases with an associated tumor which were diagnosed between 1996 and 2004. Results: All cases were adults and 3 of them had more than one tumor. Six cases had BCC, which is a higher incidence of malignant tumor association with NS, than that reported in last years. Trichoblastoma was observed in 3 cases and was the most common benign tumor in our series. Filiform, hyperkeratotic, pigmented, pedunculated and/or eroded papulonodular changes were major clinical signs of secondary tumors on NS in our series. Conclusion: Clinical features are not sufficient enough to make an exact diagnosis of benign or malignant secondary tumors. Though prophylactic excision for NS is done less in last years, especially adult patients should closely be followed for any new changes evoking tumor development on this congenital lesion.     

Treatment of basal cell carcinoma

Basal cell carcinoma is the most common tumor in Central Europe, the U.S. and Australia. The increasing incidence of basal cell carcinoma presents the health care system, especially dermatology, with great challenges. In recent years new options for treating basal cell carcinoma have become available, enriching our therapeutic options. We review the current status of each of these treatment approaches.     

Sarcomatoid carcinoma arising in the congenital pigmented nevus after treatment with carbon dioxide snow freezing method

We report a case of sarcomatoid carcinoma of the skin in a 63‐year‐old man who was treated with the carbon dioxide snow freezing method for a huge congenital pigmented nevus that extended from the right upper extremity to the right trunk during childhood. He had an exophytic red tumor on the nevus in the right upper extremity that grew slowly for 4 years and rapidly recently. Histological and immunohistochemical studies revealed both epithelial and mesenchymal malignancy in the same tumor. The epithelial component was composed of basaloid cells forming multiple nests with peripheral palisading, positive for keratins and BerEP4, implying basal cell carcinoma. The mesenchymal component was composed of spindle‐shaped cells negative for keratins and positive for vimentin, suggesting sarcoma. This is, to our knowledge, the first report of sarcomatoid carcinoma arising in the primary pigmented nevus that had been treated by the carbon dioxide snow freezing method.     

SUFU-associated Gorlin syndrome: Expanding the spectrum between classic nevoid basal cell carcinoma syndrome and multiple hereditary infundibulocystic basal cell carcinoma

Basal cell nevus syndrome (BCNS), also known as Gorlin syndrome, is characterized by an aberrant activation of the hedgehog (Hh) pathway, most cases being caused by PTCH1 mutations. However, certain features such as multiple hereditary infundibulocystic basal cell carcinomas (MHIBCC), sclerotic fibromas, childhood medulloblastoma or meningioma may be relatively specific to a SUFU mutation. We present two patients with MHIBCC, along with a more complex cutaneous and extracutaneous phenotype. MHIBCC syndrome and BCNS may share clinical features and, indeed, both syndromes probably represent different degrees of upregulation in the Hh pathway.     

Photodynamic therapy of facial nevus sebaceous

A 29‐year‐old man visited our department with an orange‐colored patch on his right cheek. A skin biopsy confirmed the diagnosis of nevus sebaceous. As surgical excision was considered too destructive, photodynamic therapy (PDT) was proposed. Sixteen sessions of PDT was performed in total. There was a definitive but transient decrease in sebum production and destruction of the sebaceous glands. Overall, we were not able to achieve long‐lasting clinical improvement after PDT.