反射式共聚焦激光扫描显微镜在光动力治疗日光性角化后随访中的应用

目的:明确反射式共聚焦激光扫描显微镜检查在光动力治疗日光性角化后随访中的应用价值。方法:对16例日光性角化患者光动力治疗后1个月、3个月、6个月分别于治疗部位行RCM扫描,如RCM扫描发现肿瘤细胞,则进一步行组织病理学检查明确诊断。结果:16例患者完成治疗后均规律复诊,并行RCM检查。其中1例光动力治疗后1个月复查,RCM下发现肿瘤细胞。2例光动力治疗后3个月复查,RCM下发现肿瘤细胞。3例均再进一步行组织病理学检查诊断明确日光性角化,其余13例患者随访6个月未发现复发。结论:RCM在光动力治疗日光性角化后随访中具有重要的应用价值。     

反射式共聚焦显微镜在多发性基底细胞癌诊断及治疗随访中的应用

目的：观察多发性基底细胞癌反射式共聚焦显微镜（RCM）影像特征,探讨RCM在多发性基底细胞癌诊断及治疗随访中的价值。方法：对在我科就诊的6例疑似多发性基底细胞癌患者64处皮损行RCM检查,62处皮损诊断为基底细胞癌,其中39处行手术切除并行组织病理检查,23处皮损外涂5%咪喹莫特乳膏治疗,治疗后RCM随访。对基底细胞癌的RCM特征进行归纳总结。结果：手术切除行组织病理检查的39处皮损均符合基底细胞癌,与RCM符合率100%,手术切除后3个月、6个月RCM随访,均未发现基底细胞癌RCM特征。外用5%咪喹莫特乳膏的 23处皮损,治疗后3个月、6个月、12个月,分别有12处、8处、4处仍有基底细胞癌RCM特征。 RCM诊断为基底细胞癌的62处皮损特征：异形角质形成细胞96.8%,与表皮相连90.3%,肿瘤细胞巢96.8%,肿瘤巢周围裂隙样暗区54.8%,肿瘤巢周边细胞栅栏状排列51.6%,肿瘤巢内高折光树枝状结构77.4%,肿瘤间质内血管增生扩张充血95.2%,肿瘤巢内及周围高折光颗粒77.4%。结论：基底细胞癌在RCM下有特征性表现,RCM可作为多发性基底细胞癌诊断及治疗随访的有效手段。     

阿维A治疗四例基底细胞上皮瘤临床观察

我们采用口服阿维A及外用0.1％的维A酸霜成功治疗4例组织病理学证实为基底细胞癌患者。治疗结束时原位组织活检,原皮损部位组织细胞形态基本正常。治疗结束后每4周随访1次,观察肿瘤是否复发。4例患者随访6个月至4年不等,均未复发。在治疗及随访期间,实验室监测血常规、肝肾功能、血脂均正常。未见明显不良反应。我们认为口服阿维A可作为老年面部基底细胞癌患者的一种新的治疗方法。     

生殖器部位基底细胞癌11例临床和病理分析

目的:分析生殖器部位基底细胞癌的临床及组织病理特点。方法:回顾第四军医大学西京皮肤医院于2007年4月—2015年4月经组织病理确诊的11例生殖器部位基底细胞癌的临床表现和组织病理特点。结果:11例患者中,男7例,女4例,平均发病年龄57岁。其中8例在术前临床诊断中误诊。11例皮损分别表现为4例红斑溃疡,边缘隆起;3例黑色斑块(其中1例呈疣状增生);2例黑色丘疹;1例黑色斑片;1例黑色结节。组织病理表现为真皮中的基底样细胞团块,周边胞核呈栅栏状排列,肿瘤周围可见裂隙。临床皮损的宽度与肿瘤浸润深度无直线相关性。除2例失访外,1例肿瘤行局部扩大切除半年后复发,余患者经局部扩大切除随访至今未出现肿瘤复发、淋巴结或远处转移。结论:生殖器部位基底细胞癌患者多为中老年人,临床少见,容易误诊。对疑似病例均应行局部扩大切除及组织病理学检查。肿瘤大小对判断手术切口深度无指导意义。     

疣状癌16例临床及病理分析

目的：探讨男性口腔、足部及阴茎部位疣状癌的临床及组织病理学特点。方法：对16例临床拟诊为疣状癌的男性患者,采取多点,多次组织病理检查;对经组织病理检查确诊为疠状癌的患者,采取外科手术切除等措施进行根治性治疗,并对组织块进行人乳头瘤毒素（HPV）定性检测。结果：经组织病理检查证实,16例患者均为疣状癌,其中9例患者HPV阳性,14例患者经手术治疗,9例术后随访1-2年无异常发现;1例术后14个月发生腹股沟淋巴结转移,1例术后23个月局部复发。1例未治疗患者4个月后发生腹股沟淋巴结转移。另有3例失访。结论：疣状癌是一种恶性肿瘤,应该早期诊断,早期进行外科根治性治疗,术后应定期随访。     

皮肤基底细胞癌364例临床病理分析

目的探讨皮肤基底细胞癌的临床特点及组织病理学类型,提高基底细胞癌诊断准确率,为临床诊治提供一定理论指导。方法收集新疆医科大学第一附属医院2002年9月—2014年2月,对经手术切除和组织病理证实的364例皮肤基底细胞癌患者的临床及组织病理资料进行回顾性分析。结果 364例患者中浅表型10例,结节型280例,微结节型8例,浸润型7例,基底细胞癌伴附属器分化7例,鳞状细胞基底细胞癌10例,角化型9例,腺样型28例,色素性4例,硬化型1例。结节型基底细胞癌患者中3例为多发性基底细胞癌,7例侵及骨骼肌,1例侵犯骨骼肌及软骨。1例复发性鳞状细胞基底细胞癌,侵犯皮下骨骼肌组织,并可见明确神经侵犯。364例均未见远处转移。5例基底细胞癌复发中的3例位于鼻部,均为鳞状细胞基底细胞癌。其中1例肿瘤侵犯皮下骨骼肌组织,并可见明确神经侵犯。1例位于右筛窦、眼眶部,肿瘤侵及邻近骨组织。1例位于右下眼睑,未见肿瘤侵犯周围组织。在9例侵袭性患者中,4例为复发性肿瘤。结论基底细胞癌组织学亚型较多,形态多样,易误诊。治疗以手术完整切除为主,5年生存率高,局部复发及周围组织侵犯可能与不能完整切除肿瘤及肿瘤距切缘较近有关。     

反射式共聚焦显微镜检查在乳房外Paget病诊断与随访中的应用分析

目的:探讨乳房外Paget病(EMPD)的反射式共聚焦显微镜(RCM)影像特征,分析RCM在EMPD诊断治疗中的临床运用。方法:选取我所2014年5月-2015年8月临床疑诊为EMPD的患者18例,分别行RCM和组织病理检查,确诊为EMPD者予手术治疗后3个月随访复查RCM和组织病理。结果:共有16例经病理检查确诊为EMPD,RCM主要表现为表皮细胞结构紊乱,表皮内可见大而圆的Paget细胞出现,基底层可见巢状的癌细胞结构或高折光的树突细胞,真皮浅层炎症细胞浸润及血管迂曲。组织病理检查表现为表皮内单个或巢状排列的Paget细胞,胞体大,呈圆形或椭圆形,无细胞间桥,胞质丰富淡染,呈空泡状;真皮内伴慢性炎症细胞浸润。16例确诊病例的RCM表现与组织病理检查结果均吻合。所有确诊病例经手术治疗后3个月随访,其中11例RCM检查无异常,3例发现异形细胞,2例发现有癌细胞复发,均与进一步组织病理检查结果一致。结论:RCM检查无创方便,在EMPD的诊断和治疗随访中具有很好的指导意义和应用前景。     

沿耳洞蔓延的基底细胞癌

报告1例基底细胞癌。患者女，58岁。耳后肿物30年，加重伴结节溃疡5个月。皮肤科检查：右侧耳后可见7 cm×2 cm暗红色斑片，边界较清，色素不均，部分破溃结痂，肿物沿耳洞蔓延至右耳垂前方，可见1 cm×1 cm紫红色结节，质硬，中央破溃，周边绕以珍珠状隆起的边缘。皮损组织病理检查：肿瘤细胞与表皮相连，真皮内可见由基底样细胞组成的嗜碱性的肿瘤团块，外周绕以肿瘤细胞，呈栅栏样排列，可见收缩间隙。免疫组化：p63(+),CK5/6(+),p53(40%～50%+)，增殖核抗原（Ki-67）(50%～60%+)。诊断：基底细胞癌。     

多发性基底细胞癌3例

目的：探讨多发性基底细胞癌的临床特点及诊治方法。方法：报告3例多发性基底细胞癌的临床表现，组织病理，结合相关文献作回顾性分析。结果：3例患者中1例表现为面颈部胸背部多发的黑褐色丘疹8年，1例表现为左侧眶周溃疡，多发结节10年，1例表现为头部多发黑色斑块2年。皮损均经组织病理检查确诊为多发性基底细胞癌。结论：多发性基底细胞癌虽然少见，但不能忽视，建议手术切除皮损，并送组织病理检查，重视术后随访。     

毛发上皮瘤的皮肤影像学特征分析

【摘要】 目的 比较毛发上皮瘤的反射式共聚焦显微镜（RCM）和皮肤镜特征与组织病理学特征。方法 2017年1月至2018年12月于武汉市第一医院皮肤科门诊收集经组织病理学确诊的毛发上皮瘤患者23例,采集RCM、皮肤镜图像,对比其与组织病理学特征的一致性。结果 23例中,男5例,女18例,年龄（39.5 ± 22.1）岁。组织病理特征：肿瘤界限清楚,周围有丰富的纤维基质;肿瘤团块为多数基底样细胞集合或相互交织的基底样细胞索,周边细胞呈栅栏样排列;肿瘤细胞不同程度地向毛乳头分化;可见不等数量的角囊肿。RCM特征：23例患者中8例可见真表皮交界处芽蕾样下延的条索状细胞,有栅栏样排列趋势;18例可见真皮层散在分布结节状似有分叶的瘤团,与周围组织无收缩间隙,呈扩大的低回声结构;16例瘤团周围有中高折光的无定形基质包绕;16例患者可见特征性的疑似原始分化毛乳头结构;20例可见清晰的角囊肿。皮肤镜特征：20例可清晰观察到珍珠白色、均质状结构,10例线状毛细血管扩张。结论 毛发上皮瘤的RCM特征与组织病理具有较高一致性,可作为辅助诊断及鉴别诊断的有效方法。     

以皮角为表现的肾透明细胞癌皮肤转移1例

患者男,55岁。右枕部红褐色皮角样增生物3个月,进行性增大1个月。2010年确诊为"肾癌"并行右肾摘除术。皮肤科情况:右枕部可见一长约2.0cm圆锥形红褐色增生物,顶部球状角化,外观似"跳棋状",基底部直径约0.8cm,质硬,皮损周围红肿。皮损组织病理示:顶端表面破溃结痂,肉芽组织增生,真皮浅层见结节状肿瘤组织,肿瘤由巢状、腺泡状透明细胞构成,细胞核轻度异型,细胞巢周围可见丰富的血窦及毛细血管。免疫病理示:EMA(+),CD10(+),vimentin(+),CK7(-),CK20(-)。诊断:肾透明细胞癌皮肤转移。术后患者拒绝化疗,现仍在随访观察中。     

Epidermotropic primary neuroendocrine (Merkel cell) carcinoma of the skin with Pautrier-like microabscesses. Report of three cases and review of the literature

Three cases of primary cutaneous neuroendocrine carcinoma involving the face are reported. In the first patient the tumor developed in the scar of a previously excised basal cell carcinoma of the nose, recurred locally, and metastasized to a regional lymph node 2 1/2 years after initial treatment. In the second and third patients the tumors were located on the forehead and were removed with a wide excision. In the second patient the tumor metastasized to regional lymph nodes 1 month after treatment. Light microscopic examination in all patients showed an undifferentiated, small cell, dermal tumor with prominent epidermotropism, forming Pautrier-like microabscesses. Immunohistochemical staining for neuron-specific enolase was positive, and ultrastructural examination revealed numerous cytoplasmic neurosecretory granules and paranuclear aggregates of intermediate-sized filaments. The literature concerning epidermal involvement by primary neuroendocrine carcinoma of the skin is reviewed; the relation with basal cell carcinoma and treatment are discussed.     

Monitoring efficacy of cryotherapy for superficial basal cell carcinomas with in vivo reflectance confocal microscopy: a preliminary study

BACKGROUND: Superficial BCCs (sBCCs) usually appear as multiple lesions in chronic sun-damaged skin of elderly people and may show a destructive growth if left untreated. Non-invasive treatment modalities, such as cryotherapy have been employed for sBCCs, all failing to provide tissue for confirming diagnosis and assessing adequacy of tumour removal. Reflectance confocal microscopy (RCM), a new non-invasive imaging technique has proven to be a useful tool for detection of basal cell carcinoma in vivo. OBJECTIVE: To non-invasively assess efficacy of cryotherapy for sBCCs by cytomorphologic analysis using RCM. METHODS: We examined 10 histologically proven sBCCs located on the trunk of 5 consecutive patients with a mean age of 84.6 years. SBCCs were frozen twice using a spray nitrogen cryoprobe. RCM imaging was performed in each sBCC before cryotherapy and after 5 and 24h to monitor resulting tissue injury. Distinct cytomorphologic characteristics were determined by three observers allowing non-invasive evaluation of therapeutic efficacy of treatment immediately after cryotherapy. Tumour clearance was assessed by RCM imaging 3 months after therapy followed by histopathologic examination. RESULTS: Characteristic RCM-features of BCC were present in all lesions before cryotherapy. Five hours after cryotherapy, all 10 sBCCs showed small bright round to polygonal structures at basal layer and black round to oval areas of varying size with such bright structures floating therein, correlating to cell necrosis and incipient blistering. Eight sBCCs showed also cell necrosis in upper dermis. After 24h all sBCCs showed necrotic cells beneath collagen bundles. Tumour clearance on later histopathologic examination was only proven in those lesions showing damage to the upper dermis after 5h with RCM. CONCLUSION: Early cell necrosis within upper dermal structures seems to correlate with ablation of overlying tumour tissue. When it is not produced by cryotherapy, a second treatment should be considered.     

Basal cell carcinoma of trunk and extremities

Background Basal cell carcinoma is the most common malignancy in Caucasians. Information about basal cell carcinoma in the Mexican population is scarce. Objective To determine the epidemiologic and clinical characteristics and treatment results of basal cell carcinoma located on the trunk and extremities of patients seen at the Institute Nacional de Cancerología of Mexico. Methods A retrospective study was performed of patients with confirmed diagnosis of basal cell carcinoma located on the trunk and extremities seen at the Institute Nacional de Cancerología of Mexico between 1966 and 1993. Results Ninety-one patients with basal cell carcinoma located on the trunk and extremities were found (6% of all patients with diagnosis of basal cell carcinoma). The median age was 64 years; 52% of the patients were women and 48% were men. A total of 119 basal cell carcinomas at these locations were diagnosed. The size of the skin tumor ranged from 0.3 to 22 cm (mean, 3.9 cm). Treatment results were evaluated in 62 patients (follow-up ranged from 24 to 240 months; mean, 80 months). Overall tumor control was accomplished in 95% of cases. Three patients died as a result of basal cell carcinoma. Conclusions Basal cell carcinoma in the Mexican population is not as infrequent as previously thought, although it is less commonly located on the trunk and extremities than in Caucasians.     

Basal cell carcinoma with myoepithelial differentiation: a distinct plasmacytoid cell variant with hyaline inclusions

We describe a 74‐year‐old man presenting with a 10‐year history of an asymptomatic, skin‐colored hard plaque on his left cheek. Microscopy revealed well‐demarcated tumor with peripheral palisading and peritumoral clefting in the dermis. The tumor included many plasmacytoid cells with cytoplasmic hyaline inclusions and eccentric nuclei. Electron microscopic examination showed that hyaline inclusions consisted of aggregates of filaments. Immunoperoxidase staining showed diffuse cytoplasmic expression of 34bE12, smooth muscle actin, calponin and p63. We diagnosed the patient with basal cell carcinoma (BCC) with myoepithelial differentiation and treated him with excision. Eight months postoperatively, the patient remained well with no recurrence. This distinct variant of BCC with myoepithelial differentiation, showing cytoplasmic hyaline inclusions and eccentric nuclei, has previously been confusingly termed ‘signet‐ring cell BCC’. However, these plasmacytoid cells differ from signet‐ring cells with vacuolated cytoplasm. To avoid confusion, we suggest the designation ‘BCC with myoepithelial differentiation’. Na SY, Choi Y‐D, Choi C, Kim S‐J, Won YH, Yun SJ. Basal cell carcinoma with myoepithelial differentiation: a distinct plasmacytoid cell variant with hyaline inclusions.     

Histological evaluation of residual basal cell carcinoma after shave biopsy prior to Mohs micrographic surgery

Background Patients who are referred for Mohs surgery after pre‐operative biopsy has been performed show in some cases no clinical or pathological evidence of tumour persistence. We have previously shown that 25% of these patients show no residual skin cancer either basal cell carcinoma or squamous cell carcinoma. The reasons for ‘disappearance’ of the tumour may be true non‐persistence or false non‐persistence because of wrong‐site Mohs surgery. Objective To determine the incidence of residual basal cell carcinoma after shave biopsy of primary nodular basal cell carcinoma prior to Mohs micrographic surgery. Methods A prospective unblinded study was performed on patients undergoing Mohs surgery for primary nodular basal cell carcinoma. The tumour was removed as a shaved excision using a No. 15 blade at the clinical borders like a shave biopsy (Mohs shave). The bases of the tumors were excised and then sectioned vertically at the middle and cut to the periphery at 10–15 μm intervals till the edge. Results Fifty‐one patients were evaluated. In 40 patients, residual basal cell carcinoma was found at the base of the shave excision site (78.4%). Conclusions Pre‐operative shave biopsy performed during Mohs surgery for primary nodular basal cell carcinoma is ‘curative’ in 22% of the patients.     

播散性低分化腺癌并发印戒细胞癌皮肤转移

报告1例播散性低分化腺癌并发印戒细胞癌皮肤转移.患者男,23岁.躯干、头面部、四肢出现黄豆至鸽卵大结节2个半月,无自觉症状.皮损组织病理检查:真皮胶原纤维间及皮下组织内肿瘤细胞弥漫性浸润,真皮胶原纤维被破坏,肿瘤细胞体积较大,胞质略空,并见瘤巨细胞.免疫组化染色示LCA、CK7、CD138均(-),CK20( ).诊断:低分化腺癌并发印戒细胞癌皮肤转移.患者于皮肤转移癌出现后8个月死亡.     

Treatment of arsenical keratosis and Bowen's disease with acitretin

BACKGROUND: Long-term exposure to arsenic is associated with the development of arsenical keratosis, Bowen's disease, squamous cell carcinoma, and basal cell carcinoma. The efficacy of acitretin therapy was examined in two patients with cutaneous arsenical neoplasms. METHODS: Lipid profile, hematological and liver function tests were performed regularly during the therapy at monthly intervals. RESULTS: After the third month of treatment, improvement of lesions of arsenical keratosis and Bowen's disease were observed in both patients. For the first patient who received 1 mg/kg daily acitretin for 10 months nearly total clearing was obtained at the end of therapy. The second patient discontinued the treatment after a period of 5 months because of symptomatic side-effects. During therapy no new lesions and no laboratory side-effects were observed in either patient. CONCLUSIONS: Although these results need to be confirmed by larger, long-term trials, it appears that acitretin is effective in the treatment of Bowen's disease related with arsenic, as well as arsenical keratosis.