外毛根鞘癌2例

报告2例外毛根鞘癌。患者分别为72岁和82岁,病程1~2年。临床均表现为颞部结节或肿块,渐增大伴角化、破溃。皮损组织病理学检查示:真皮内可见与表皮相连的分叶状肿瘤团块,主要由外毛根鞘型角化、非典型透明细胞组成,团块内可见核异形及病理性核分裂象。诊断:外毛根鞘癌。     

增生性外毛根鞘瘤

报告1例增生性外毛根鞘瘤.患者女,32岁.左侧头顶部外向增生性肿物12年余,缓慢增生,呈菜花状,质地呈实性.组织病理检查:瘤团位于真皮,呈分叶状,主要由大小基本一致的PAS染色阳性细胞组成,周边细胞呈栅栏状排列,其间可见毛鞘角化和鳞状涡形成.诊断:增生性外毛根鞘瘤.     

恶性增生性甲外毛根鞘样囊肿

报告1例恶性增生性甲外毛根鞘样囊肿。患者男,78岁。右手拇指指甲增厚、破溃30年,伴疼痛。组织病理检查见甲床下方大量囊肿样的肿瘤细胞团块,瘤细胞为鳞状上皮,异形性明显,中央可见毛鞘样角化,未见颗粒层,可见透明细胞,瘤细胞未侵入指骨。免疫组化结果显示肿瘤细胞CK1阳性,CK6阳性,CK10部分阳性,CK7阴性、CK15阴性、Ki-67增殖指数约20%。结合临床、组织病理及免疫组化结果诊断为恶性增生性甲外毛根鞘样囊肿。     

外毛根鞘癌1例

患者,女,62岁。头部起结节10余年,增大、局部破溃4个月。皮损组织病理示:异型透明细胞及显著的毛鞘角化;PAS染色可见肿瘤团块周围增厚的基膜。诊断:外毛根鞘癌。     

毛囊瘤

<正>组织病理特征真皮内可见多个扩张的毛囊,其中2个毛囊开口于表皮,毛囊口角化过度,自囊壁长出多个次级毛囊。真皮内可见囊性扩张的毛囊结构,有多个基底样细胞条索。组织病理分析图1的病理特征符合毛囊瘤(trichofolliculoma)。毛囊瘤又称为毛囊上皮瘤(follicular epithelioma),是一种毛鞘错构瘤。病变为1个或多个扩大而扭曲的原发性毛囊,多开口于表皮,毛囊口角化过度,原发性毛囊内有角质及多数毛干,周围为放射状排列的次级毛囊。次级毛囊周围有明显的纤维性毛根鞘环绕中央的原发性毛囊,可见到内毛根鞘、外毛根鞘、     

外毛根鞘瘤1例

患者男,19岁.因左面颊部赘生物半年,于2011年1月25日来我科门诊就诊.病程中皮损无瘙痒、疼痛.既往体健,家族成员中无类似疾病患者.体格检查:一般情况良好,各系统检查无异常.皮肤科检查:左侧鼻唇沟外侧一直径约0.6 cm的半球形肤色丘疹,表面粗糙,轻度脱屑(图1A),质硬,无压痛.疑诊为"寻常疣",予以手术切除.皮损组织病理检查:表皮角化过度,乳头瘤样增生;真皮内多个小叶状增生的瘤团,与表皮相连(图1B),瘤团由向外毛根鞘分化的鳞状上皮细胞组成,胞质淡染透明,边缘细胞嗜碱性,呈栅栏状排列;肿瘤团块中央突然角化为嗜酸性均质角化物质,部分伴有囊腔形成(图1C);瘤团边缘的基膜增厚嗜酸性透明样变性;瘤团周围有以淋巴细胞为主的炎性细胞浸润(图1D).结合患者的临床表现及组织病理改变诊断为:外毛根鞘瘤.     

毛胚瘤一例

国内首次报道一例良性毛囊性肿瘤——毛胚瘤.患者男,48岁,前胸壁无症状皮下结节10年.组织学显示肿瘤位于真皮,境界清楚,边缘有纤维性假包膜,瘤团由结节和囊肿构成,大多数结节显示中央透明细胞呈同心圆分布,周围嗜碱性细胞呈栅栏状排列.可见肿瘤向毛球、内毛根鞘、外毛根鞘和毛囊漏斗部分化.免疫组化显示,肿瘤细胞表达角蛋白AE1/AE3、CK5/6和CK17,不表达CK7或CK20.中央透明细胞和周边栅栏状细胞显示完全不同的免疫组化表达方式.结合组织学和免疫组化改变诊断毛胚瘤.     

毛胚瘤一例北大核心CSCD

国内首次报道一例良性毛囊性肿瘤——毛胚瘤.患者男,48岁,前胸壁无症状皮下结节10年.组织学显示肿瘤位于真皮,境界清楚,边缘有纤维性假包膜,瘤团由结节和囊肿构成,大多数结节显示中央透明细胞呈同心圆分布,周围嗜碱性细胞呈栅栏状排列.可见肿瘤向毛球、内毛根鞘、外毛根鞘和毛囊漏斗部分化.免疫组化显示,肿瘤细胞表达角蛋白AE1/AE3、CK5/6和CK17,不表达CK7或CK20.中央透明细胞和周边栅栏状细胞显示完全不同的免疫组化表达方式.结合组织学和免疫组化改变诊断毛胚瘤.     

增殖性外毛根鞘瘤伴表皮囊肿1例

临床资料 患者男，31岁。因左下颌起结节3个月，于2005年12月1日来我科就诊。患者3个月前无明显诱因于左下颌部出现一芝麻大红色丘疹，并逐渐增大，无自觉症状。体检：一般情况良好，各系统检查未见异常。皮肤科情况：左下颌见一约蚕豆大灰白色坚实结节，表面粗糙，周围有红晕（图1）。皮损组织病理示：肿瘤位于真皮内，边界清楚，由外毛根鞘细胞组成，叶中央有突然角化而不形成透明角蛋白，呈外毛根鞘角化；其下方有一囊腔，囊壁与毛囊漏斗部上皮相似，由外向内依次为基底细胞层、棘层与颗粒层，表皮突消失，囊内为角质物（图2、3）。诊断：增殖性外毛根鞘瘤伴表皮囊肿。     

细胞角蛋白和c-erbB-2在外毛根鞘癌中的表达与意义

目的 探索皮肤外毛根鞘癌的诊断与鉴别诊断及细胞角蛋白(CK)和原癌基因蛋白(c-erbB-2)的表达与意义。方法 应用HE染色观察和免疫组化法对22例外毛根鞘癌和9例鳞状细胞癌(鳞癌)进行高分子角蛋白(CK-H)和低分子角蛋白(CK-L)及c-erbB-2免疫标记。结果 外毛根鞘癌的分叶状结构和中央的骤然角化是其独特的形态学特点，也是与鳞癌进行鉴别的重要依据；免疫组化标记。CK-H在外毛根鞘癌的阳性表达率为81．8％(18／22)，其阳性细胞分布在癌巢中央角化与周边瘤细胞之间的中间区，与鳞癌的表达不同。c-erbB-2表达阳性率为50％(11／22)，阳性细胞分布于癌巢的周边区．且随着分化程度的降低而表达增强。结论 外毛根鞘癌的形态学与鳞癌不同，两者的鉴别决定该肿瘤患者的治疗与预后。CK-H免疫组化标记的特殊分布提示其外毛根鞘来源；c-erbB-2参与外毛根鞘癌的激活并与其分化有关。     

Clear cell carcinoma of the skin: a tricholemmal carcinoma?

We report the light and electron microscopic findings of an unusual, locally aggressive cutaneous clear cell carcinoma involving extensively the left cheek and upper lip of a 61-year-old woman. The patient remained free of recurrence 5 years after wide local excision. Microscopically, the tumor was a poorly circumscribed and deeply invasive clear cell neoplasm characterized by large lobules and convoluted trabeculae of polygonal and columnar cells with palisading of the peripheral cells rimmed by thick basement membranes, and horn microcysts with tricholemmal keratinization. The tumor infiltrated the muscle and the salivary glands. Only slight cytologic atypia and a few mitotic figures were present. No definite ductal differentiation was found. Immunoperoxidase staining for carcinoembryonic and epithelial membrane antigens was negative. Ultrastructurally, the tumor cells were joined by desmosomes, and surrounded by thick basal lamina. The cytoplasm contained large pools of glycogen. Peculiar whorls of tonofilaments and aggregates of needle-shaped and club-shaped structures were observed in a small keratinizing focus. The tumor showed features resembling the outer root sheath of the hair follicle microscopically. Furthermore, the lack of duct-like structures and immunoreactivity of carcinoembryonic antigen tend to favor tricholemmal over sweat gland differentiation in this tumor which possibly represents a rare example of tricholemmal carcinoma.     

Tricholemmal keratosis and tricholemmal cancer

Three cases of tricholemmal keratosis and two of tricholemmal carcinoma are reported. All patients were female and the age range was from 71 to 83 years. These rare tumors occur on the face and are obviously the result of long-standing actinic skin damage. Clinically, verrucous hyperkeratosis or cornu cutaneum (keratosis) are observed and in the case of tricholemmal carcinomas, ulcerated tumor nodules. Histologically pale, glycogen-rich polygonal cells with signs of tricholemmal keratinization without the presence of a granular cell layer are characteristic features. Tricholemmal keratoses exhibit no atypia or only a mild form; however, carcinoma in situ may occasionally develop. In contrast, tricholemmal carcinomas are characterized by increased pleomorphia, an increase in the rate of mitosis, and an invasive growth pattern. The prognosis is favourable.     

Proliferating tricholemmal tumor

We report an unusually located proliferating tricholemmal tumor on the back of a male patient. Ladewig staining clearly demonstrated different patterns of tricholemmal and epidermal keratinization.     

Folliculocentric squamous cell carcinoma with tricholemmal differentiation: a reappraisal of tricholemmal carcinoma

Background. The diagnostic criteria for tricholemmal carcinoma remain controversial, and even the existence of tricholemmal carcinoma has been the subject of debate. Follicular (infundibular) squamous cell carcinoma (SCC) is a distinctive subset of SCC, which develops solely with folliculocentricity, and displays the features of conventional SCC without tricholemmal differentiation. Aim. To examine the existence of pure folliculocentric SCCs showing tricholemmal differentiation, that is, tricholemmal carcinoma. Methods. In total, 812 SCCs were examined, and those meeting the following diagnostic criteria were selected: (i) pure folliculocentricity without any associated Bowen's disease or actinic keratosis; (ii) composition primarily of lightly eosinophilic cells or clear cells containing glycogen; (iii) columnar lightly eosinophilic or clear cells aligned in a palisade along a discernible basement membrane; (iv) tricholemmal keratinization; (v) glycogen contained within the pale/clear cells; and (vi) cytological atypia and or infiltrative growth. We also evaluated whether the immunohistochemical profile [cytokeratin (CK)1, CK10, CK17, CD34 and D2–40] seen in normal hair follicles was retained in the selected lesions. Results. Only two lesions met the criteria. The immunohistochemical profile of the normal outer root sheath cells was generally retained in these lesions, except for CD34. Conclusions. Tricholemmal carcinoma is a rare occurrence, but it does exist, and at least one type of tricholemmal carcinoma is considered to be related to follicular (infundibular) SCC.     

p53、增殖细胞核抗原和Bcl-2在皮肤外毛根鞘癌中的表达

目的 探索外毛根鞘癌的临床病理学特征及p53、增殖细胞核抗原(PCNA)和Bcl-2的表达与意义。方法 应用HE染色观察和免疫组化S-P方法检测22例外毛根鞘癌p53、PCNA和Bcl-2蛋白表达。结果 22例外毛根鞘癌患者中女15例,男7例,年龄40~79岁,发生于头顶枕部皮肤16例。免疫组化标记结果显示:p53阳性表达为72%(16/22),阳性分布广泛;PCNA全部阳性,但阳性细胞在高中低分化中呈递增趋势;Bcl-2阳性为63%,在各级之间表达差异有显著性(P<0.01)。结论 分叶状结构和骤然角化是外毛根鞘癌的组织学特征;p53、PCNA、Bcl-2在外毛根鞘癌均有不同程度的表达,参与肿瘤发生发展和生长调控。     

Cornification (keratinization) in Basal cell carcinoma: a histopathological and immunohistochemical study of 16 cases

The concept of keratotic BCC is obscure and not well-defined. To elucidate the histopathological and immunohistochemical properties of cornification in BCC and to clarify the concept of keratotic BCC, by careful examination of 600 BCC specimens, we selected 16 cases of BCC that showed cornification. We investigated the precise histopathological features of these 16 cases, and studied the immunohistochemical expression patterns of anticytokeratin (CK) antibodies (CKs 1, 10, 13, 14, 17) and other antibodies in these cornifying (keratotic) BCCs. We compared these data to those from normal adult hair follicles and three types of cornifying cysts (epidermal cyst, tricholemmal cyst and steatocystoma). Six types of cornification were observed in these BCCs; 1) infundibular type (4 cases) with thin laminated corneocytes expressing CKs 1 and 10, 2) tricholemmal (isthmus) type (9 cases) showing compact, homogenous cornified contents with CK 17 expression on the surrounding cells, 3) inner root sheath type (1 case) characterized by compact, blue-gray corneocytes lined by CK 13 positive-squamous cells with red trichohyalin granules, 4) sebaceous duct type (1 case) characterized by crenulated cornified cells expressing CK 17, 5) apocrine acrosyringium type (2 cases) characterized by small duct-like structures lined by eosinophilic cuticle expressing CEA, in association with keratohyaline granules, and 6) cornifying microcyst type (10 cases) characterized by micro and small cystic structures containing the debris of cornified cells, which was associated with the infundibular or tricholemmal type and could be classified as having the primitive features of the tricholemmal type of cornification. The tricholemmal type could be subdivided into two groups: one with keratohyaline granules and the other without keratohyaline granules, and the cornified contents in approximately 30% of the cornified areas in this type were positive for CK 17. The matrical type of cornification (seventh type) was not seen in our study. The examples described as "keratotic BCC" thus far were similar to BCCs with cornification of the tricholemmal (isthmus) or infundibular type. The cornification in BCCs could be classified into seven types. Excluding the cornifying microcyst type, the tricholemmal type is the most common type of cornification. This type will be abnormal and incomplete in attempts to cornify in the form of an isthmus, occasionally with concomitant exhibition of lower infundibular differentiation. The keratotic BCC is considered to be BCC with cornification of the tricholemmal (isthmus) or infundibular type.     

外毛根鞘癌

报告1例外毛根鞘癌.患者女,84岁.右侧面部出现肿块半年,增大、破溃,大小约3 cm×3 cm.皮损组织病理检查示呈小叶状增生且与表皮相连的肿瘤组织.部分肿瘤组织显示外毛根鞘角化.该肿瘤组织主要由内含透明细胞质之非典型大型细胞所组成,免疫组化染色显示角蛋白单克隆抗体(AE1/AE3)阳性,过碘酸-希夫染色(PAS)阳性,上皮膜抗原(EMA)阳性,S-100蛋白(S-100)阴性,平滑肌抗体(SMA)阴性,细胞角蛋白7(CK-7)阴性,临床诊断为外毛根鞘癌.建议患者行局部肿瘤切除.     

Proliferating tricholemmal tumour with lymph node metastases

A 42-year-old woman with a proliferating tricholemmal tumour (PTT) with regional lymph node metastases is reported. Histochemical studies showed evidence of tricholemmal keratinization. There was recurrence following excision and subsequently the patient developed lymph node metastases.