少见组织病理类型的基底细胞癌

约70%以上的基底细胞癌在组织病理学上表现为结节性或结节囊肿性基底细胞癌,但亦有一些少见类型,如浅表多中心型基底细胞癌、微小结节型基底细胞癌、硬化性基底细胞癌、纤维上皮瘤型基底细胞癌等.该文主要介绍一些少见的组织病理类型基底细胞癌,掌握这些少见的类型对基底细胞癌的诊断和鉴别诊断具有重要意义.     

基底细胞癌31例临床及病理分析

基底细胞癌又名基底细胞上皮瘤 ,是一种低度恶性的皮肤肿瘤 ,临床上常单发 ,男女并无差异。现将临床上所遇 31例并经病理证实的基底细胞癌总结分析如下 :1　临床资料1.1　性别与年龄分布 :共 31例 ,其中男性 19例 ,女性 12例 ;年龄 :从 2 9～ 79岁 ,其中 5 0岁以下者 5例 ,5 0岁及以上者 2 6例 ,计 31例 ,平均 5 8.7岁。1.2　病程分布　从 6个月到 30年 ,其中1年以内者 1例 ;1～ 5年者 17例 ;6～ 10年者 11例 ;10年以上者 2例 ;平均病程6 .3年。1.3　肿瘤部位分布　颜面 13例 ;头皮 8例 ;胸 2例 ;腰背 3例 ;上肢 3例 ;下肢 2例。1.4　肿瘤大…     

皮肤基底细胞癌238例临床与病理回顾性分析

皮肤基底细胞癌(basal cell carcinoma,BCC)是源自表皮或其附属器,尤其是毛囊基底细胞的恶性肿瘤(目前认为BCC是一种毛源性肿瘤),是皮肤科最常见的恶性肿瘤之一,其发病率较高,占所有皮肤恶性肿瘤的65％～75％[1].BCC的发病率随着人口老龄化而持续性升高,虽然本病恶性程度低,但部分可呈侵袭性生长...     

62例基底细胞癌临床和病理分析

基底细胞癌又称基底细胞瘤、基底细胞上皮瘤 ,是发生在皮肤任何部位的一种常见的皮肤肿瘤 ,其临床和病理可分多种类型。我们收集 1990～ 1999年临床、病理确诊且资料完整的基底细胞癌共 6 2例 ,分析如下。1　临床资料6 2例中男 2 2例 ,女 40例 ,男女之比1:1.82 ;年龄最小 2 8岁 ,最大 85岁 ,平均年龄 6 3.2 4岁 ;年龄分布 <30岁 1例、30～39岁 3例、40～ 49岁 6例、5 0～ 5 9岁 17例、6 0～ 6 9岁 2 5例、70～ 79岁 7例、>80岁 3例 ;病期最短 2个月 ,最长 14年 ,平均 5 .4年 ,其中 5年以上 32例 ( 5 1.6 1% )。肿瘤部位 :头、面、颈部共 5 5…     

基底细胞癌75例临床病理分析

目的探讨皮肤基底细胞癌(BCC)组织病理特征及其鉴别诊断,以对治疗方案的选择提供指导。方法分析75例患者的临床及组织病理资料。结果按组织病理分型,实性BCC 33例,色素性BCC 14例,浅表性BCC 8例,硬斑病样BCC 5例,囊性BCC 3例,角化性BCC 4例,腺样BCC 2例,纤维上皮瘤性BCC 2例,实体与其他混合型4例。以上各型易与脂溢性角化病、光线性角化病、色痣、角化棘皮瘤、黑素细胞瘤、Bowen病等鉴别。结论各型皮肤基底细胞癌均具有明确的组织病理学特征,易与其他皮肤疾病鉴别。外科手术仍为首选治疗,Mohs显微外科手术在预防复发和美观方面更具优势,光动力疗法对表浅型BCC疗效较佳。     

内蒙地区基底细胞癌41例临床病理分析

基底细胞癌(以下称基癌)是临床较常见的皮肤肿瘤。近年我区基癌的病人也渐增。现收集我科病理室较完整的病例分析如下。临床资料　男23例,女18例,男女之比为1.3∶1。年龄26～80岁,平均55.5岁,其中26～39岁4例,40～49岁5例,50～59岁15例,60～69岁9例,>70岁8例。汉族35例,蒙古族4例,回族2例。病程3个月～20余年,其中5年以上16例(39.1%)。位于头面部32例(78%),包括头皮3例,额颞部4例,面颊及眼周15例,鼻部9例,其余9例分别在腋窝、腹部、背部、肛门上缘及足部。临床类型包括结节型(溃疡型)、色素型及浅表型和硬斑病样型。肿瘤的形态学表现　大多…     

62例基底细胞癌误诊的临床及组织病理分析

目的分析62例基底细胞癌误诊情况,提高诊断水平,避免误诊误治。方法回顾性分析62例基底细胞癌初步误诊病人临床及组织病理资料。结果 62例患者中误诊为脂溢性角化病7例;色素痣6例;鳞状细胞癌4例;恶性黑素瘤3例;Bowen病3例;日光性角化病2例;乳房外paget病3例;化脓性肉芽肿3例;血管瘤2例;寻常疣3例;炎性肉芽肿3例;表皮囊肿3例;毛母细胞瘤3例;皮肤溃疡4例;盘状红斑狼疮1例;增生性瘢痕2例;皮肤纤维瘤2例;蓝痣1例;包块性质待诊7例。结论提高临床水平及皮肤病检水平不仅减少误诊误治,更重要的是为治疗做出更好的选择。     

皮肤基底细胞癌70例临床病理分析

目的探讨皮肤基底细胞癌(BCC)临床病理特点及诱发因素。方法对70例患者的临床及组织病理资料进行分析。结果按皮肤损害分型,结节溃疡型38例,色素型14例,浅表型6例,硬斑型10例,纤维上皮瘤型2例。97.2%的肿瘤发生于头面部暴露部位。结论紫外线是BCC的重要诱因。采用扩切病变部后植皮术或旋转皮瓣,既达到根治目的,又保持美观。     

浅表型基底细胞癌34例临床表现、皮肤镜及组织病理特征分析

目的:总结34例浅表型基底细胞癌(BCC)患者的临床表现、皮肤镜及组织病理特点。方法:对2009年1月—2017年12月该院皮肤科门诊确诊的34例浅表型BCC患者临床表现、皮肤镜与皮损组织病理资料进行回顾性分析。结果:34例患者中男14例,女20例,以老年人居多,皮损最好发于躯干。32例皮损表现为单发性红斑、斑片及糜烂,2例为多发皮损。皮肤镜下皮损部位主要表现为枫叶样结构及轮辐状区域。皮损组织病理表现为真皮内芽蕾样嗜碱性细胞团块,与表皮相连,沿水平方向延伸、生长;边缘细胞呈栅栏状排列,可见周边裂隙。大部分患者真皮浅层可见淋巴细胞浸润(85.3%)、肿瘤团块内色素沉积(67.6%)及周边纤维组织增生(76.5%)。结论:浅表型BCC的临床表现、皮肤镜及组织病理特点均与经典型BCC相异,临床医生需提高对该病的认识以减少误诊。     

Comparison of basal cell carcinoma subtypes observed in preoperative biopsy and Mohs micrographic surgery

BackgroundThe treatment of basal cell carcinoma depends on its histological subtype. Therefore, a biopsy should be performed before definitive treatment. However, as the biopsy is only a sample of the tumor, it does not always shows every histological subtype present in the neoplasm. Few studies have compared the histological findings of biopsies with the findings of Mohs micrographic surgery. By evaluating the totality of the peripheral margins, in addition to sampling large tumor areas, this technique provides a more representative amount of tissue than preoperative biopsy.Objectivesa) Determine the agreement between the histological subtype of basal cell carcinoma from punch biopsy and the findings of Mohs surgery; b) To assess, among the discordant cases, the prevalence of non-aggressive tumors in the preoperative biopsy that were reclassified as aggressive by Mohs surgery.MethodsRetrospective analysis of 79 cases of basal cell carcinomas submitted to punch biopsy and subsequent Mohs surgery.ResultsThe agreement between the classification of the subtypes in the biopsy and in Mohs surgery was 40.5%. Punch biopsy was able to predict the most aggressive basal cell carcinoma growth pattern in 83% of cases.Study limitationsRetrospective nature, sample size, and biopsies performed by different professionals.ConclusionsThe agreement between the histopathological subtypes of basal cell carcinoma as seen in preoperative biopsy and Mohs surgery was low. However, preoperative biopsy presented good accuracy (83%) in detecting aggressive histopathological subtypes.     

Variations of basal cell carcinomas according to gender,age, location and histopathological subtype

BACKGROUND: Most published series of basal cell carcinomas (BCCs) do not take into account the histopathological subtype. Recent studies suggest that the nodular and superficial types could be induced by different causal factors. OBJECTIVES: To analyse the three major subtypes of BCC with regard to sex, age and anatomical distribution. METHODS: We retrospectively included all cases of BCC diagnosed at a single centre of dermatopathology during 1967-96. The diagnosis and subtype (nodular, superficial, morphoeiform) were confirmed by two dermatopathologists. Gender, age at excision, number of tumours and location were recorded, and analysed by histopathological subtype. RESULTS: We recorded 13 457 cases in 10 245 patients (M/F ratio 0.92) of mean age 65 years. Of the BCCs, 78.7% were nodular, 15.1% superficial and 6.2% morphoeiform. Nodular tumours occurred at a mean age of 66.3 years, whereas superficial tumours were excised earlier (63.0 years) and more frequently in women (M/F ratio 0.96). Patients with morphoeiform BCC had a mean age of 65.8 years and were predominantly women (M/F ratio 0.73). Both nodular and morphoeiform types predominated on the head (89.6% and 94.8%), whereas the trunk was the most common location for the superficial type (45.9%). Superficial carcinomas were predominantly located on the head in women (44.8% vs. 34.7% in men), whereas they predominated on the trunk in men (49.9% vs. 42% in women). Tumours of the trunk were excised earlier than those of the face, whatever their histological subtype, in both men and women. CONCLUSIONS: This is the largest series of BCCs in the literature, and shows striking differences in anatomical distribution, sex and mean age according to histological type. The results suggest that the tumours of the trunk, and not only those of the superficial type, could represent a particular subtype of BCC. The analysis also suggests that the hypothesis of chronic vs. intermittent sun exposure cannot be simply extrapolated to BCC. Other causal factors, such as a genetic predisposition, could be involved in the development of carcinomas located on the trunk.     

Jagged1蛋白在银屑病、基底细胞癌及皮肤鳞状细胞癌中的表达

目的探讨Jagged1蛋白在银屑病、基底细胞癌及皮肤鳞状细胞癌中的表达及意义。方法采用免疫组化Envision法检测Jagged1蛋白在银屑病、基底细胞癌及皮肤鳞状细胞癌皮损中的表达。结果 Jagged1蛋白在寻常性银屑病患者皮损中呈阴性表达,在基底细胞癌及皮肤鳞状细胞癌中的表达较正常人皮肤增强,差异有统计学意义(P<0.01);Jagged1蛋白在基底细胞癌及皮肤鳞状细胞癌中的表达较银屑病增强,差异有统计学意义(P<0.05)。结论 Jagged1蛋白在银屑病发病机制中与角质形成细胞异常增生及真皮乳头血管增生等组织病理变化可能不相关,提示此蛋白可能与皮肤恶性肿瘤的异常增生有关。     

The relation between dermoscopy and histopathology of basal cell carcinoma

BACKGROUND:

Basal cell carcinoma is the most frequent cancer in fair-skinned populations and dermoscopy is an important, non-invasive technique that aids in the diagnosis of Basal cell carcinoma.

OBJECTIVES:

The aim of this study was to evaluate the relationship between histopathological subtypes and dermoscopic features of Basal cell carcinoma.

METHODS:

This study included 98 patients with clinically and histopathologically confirmed Basal cell carcinomas. The dermoscopic features of the lesions from each patient were analyzed before the histopathological findings were evaluated.

RESULTS:

Dermoscopic structures were observed in all 98 patients and irregular vascularity was identified in 78 patients (79.6%). The most common vascular pattern was the presence of arborizing vessels (42 patients, 42.9%) followed by arborizing microvessels (21 patients, 21.4%) and short fine telangiectasias (SFTs; 15 patients, 15.3%). White streaks (38 patients, 38.8%), translucency (31 patients, 31.6%), a milky-pink to red background (42 patients, 42.9%), and erosion/ulceration (29 patients, 29.6%) were also observed. Pigmented islands were seen as blue-gray globules (7 patients, 7.1%) and blue-gray ovoid nests (42 patients, 42.9%). The pigment distribution pattern was maple leaf-like areas in 9 patients (9.2 %) and spoke wheel-like areas in 6 patients (6.1%).

CONCLUSIONS:

Basal cell carcinomas show a wide spectrum of dermoscopic features. Arborizing vessels were the most common dermoscopic findings in Basal cell carcinomas, while superficial Basal cell carcinomas displayed mainly milky-pink to red areas, and arborizing microvessels. The most common dermoscopic features of pigmented types were islands of pigment (blue-gray globules, blue-gray ovoid nests). In conclusion, dermoscopy can be used as a valuable tool for the diagnosis of Basal cell carcinomas and prediction of their histopathological subtypes.     

基底细胞癌的治疗

基底细胞癌是最常见的皮肤恶性肿瘤,该病几乎不发生转移,如不治疗,肿瘤会发生局部浸润性生长而破坏邻近组织,影响功能和美观,严重时危及生命.基底细胞癌的治疗方法很多,主要分为手术疗法和非手术疗法.手术疗法是首选的治疗手段,包括常规手术切除和Mohs显微外科手术切除,较大的缺损可以通过多种治疗手段进行创面修复.非手术疗法包括光动力学疗法、放射治疗、局部化疗、免疫调节剂治疗以及分子靶向治疗等.     

热休克蛋白10、60在皮肤鳞状细胞癌、基底细胞癌、日光性角化病中的表达

目的 探讨热休克蛋白（HSP）10、60在皮肤鳞状细胞癌（SCC）、基底细胞癌（BCC）和日光性角化病（AK）中的表达水平。方法 采用免疫组化EnVision两步法测定HSP10、60在皮肤SCC、BCC、AK中的阳性表达水平,并与正常组对照。结果 与对照组比较,HSP10组只有BCC组的阳性表达高于正常组（Z = 3.24,P < 0.01）,AK组（Z = 0.74,P > 0.05）和SCC组（Z = 0.52,P > 0.05）与对照组比较差异无统计学意义;HSP10组中AK与BCC,AK与SCC的差异有统计学意义（P < 0.05）,但SCC与BCC组间差异无统计学意义（P > 0.05）。HSP60组三组的阳性表达均高于正常组,其中AK（Z = -2.90,P < 0.01）、BCC（Z = -2.15,P < 0.05）、SCC（Z = -2.78,P < 0.01）;三组间两两比较结果为AK = SCC > BCC（P < 0.05）。结论 HSP60的高表达可能与鳞状细胞癌、日光性角化病的生物行为有关。     

Lepromatous leprosy,melanoma, and basal cell carcinoma: clinical-histopathologic association

Cutaneous neoplasms frequently occur in leprosy, but there are few reports of the coexistence of leprosy and basal cell carcinoma in the same lesion. This case reports a 49-year-old male with an ulcerated plaque on the right lateral nasal wall, bright papules on the sternal region, and a blackened plaque on the right temporal region. The nasal and temporal lesions were diagnosed by histopathology as basal cell carcinoma and melanoma, respectively. The sternal lesions were excised with the repair of the “dog ear” which histopathological examination showed macrophages in the dermis parasitized with acid-fast bacilli, confirming the diagnosis of lepromatous leprosy with Fite-Faraco staining. This case report highlights the importance of referring the dog-ear specimen for histopathologic analysis.     

Correlation between the dermatoscopic and histopathological features of pigmented basal cell carcinoma

Background Dermatoscopy has a great value in the diagnosis of pigmented basal cell carcinoma (BCC), which is a clinical variant of BCC. The precise definitions of histopathological correlates of dermatoscopic features observed in pigmented BCC have not been established yet. Objective The present study aimed to investigate the correlation between the dermatoscopic features of pigmented BCC and their histopathological counterparts to provide clear histopathological definitions of each dermatoscopic feature. Methods In this case series that comprised a methodological component, after the orientation of dermatoscopic features was determined by placing sutures in the lesions, the histopathological counterparts of each were examined and definitions were made accordingly. Results Although the most common histopathological subtype of BCC is the solid type, the most common histopathological subtype observed in the pigmented BCC lesions in the present study was the superficial multifocal type (72.5%). Blue‐whitish veil was observed in 57.5% (n = 23) of the lesions, a percentage higher than that reported in the literature. In addition to confirming the previously histopathologically defined dermatoscopic features of pigmented BCC, we identified three histopathologically undefined features of pigmented BCC that are spoke‐wheel areas, large blue‐grey ovoid nests and multiple blue‐grey globules. Conclusion Dermatoscopy facilitates prediction of the corresponding histopathological findings in pigmented BCC, based on specific dermatoscopic features.