色素性基底细胞癌

报告1例色素性基底细胞癌。患者女,68岁。右侧腋下黑色条状斑块10余年。皮肤科检查:右侧腋下约3.0 cm×0.2 cm大黑色斑块,边界尚清,其上散在分布数个米粒大黑色丘疹,斑块中部可见糜烂、渗液,渗液周边可见炎症性红斑,无触痛。皮损组织病理检查:表皮层局灶瘤细胞巢,表皮至真皮层可见一肿块,由嗜碱性基底样细胞组成,可见细胞异形性及有丝分裂象,在肿块周边细胞呈栅栏状排列,可见收缩间隙。诊断:色素性基底细胞癌。     

Merkel cell carcinoma arising within a poroma: report of two cases

Merkel cell carcinoma (MCC) has been reported in association with other types of cutaneous neoplasms within the same lesion, including squamous cell carcinoma, Bowen's disease, actinic keratosis, follicular cysts, trichoblastoma and lentigo maligna, among others. However, the association of MCC and sweat gland tumors has never been described in the literature. We report two unique cases of MCC that developed within cutaneous poromas. A 56‐year‐old male (Patient 1) and an 81‐year‐old female (Patient 2) presented with nodules on the upper arm and lower back, respectively. Histopathologic study of both cases revealed a tumor in the dermis composed of poroid and cuticular cells intermingled with a proliferation of small round cells that showed characteristic histopathological and immunohistochemical features of MCC. In both cases, the two neoplasms were tightly admixed and distinct, suggesting that the MCC could have developed within a previously existing poroma. No morphological features of transition between the two tumors were seen. Neoplastic cells of MCC expressed immunoreactivity for chromogranin, synaptophysin, neuron‐specific enolase, CAM 5.2 and cytokeratin 20, the last two markers showing the characteristic paranuclear dot‐like pattern. In contrast, the poroma cells only expressed cytokeratin MNF116. Metastatic deposits were not identified in the regional lymph nodes or distantly.     

Pigmented basal cell carcinoma: investigation of 70 cases.

BACKGROUND: Pigmented basal cell carcinoma (PBCC) is a clinical and histologic variant of BCC. OBJECTIVE: Our purpose was to identify the histologic subtypes of BCC that were most often associated with pigment and to determine whether this correlated with outcome after excision. METHODS: A series of PBCC was identified and the histologic subtype noted. Margins of all excisions were examined for residual tumor. These results were then compared with a series of nonpigmented BCCs. RESULTS: In a series of 1039 consecutive BCCs, 70 (6.7%) contained pigment. The histologic growth pattern most frequently associated with pigment was the nodular/micronodular pattern (12.4%) followed by the nodular (7.7%), superficial (7.2%), micronodular (4.0%), and the nodular/micronodular/infiltrative (3.4%) patterns. Margins were examined for evidence of residual tumor in the 40 cases that were excised. In only one case (2.5%) was the margin positive for tumor. This was statistically significant (p less than 0.05) compared with 388 excisions of nonpigmented BCCs with comparable growth patterns in which 69 (17.7%) showed positive margins. CONCLUSION: PBCC, as a clinical variant, is more frequently excised with adequate margins than are tumors of comparable histologic subtypes that do not contain pigment.     

色素性汗孔瘤

报告1例色素性汗孔瘤。患者女,56岁。左侧头皮黑色结节6余年。皮肤科检查:左侧头皮一直径约0.6 cm黑色结节,无破溃。皮损组织病理检查:表皮呈宽幅条索状向下不规则增生,形成团块,增生细胞为小立方形细胞,与表皮相连,但与周围鳞状上皮细胞分界清晰,可见导管分化,部分区域肿瘤细胞含有较多色素颗粒。免疫组化:上皮膜抗原(EMA)、癌胚抗原(CEA)及p63均阳性。诊断:色素性汗孔瘤。治疗:予手术切除,随访至今未复发。     

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     

Pigmented basal cell carcinoma developing on the lower extremities--three cases masquerading as malignant melanoma

Three cases of pigmented basal cell carcinoma were reported which needed to be differentiated from malignant melanoma based on their location and clinical features. Clinicopathologically, they were characterized by a large number of melanophages in the stroma, blockade melanocytes in the parenchyma, and phagocytosis of melanosomes in tumor cells as well as a large number of intraparenchymal melanophages. Two cases were characterized by the aggregation of melanophages in cystic spaces caused by stellate atrophy.     

Pigmented basal cell carcinomas in Gorlin syndrome: two cases with different dermatoscopic patterns

We describe two nonconsanguineous white patients with multiple pigmented basal cell carcinomas (BCCs) that were histopathologically confirmed. The first patient had calcification of the cerebral falx, multiple keratocysts in the jaw, and other malformations of the cranial and finger bones. The second patient presented with multiple dermoid cysts, calcification of the cerebral falx, keratocysts of the mandible, and agenesis of left kidney. Both patients had palmar pits. Both denied any family history of cutaneous tumours. On dermatoscopic examination of patient 1, multiple, bluish, confluent and large globules were seen. The second patient had blue ovoid globules, arborizing vessels, and areas shaped like maple leaves and spoke-wheels. Based on the clinical and radiological features we diagnosed both patients as having Gorlin syndrome (GS). To our knowledge, there are no previous reports of white patients with GS showing only pigmented BCCs. The dermatoscopic patterns were different in the two patients, and to our knowledge, this is the first report of a patient with GS showing a spoked-wheel dermatoscopic pattern.     

Pigmented mammary Paget's disease mimicking melanoma: report of three cases

Pigmented mammary Paget's disease (PMPD) is a rare subtype of mammary Paget's disease. The differential diagnosis of PMPD and melanoma is difficult clinically and sometimes histopathologically. Here we present three cases of PMPD with a variable-sized lesion. All cases showed an irregular-shaped black-brown macule, one of which was accompanied by nipple retraction. Dermoscopically, all cases showed reticular pigmentation with or without irregular black dots, regression structures and streaks, which were indistinguishable from those of melanoma. In all but one of the cases, preoperative examinations confirmed the presence of a subcutaneous mammary lesion. All patients underwent a total mastectomy with the histopathological results indicating invasive ductal carcinoma. These cases emphasize how difficult it is to distinguish PMPD from melanoma. Dermoscopic features also mimic those of melanoma, but the reticular pigmentation seen in all cases could be a feature specific to PMPD. For suspicious cases, histopathological assessment using immunohistochemistry is highly recommended.     

Metastatic basal cell carcinoma: review, pathogenesis, and report of two cases.

In 93 reported cases of metastatic basal cell carcinoma (BCC), 76 had spread through lymphatics or blood vessels. Two more cases are presented, bringing the total to 78. Metastasis to regional lymph nodes was the most frequent, followed in frequency by lungs, bones, and other organs. The size of the primary tumor, its site, its resistance to x-ray therapy, and the effects of radiation appeared to contribute to the occurrence of metastasis. However, in an appreciable number of cases, tumor dissemination was related to incomplete excision followed by immediate wound closure, particularly by grafting. It is recommended that wound grafting be delayed for at least six months after excision or large or recurrent BCC in order to assure complete removal.     

Granular cell basal cell carcinoma: A case report

Granular cell basal cell carcinoma (BCC) is a rare histopathological variant of BCC. Our review of the literature revealed only 17 previously identified cases. We report the case of a 47‐year‐old man who presented with an ulceration on his right upper lip which was subsequently removed. Histopathologic examination revealed that the tumor was composed solely of granular cells with numerous cytoplasmic eosinophilic round inclusion bodies. Mitotic figures ranged from 8 to 15 per 10 high‐power fields, with a Ki‐67 proliferative index of ~5%. Immunohistochemically, the granular cells showed strong and diffuse positivity for Ber‐EP4, pan‐cytokeratin, AE1/AE3, CK5/6 and p63 and focal positivity for lysozyme, CD68 (clone KP1) and Bcl‐2.     

Extensive and fatal basal cell carcinoma: a report of three cases

Three cases of basal cell carcinoma (BCC) with extensive invasion are described. The first two patients had meningeal and cerebral involvement with exposure of their dural meninges following full thickness skull erosion. The third patient had bilateral orbital and optic nerve involvement resulting in complete blindness. All three patients subsequently died from their disease.     

毛漏斗囊性基底细胞癌

报告1例毛漏斗囊性基底细胞癌.患者男,54岁.面部无痛性丘疹3年.3年前右下颌出现单个绿豆大肤色丘疹,质韧,表面光滑.皮损组织病理检查示真皮内境界清楚的肿瘤,呈上皮样细胞条索状增殖,相互交织成网状,中间有多个毛囊漏斗部上皮样细胞结构的囊肿,内含角蛋白或毳毛,但无毛球、毛乳头样结构.有少量间质成分和成纤维细胞,黏蛋白丰富.诊断:毛漏斗囊性基底细胞癌.