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。     

外毛根鞘癌1例

患者,男,79岁。右颞部新生肿物2年。组织病理示:增生的表皮呈叶状或不规则伸入真皮下部,增生细胞由鳞状细胞及类似外毛根鞘的透明细胞组成,细胞有不同程度的异型性。诊断为外毛根鞘癌。     

外毛根鞘癌一例

患者,男,71岁。主因左鬓皮肤结节2年,激光术后复发6个月,于2011年12月6日就诊。患者2年前无明显诱因左耳前面部皮肤出现单发的小丘疹,无自觉症状,皮损渐增大至蚕豆大小,时有破溃、结痂,偶有微痛。曾在外院就诊,诊断为寻常疣,予以CO2激光治疗。激光后约2个月,在原发部位又有相似皮损出现,逐渐增大至花生粒大,无瘙痒,略有疼痛。否认个人和家族中有肿瘤史。体格检查：消瘦面容,一般状况可,精神状况佳,未触及浅表淋巴结增大,各系统检查未见异常。皮肤科情况：左鬓处皮肤见一花生粒大的淡红色结节,触之坚实,顶部可见五六片分叶,中央凹陷呈火山口状,边界清楚,表面无破溃,周边附浆液性结痂（图1）。手术切除肿瘤行组织病理检查：表皮角化过度,真皮内见较大的瘤细胞团,呈分叶状,大小不一;大多数瘤细胞呈鳞状细胞样,局部呈透明细胞样,细胞排列紊乱,异形明显,核大深染、有明显的核仁,可见核分裂像;瘤团周边细胞成栅栏状排列,周围见纤维状的结缔组织增生及大量单一核细胞浸润（图2）。免疫组化染色：p53蛋白和细胞角蛋白（CK）强阳性,Ki-67约10%细胞阳性, ;S-100蛋白阴性（图3）。诊断：外毛根鞘癌。     

巨大外毛根鞘癌1例

报告1例外毛根鞘癌，患者男，64岁，右侧臂部出现一红色斑块，渐增大伴微痒20余年，组织病理检查可见表皮不规则增生，表皮突呈树枝状仰入真皮下部，增生的细胞胞质染色较淡，排列紊乱，可见异常核分裂像，部分细胞核大，深染，胞质透明，PAS染色阳性。     

巨大外毛根鞘癌一例

患者男,79岁,因头枕部起肿物1年半而来我院就诊.患者1年半前发现头枕部长出一黄豆大皮疹,无痛痒.有时自行抠破,偶有流血.皮损逐渐增大,呈角样.近2个月生长迅速,肿瘤高至15 cm,因不慎摔倒,肿物折断,于我院就诊,家属考虑患者高龄并患糖尿病,拒手术治疗,仅在门诊切除肿物表面折断部分,回家休养.近2个月,肿物生长更加迅速,并伴疼痛、血性分泌物,为进一步诊疗,入住我科.患者精神饮食尚可.     

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.     

外毛根鞘囊肿

报告1例外毛根鞘囊肿.患者女,41岁.因头皮部丘疹逐渐增大6个月余就诊,患者无不适主诉.家族中无同病患者.体格检查:患者一般状况良好.头皮部近前额发际处可见一单发、隆起的圆形肿物,表面光滑,淡黄色,质地较韧,周围皮肤无炎症.皮损组织病理检查示外毛根鞘囊肿.     

外毛根鞘囊肿2例

外毛根鞘囊肿(trichilemmal cyst)主要分布于头皮,偶见于面部、颈部和躯干等.近期我科诊治2 例外毛根鞘囊肿,分别发生于头皮和左股外侧,现报告如下.     

外毛根鞘黑素细胞研究进展

外毛根鞘存在未活化无黑素性黑素细胞。与表皮黑素细胞一样同源于神经嵴。但它们之间在树突形态、黑素合成、抗原表达、分化程度等方面不尽相同。现认为无黑素性黑素细胞不仅可能为生长期毛囊提供黑素干细胞 ,而且在白癜风色素再生时 ,它可被紫外线辐射、生长因子、擦皮术等因素激活后迁至白斑区起黑素细胞储库作用。     

8例外毛根鞘癌的组织病理学分析

外毛根鞘癌是一种少见的皮肤附属器恶性肿瘤。临床上常见于老年患者的曝光部位皮肤,表现为小的肿块或呈菜花状,表面可有溃疡,发病相对缓慢,组织病理有其独特的改变且需与多种皮肤肿瘤相鉴别。现将我科近6年发现的8例外毛根鞘癌作一总结。一、临床资料8例中男2例,女6例;年龄63～86岁;病期6个月至2年。肿瘤位于前额、颞部和枕后发际处各2例;鼻唇沟和腹部各1例,初起为米粒至绿豆大小,表面粗糙不平,渐增至黄豆到花生米大小,3例破溃,溃疡边缘稍隆起或外翻。临床上拟诊:4例鳞状细胞癌;3例基底细胞癌和1例角化棘皮瘤。二、组织病理常见表皮增生、角化过度(5例)伴角化不全。部分表皮突下伸至真皮网状深层。     

Tricholemmal carcinoma:

Tricholemmal carcinoma (TLC) is a cutaneous adnexal tumor with presumed external hair sheath differentiation. In order to better understand the salient features of this neoplasm, we analyzed the histologic and clinical findings in 10 cases of TLC. Eight patients were males, and two were female; they ranged in age from 55-88 years. Each tumor occurred in hair bearing, sun-exposed skin, and involved the scalp, face, trunk, or upper extremities. The lesions were usually slightly raised, pale tan or reddish, and keratotic; were usually present for less than 1 year; and measured 0.4-2.0 cm. All of them were treated by wide local excision; neither recurrence nor metastasis was reported after 11 to 92 months of clinical followup. Histologically, each TLC was composed of a lobular proliferation centered on the pilar apparatus. Cells with glycogen-rich, mucin-negative, clear or pale eosinophilic cytoplasm predominated. Brisk mitotic activity (4-39 mitoses per 10 high power fields) was typical. Involvement of the interfollicular epidermis was invariably noted, with superficial ulceration in seven tumors. Transitional zones between TLC and the adjacent epidermis were not seen, although pagetoid spread occurred in two examples. Invasion of reticular dermis was present in eight cases, with infiltration to mid-dermis in five TLC. All tumors exhibited areas of tricholemmal type keratinization; dyskeratotic cells were noted in six examples. Hyperkeratosis and parakeratosis were variably present as well. Actinic damage was a constant feature. Despite local invasion at diagnosis, the clinical course of TLC was indolent in all cases.     

Tricholemmal carcinoma:

Seven cases of tricholemmal carcinoma (TLC), a rarely recognized cutaneous adnexal neoplasm of external hair sheath origin, are described. Most occurred on sun-exposed skin; five involved the head and neck, one the right leg, and one the right thigh. TLC had a generally short history and all were treated by local excision. The lesions had an exophytic (3 cases) or polypoid (4 cases) gross appearance. Histologically, TLC exhibited a sharply circumscribed, lobular epithelial proliferation in continuity with the epidermis. A cytologic hallmark of these tumors was the presence of large cells with PAS-reactive, diastase-sensitive, clear or pale eosinophilic cytoplasm. High mitotic rate was a constant feature. Four tumors were infiltrative, with pushing borders, whereas three were intraepithelial. One case showed acantholysis. Immunocytochemistry revealed positivity for prekeratin and negativity for CEA and EMA, supporting the trichogenic origin of these tumors. Ultrastructural examination gave clear indication of epithelial origin for the cells but did not verify hair follicular differentiation. Despite locally aggressive growth, the clinical course of TLC appeared indolent. Moreover, there are no cases with metastases reported in the literature.     

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.     

Focus of tricholemmal differentiation (tricholemmal carcinoma) within Bowen's disease/carcinoma

Bowen's disease (BD)/carcinoma is a type of squamous cell carcinoma of the skin, however, the possibility of adnexal differentiation (the development of sebaceous carcinoma or porocarcinoma) occurring in BD/carcinoma has been suggested. We herein describe a case of BD with superficial invasive carcinoma, which showed a clear cell focus, demonstrating tricholemmal differentiation. This clear cell focus showed the following findings: primarily composed of clear cells, somewhat columnar clear cells aligned in a palisade along a discernible basement membrane, tricholemmal keratinization and glycogen contained within the cells. In addition, the immunohistochemical profile in this clear cell focus, namely, negative staining for cytokeratin (CK)1 and positive staining for CK17 and calretinin in the inner cells of the neoplastic lobule, corresponded to that of the outer root sheath cells. This case suggested that adnexal differentiation can rarely occur within true BD/carcinoma, although adnexal carcinomas are commonly associated with a simple bowenoid change.     

Tricholemmal carcinoma. Report of 11 cases

Eleven cases of tricholemmal carcinoma are reported. The histological features of tricholemmal carcinoma are compared with those of tricholemmoma. The tumor is very rare and occurs in slightly damaged skin of elderly people. Whereas its clinical appearance is nonspecific, it can be differentiated from tricholemmoma by the occurrence of marked cellular and nuclear atypia and less orderly architecture. Although the histological picture suggests a high-grade malignancy, its biological behaviour appears to be relatively benign. To date, no metastases have been observed in our patients.     

Tricholemmal carcinoma in continuity with trichoblastoma within nevus sebaceus

A nodule arising within the nevus sebaceus on the vertex of the scalp of a 68-year-old woman was histopathologically and immunohistochemically investigated. We also used immunohistochemistry to investigate the cytokeratin (CK) distribution of the outer root sheaths of normal terminal hair follicles. The nodule consisted of two parts, a main exophytic part with a lobular proliferation and a small peripheral part with the features of trichoblastoma. The main exophytic lesion consisted of lobular aggregations composed of both or either basaloid cells and clear cells with the silhouette and cytology of malignancy. The columnar clear cells were aligned in a palisade at the periphery of the aggregations of clear cells, and the aggregations located in the superficial dermis were connected to the follicular infundibular structures. Almost all of the neoplastic aggregations were diffusely positive for CK7 (OV/TLR/30), and the innermost or inner cells of the neoplastic aggregations were positive for CK17; a similar staining pattern to that in the lower portion of the outer root sheath between the A and B fringes in normal terminal hair follicles. The exophytic part of the lesion was a malignant neoplasm with differentiation mainly toward the lower segment of the outer sheath between the A and B fringes of the terminal hair follicle, namely tricholemmal carcinoma. Our case may represent a collision of two distinctive neoplasms (tricholemmal carcinoma and trichoblastoma), however, an intimate relationship between these two neoplasms also should be considered.     

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.     

面部增生性外毛根鞘瘤1例

患者女,92岁。右面部肿物9月余。查体见右侧颜面部约4cm×6cm大小乳头状增生物,表面结痂,有少许分泌物。组织病理检查示肿瘤位于真皮,与表皮相连,由多个鳞状上皮细胞团块组成,周边基底样细胞呈栅栏状排列,中央有上皮细胞突角化形成的无定型角质、钙化灶。临床及组织病理改变符合增生性外毛根鞘瘤。