73例脂溢性角化病临床及病理分析

７３例脂溢性角化病临床及病理分析庞毓凌，马烈，姚军英，蒋伟（皮肤科）邓铁成，张梅兮，周晓燕（口腔科）（哈尔滨医科大学附属第二医院，１５００８６）刘成德（黑龙江省中医学院病理科）脂溢性角化病（Ｓｅｂｏｒｒｈｅｉｃｋｅｒａｔｏｓｉｓ，简称ＳＫ）又称脂溢性...     

153例脂溢性角化病的临床与病理分析

回顾性分析我科近4年诊断为脂溢性角化病153例的临床及组织病理学情况。病理诊断主要是棘层肥厚型、角化过度型、棘层肥厚型和角化过度型的混合型、腺样型、刺激型、菌落型与黑素棘皮瘤型。该病临床诊断与组织病理之间有一定的差异性,本组临床诊断为脂溢性角化病的115例中,组织病理符合91例,临床误诊率为20.9%;病理诊断为脂溢性角化病的153例中临床误诊62例。应注意与相关疾病鉴别,日光对脂溢性角化病的形成及其发病年龄提前有一定影响。     

38例脂溢性角化病的临床与病理分析

脂溢性角化病（ｓｅｂｏｒｒｈｅｉｃｋｅｒａｔｏｓｉｓ，ＣＫ）是老年人常见良性表皮肿瘤，临床诊断不难，偶有误诊为恶性黑素瘤，但临床个别老年人出现ＬｅｓｅｒＴｒｅｌａｔ征，提示恶性肿瘤存在的可能。本病病理上有某些特征及变异。我们对３８例脂溢性角化病老...     

脂溢性角化和扁平疣的共聚焦显微镜图像分析

目的通过共聚焦激光扫描显微镜(confocal laser scanning microscopy,CLSM)采集易混淆脂溢性角化病和扁平疣图像,分析两者的共聚焦扫描显微镜图像特征,为临床诊断提供影像学依据。方法对易混淆的脂溢性角化病和扁平疣进行病理确诊后应用CLSM采集图像,对照病理图像分析两者的共聚焦显微镜图像特征。结果脂溢性角化病和扁平疣的CLSM图像特征和病理图像具有较高的一致性,CLSM脂溢性角化病特征性指标为"脑回状"结构、角囊肿。扁平疣的特征性指标为"花团状"结构和空泡细胞。结论 CLSM检测利于脂溢性角化病和扁平疣两种疾病的鉴别诊断。     

脂溢性角化病120例临床病理分析

脂溢性角化病又名老年疣、基底细胞乳头状瘤，是一种常见的良性表皮内肿瘤，临床及病理不难诊断，但南丁其临床及病理类型较多，易与多种良、恶性皮肤病变混淆。本文收集1999年1月～2003年12月经手术切除病理证实的脂溢性角化病120例，分析其临床病理特点。     

光线性角化病385例临床与组织病理特点回顾性分析

目的:总结光线性角化病的临床、组织病理特点,提高本病的诊断率。方法 :对西京医院皮肤科门诊2008年1月—2013年1月间694例临床诊断为光线性角化病的患者资料进行临床与组织病理回顾性分析。结果:光线性角化病临床与病理诊断符合率仅为21.18%。临床最易误诊为脂溢性角化病,而且,组织病理上也易与脂溢性角化病相混淆。结论:光线性角化病虽然临床常见、多发,但不易正确诊断,临床医生需要提高对光线性角化病临床、组织病理特点的认识。     

角化性皮肤病

20140767脂溢性角化病皮损的皮肤镜特点/李薇薇（北京大学第一医院皮肤科）,涂平,杨淑霞…∥临床皮肤科杂志.-2013,42（11）.-641-645 回顾性分析2009年9月-2011年11月在北京大学第一医院皮肤科行皮肤镜检查并经组织病理确诊的脂溢性角化病皮损的皮肤镜图像。结果：共分析了100例患者的110个脂溢性角化病皮损,最主要的皮肤镜指征按出现频率由高到低分别为粉刺样开口（63．6％）、发卡样血管和沟脊结构（均为42．7％）、粟粒样囊肿（40．0％）及灰白色粗壮网格样结构（30．9％）。     

临沧市佤族136例脂溢性角化病的临床病理分析

目的探讨临沧市佤族脂溢性角化病的临床和组织病理学特点。方法回顾性分析我院136例脂溢性角化病的临床表现及组织病理学资料。结果 136例脂溢性角化病患者病理分型主要为棘层肥厚型占44%、角化过度型占30%。患者男女比例为1.61∶1,发病年龄50岁以上占84.5%,头面颈部等暴光部位占发病部位的71.5%。结论年龄和日光照射可能是临沧市脂溢性角化病的重要致病因素。临床上典型的脂溢性角化病不难诊断,不典型者容易与日光性角化病、黑色素瘤、扁平疣等相混淆,临床表现与组织病理的结合有助于降低误诊率。     

Smad7在脂溢性角化病、日光性角化病及基底细胞癌中的表达

目的： 检测Smad7在脂溢性角化病、日光性角化病以及基底细胞癌中的表达。方法：对脂溢性角化病、日光性角化病及基底细胞癌标本（各30例）和30例正常标本进行免疫组化染色。结果：23例脂溢性角化病标本、23例日光性角化病标本和28例基底细胞癌标本中Smad7染色阳性,阳性细胞率分别为（31.0±23.0）%,（32.7±26.3）%和（62.6±32.1）%,均显著高于正常组织的（6.7±5.0%）。结论： Samd7可能与脂溢性角化病、日光性角化病以及基底细胞癌的发病有关。     

脂溢性角化病皮损表皮中负性调节因子Smad7的表达

目的：探讨负性调节因子Smad7在脂溢性角化病皮损中表达水平的变化及其意义。方法：采用实时定量（quantitative real-time）PCR和免疫组化技术分别检测脂溢性角化病皮损及正常对照皮肤中Smad7的表达。结果：Smad7在脂溢性角化病皮损中的表达较正常表皮显著升高（P〈0.01）。结论：脂溢性角化病皮损表皮中Smad7过度表达可能有助于表皮细胞的异常增生,促进脂溢性角化病的形成。     

Clinical and pathological study of lichen-planus-like keratosis in China

Lichen-planus-like keratosis is usually diagnosed pathologically; rarely, a definitive diagnosis can be made grossly in the clinic. Only a few cases of lichen-planus-like keratosis have been reported in China. The purpose of this study was to investigate the clinical and pathological features of lichen-planus-like keratosis in China. Fifty cases of lichen-planus-like keratosis patients diagnosed pathologically during a 5-year period in our clinic were analyzed. Clinical features were recorded. Sectioned specimens were subjected to hematoxylin and eosin staining to observe pathological changes. Results showed that there were 34 males and 16 females (ratio 2:1) with an average age of 61.2 years. Most of the lesions were single papules or plaques with rough surfaces. They were distributed on the face, larger than 1 cm, and dark red to brown in color. Only one case (2%) was considered to be lichen-planus-like keratosis clinically. By hematoxylin and eosin staining, solar lentigo and solar elastosis could be found in 68% and 32% of lichen-planus-like keratosis lesions, respectively. Eosinophil (42%) and plasma cell (36%) infiltration was also found frequently. Exoerythrocytes could be detected in 50% of the cases. Lichen-planus-like keratosis is not uncommon in clinical practice in China, the diagnosis of lichen-planus-like keratosis should be made by a combination of clinical manifestations and pathological changes. It is better to classify lichen-planus-like keratosis as a benign skin tumor. More attention should be paid to lichen-planus-like keratosis in China.     

Nuclear DNA analysis of benign skin tumor and carcinoma in site developed from keratinocyte

To know the variation of DNA contents of seborrheic keratosis, keratoacanthoma, actinic keratosis, and Bowen's disease, cytophotometric assay was used. As the results, following findings were obtained. 1. DNA index of actinic keratosis was higher than those of seborrheic keratosis and keratoacanthoma. 2. DNA index of Bowen's disease was higher than that of seborrheic keratosis. 3. Polyploid cell population (greater than 6C) of keratoacanthoma was higher than that of seborrheic keratosis. 4. Polyploid cell populations (greater than GC) of carcinoma in site (actinic keratosis, Bowen's disease) were higher than that of keratoacanthoma .These date suggested that polyploid cell population and DNA index reflect grade of malignancy of tumor developed from keratinocytes. A clinic keratosis and Bowen's disease revealed almost the same DNA pattern. And the difference of polyploid cell population of keratoacanthoma++ ++ and seborrheic keratosis suggested the difference of the biological activity of them.     

Large-cell acanthoma is a solar lentigo.

On the basis of a study of 54 specimens each of large-cell acanthoma, solar lentigo, reticulated seborrheic keratosis, and lichen planus-like keratosis, it is concluded that clinically, histopathologically, and biologically, large-cell acanthoma is a variant of solar lentigo, and solar lentigo (including the large-cell variant) is a stage in the evolution of reticulated seborrheic keratosis and of lichen planus-like keratosis.     

Diagnosis and management of facial pigmented macules

The differential diagnosis of pigmented macules on the mottled chronic sun-damaged skin of the face is challenging and includes lentigo maligna (LM), pigmented actinic (solar) keratosis, solar lentigo, and lichen-planus-like keratosis. Although dermatoscopy improves the diagnostic accuracy of the unaided eye, the accurate diagnosis and management of pigmented facial macules remains one of the most challenging scenarios in daily practice. This is related to the fact that pigmented actinic (solar) keratosis, lichen-planus-like keratosis, and LM may reveal overlapping criteria, making their differential diagnosis clinically difficult. For this reason, practical rules have been introduced, which should help to minimize the risk for inappropriate diagnosis and management of LM.     

Effectiveness and safety of topical calcipotriol in the treatment of flat seborrheic keratosis on the face

Seborrheic keratosis is the most common slow-growing, benign epithelial tumour, usually appearing on sun-exposed areas. Treatment modalities for seborrheic keratosis may be uncomfortable and/or time-consuming. We present a case series of 12 patients with solitary seborrheic keratosis localized on the face treated with 0.005% calcipotriol ointment. The treatment lasted 3–8 months and resulted in complete regression of the lesions. Remission (follow-up period) lasted from 6 to 10 years. We conclude that topical calcipotriol may be a useful treatment option for seborrheic keratosis.     

皮肤镜诊断面部光线性角化病的初步研究

目的 评价皮肤镜在面部光线性角化病诊断中的价值.方法 面部疑似光线性角化病患者40例,其中男27例,女13例;年龄46～88岁;病程2～20年.分别对其行皮肤镜检查及组织病理学检查;以病理诊断为"金标准",通过诊断性试验的研究方法,研究皮肤镜诊断面部非色素性光线性角化病的敏感性、特异性及一致性.结果 与病理诊断比较,两位医生皮肤镜诊断面部非色素性光线性角化病的灵敏度、特异度、Youden指数及Kappa值分别为90.91%、88.89%、79.80%、0.798(χ2=0.25,P>0.05)和86.36%、94.44%、80.80%、0.800(χ2=0.25,P>0.05).结论 皮肤镜检查对面部非色素性光线性角化病诊断与病理组织检查结果存在较好的一致性.     

中国光线性角化病临床诊疗专家共识（2021）

【摘要】 光线性角化病是一种慢性进行性癌前病变,可进展为皮肤鳞状细胞癌。随着中国患病人数逐渐增多,亟须建立合适的诊断及治疗规范。中国康复医学会皮肤病康复专业委员会、中华医学会皮肤性病学分会联合中国医学装备协会皮肤病与皮肤美容分会组织光线性角化病相关领域部分专家,在国内外文献数据、国际指南和专家临床经验的基础上,结合我国诊疗现状,制定中国光线性角化病临床诊疗专家共识。本共识从光线性角化病的流行病学、发病因素及临床转归、临床表现及分级、诊断及鉴别诊断、治疗策略和患者教育管理等方面进行阐述,诊断方面包含了皮肤镜、反射式共聚焦显微镜和皮肤病理等手段,治疗策略涵盖了常见局部治疗和系统治疗方法,局部治疗包括光动力治疗、外用药物、物理治疗和手术切除,且按照证据等级给予推荐级别,为皮肤科医师诊疗工作提供参考。     

Glutathione in human epidermal tumors

Summary Methods for the determination of glutathione in small epidermal and tumor fragments are compared. The best results were obtained by an enzymatic cycling technique. The total glutathione concentrations in basal cell epithelioma, squamous cell epithelioma, and verruca seborrhoeica were 2.08, 1.81, and 1.87 mg/g dry weight, respectively. In normal epidermis adjacent to the basal cell epitheliomas the concentration was 1.27 mg/g dry weight.     

Defective beta1-integrins expression in arsenical keratosis and arsenic-treated cultured human keratinocytes

BACKGROUND: beta1-integrins, which localize to the basolateral surface of basal keratinocytes, are important in the differentiation control and proliferation of the epidermis. Many cutaneous diseases with perturbed differentiation, including arsenical keratosis, show altered patterns of integrin distribution and expression. Arsenic may induce arsenical keratosis through the differentiation and apoptosis aberration by integrins. The purpose of this study is to investigate the role of integrin and arsenic in the pathogenesis of arsenical keratosis. METHODS: Twenty-five specimens obtained from 25 patients with arsenical keratosis disease were studied. Immunohistochemistry staining to beta1, alpha2beta1, or alpha3beta1 integrins was performed in arsenical keratosis and clinically normal perilesional skin. Western blotting was used to assess the expression of integrin beta1 and focal adhesion kinase (FAK) in arsenic-treated cultured keratinocytes. RESULTS: A decreased expression of beta1, alpha2beta1, or alpha3beta1 integrins was demonstrated in arsenical keratosis and clinical normal perilesional skin in a large proportion of arsenical keratosis cases studied. The expressions of integrin beta1 and FAK were both decreased in arsenic-treated keratinocytes. CONCLUSIONS: Our results suggest that arsenic induces abnormal differentiation in arsenical keratosis via the effects of integrin expression in keratinocytes.     

Prevalence of melanoma clinically resembling seborrheic keratosis: analysis of 9204 cases

OBJECTIVE: To estimate the prevalence of melanoma clinically mimicking seborrheic keratosis. DESIGN: Retrospective review of cases submitted for histological examination with a clinical diagnosis of seborrheic keratosis or with a differential diagnosis that included seborrheic keratosis. SETTING: A tertiary medical care center-based dermatopathology laboratory serving academic dermatology clinics that have a busy pigmented lesion clinic. MATERIALS AND METHODS: A total of 9204 consecutive pathology reports containing a diagnosis of seborrheic keratosis in the clinical information field were identified between the years 1992 and 2001 through a computer database search. Reports with a final histological diagnosis of melanoma were selected for further review and clinicopathological analysis. MAIN OUTCOME MEASURE: Histological diagnosis, which was correlated with the preoperative clinical diagnosis. RESULTS: Melanoma was identified in 61 cases (0.66%) submitted for histological examination with a clinical diagnosis that included seborrheic keratosis. Melanoma was in the clinical differential diagnosis of 31 cases (51%). The remaining lesions had a differential diagnosis of seborrheic keratosis vs melanocytic nevus (17 cases, 28%), basal cell carcinoma (7 cases, 12%), or a squamous proliferation (3 cases, 5%). In 3 cases (5%), seborrheic keratosis was the only clinical diagnosis. All histological types of melanoma were represented. CONCLUSIONS: Our results confirm that melanoma can mimic seborrheic keratosis. These data strongly support the current policy of submitting for histological examination all specimens that have been removed from patients.