银屑病患者光疗发生鳞状细胞癌

因接受光疗而发生皮肤恶性肿瘤者少见,作者报告1例光疗5年的银屑病患者先后发生Bowen病及鳞状细胞癌(SC)共6处。     

银屑病素在光线性角化病、Bowen病及皮肤鳞状细胞癌组织中的表达及意义

目的 研究银屑病素在光线性角化病、Bowen病及皮肤鳞状细胞癌(鳞癌)中的表达.方法 用免疫组化的方法检测18例正常皮肤组织、20例光线性角化病、25例Bowen病、21例高分化皮肤鳞癌及16例低分化鳞癌皮损中银屑病素的表达.结果 银屑病素在正常皮肤组织中表达阳性率为11.1％.在光线性角化病中19例银屑病素表达于角质层至棘层上1～3层,胞质着色,阳性率为95.0％.在Bowen病中22例银屑病素表达于表皮全层角质形成细胞,胞质着色,空泡状细胞包膜及胞质着色,阳性率为88％.在高分化鳞癌中20例银屑病素表达于角质层至棘层全层,角化珠及角化不良细胞着色,阳性率为95.2％;在低分化鳞癌中13例银屑病素表达于角质层至棘层上1～5层,低分化的鳞状细胞不着色,阳性率为92.3％.与正常皮肤组相比,银屑病素在光线性角化病、Bowen病、高分化鳞癌和低分化鳞癌中的表达差异均有统计学意义(P＜0.01).银屑病素在光线性角化病、Bowen病、高分化鳞癌中表达强度逐渐升高,而在低分化鳞癌中表达强度降低,但仍高于正常皮肤组织(P＜0.05).结论 银屑病素在鳞状细胞分化异常的皮肤病中表达异常.     

Raptor、Rictor和磷酸化Akt在日光性角化病、Bowen病及鳞状细胞癌中的表达

目的:检测Raptor、Rictor和磷酸化Akt(p-Akt)在日光性角化病、Bowen病和鳞状细胞癌中的表达。方法:采用免疫组化法检测Raptor、Rictor及p-Akt(Ser473)在20例正常皮肤、20例日光性角化病、20例Bowen病及40例鳞状细胞癌中的表达。结果:Raptor在鳞状细胞癌、Bowen病和日光性角化病中的阳性表达率分别为87.50%、70.00%和60.00%,均高于正常皮肤的25.00%(均P0.05);其中低分化鳞状细胞癌中Raptor的阳性表达率为100%,高于高分化鳞状细胞癌的阳性表达率75%(P0.05)。Rictor在鳞状细胞癌、Bowen病和日光性角化病中的阳性表达率分别为80.00%、70.00%及55.00%,均高于正常皮肤阳性表达率的20%(均P0.05);p-Akt(Ser473)在鳞状细胞癌、Bowen病和日光性角化病中的阳性表达率分别为77.50%、65.00%及50.00%,而正常皮肤阳性表达率为0。鳞状细胞癌、Bowen病和日光性角化病中Rictor的阳性表达水平和p-Akt(Ser473)的阳性表达水平均呈正相关(均P0.05)。结论:Raptor、Rictor和p-Akt(Ser473)的高表达可能与日光性角化病、Bowen病和鳞状细胞癌的发生发展有关。     

水通道蛋白3在四种皮肤肿瘤中的表达

目的 探讨水通道蛋白3（AQP3）在四种皮肤肿瘤组织中的表达及意义。方法 应用免疫组织化学方法检测30例脂溢性角化病、15例Bowen病、32例鳞状细胞癌、17例恶性黑素瘤及15例正常人皮肤组织中AQP3的表达。结果 脂溢性角化病、Bowen病、鳞状细胞癌、恶性黑素瘤及正常人表皮组织中均存在AQP3蛋白的表达;脂溢性角化病皮损中AQP3表达水平与正常人对照组差异无统计学意义（P > 0.05）;Bowen病、鳞状细胞癌及恶性黑素瘤皮损中AQP3蛋白表达显著高于正常人对照组（P < 0.01）,其中鳞状细胞癌与恶性黑素瘤的表达最强,均显著高于Bowen病（P < 0.01）,但鳞状细胞癌与恶性黑素瘤比较差异无统计学意义（P > 0.05）。此外,在鳞状细胞癌中AQP3的表达与肿瘤的分化有显著相关性（P < 0.01）;在已转移恶性黑素瘤中AQP3的表达显著高于未转移恶性黑素瘤（P < 0.05）。结论 AQP3在皮肤恶性肿瘤中表达上调。     

Ber EP4与EMA染色在皮肤基底细胞上皮瘤和鳞状细胞癌诊断中的意义

目的 观察BerEP4和EMA染色在皮肤基底细胞上皮瘤和鳞状细胞癌诊断中的意义.方法 用免疫组化SP法检测BerEP4和EMA在皮肤基底细胞上皮瘤、鳞状细胞癌、光线性角化病、Bowen病、脂溢性角化病、寻常疣和基底鳞状细胞癌皮损肿瘤成分及周围组织、皮肤附属腺体中的表达.结果 所有基底细胞上皮瘤和基底鳞状细胞癌肿瘤细胞呈BerEP4阳性,而鳞状细胞癌、光线性角化病、Bowen病、脂溢性角化病和寻常疣呈BerEP4阴性;多数鳞状细胞癌、Bowen病和部分光线性角化病肿瘤细胞及病变区域呈EMA阳性,而基底细胞上皮瘤、基底鳞状细胞癌、脂溢性角化病和寻常疣呈EMA阴性.结论 联合使用BerEP4和EMA能很好地协助诊断皮肤基底细胞上皮瘤、基底鳞状细胞癌、癌前病变及一些良性增生性皮肤病.     

5-氨基酮戊酸光动力治疗皮肤肿瘤的疗效观察

目的评价5-氨基酮戊酸光动力(ALA-PDT)治疗日光性角化病、Bowen病、基底细胞癌和鳞状细胞癌的临床疗效。方法将光敏剂5-氨基酮戊酸(ALA)涂于53例日光性角化病、23例Bowen病、36例基底细胞癌、40例鳞状细胞癌患者的皮损处,避光3~4h后,使用光动力治疗仪照射约20min,1次/周,经4~6次治疗后评估疗效。结果 ALA-PDT疗法治疗日光性角化病及Bowen病的有效率为100%;基底细胞癌浅表型的疗程短(3~5次),且有效率为100%,结节型疗程长(4~6次),且有效率仅为77.77%;高分化鳞癌有效率为100%,中分化为85.71%,低分化鳞癌有效率为40.00%,所有皮肤肿瘤患者的总痊愈率为84.21%,有效率为95.35%。结论 ALA-PDT治疗日光性角化病、Bowen病、浅表型基底及高分化鳞状细胞癌疗效确切,美容效果佳,无不良反应,治疗结节性基底细胞癌及中分化、低分化鳞状细胞癌尤其是年老体弱、美容要求高的患者亦有一定的疗效。     

Bowen病的治疗现状及进展

Bowen病是一种表皮内鳞状细胞癌,可逐渐发展为侵袭性鳞状细胞癌.Bowen病的治疗方法包括手术和非手术疗法.手术治疗包括单纯切除、莫氏显微外科治疗、切削电灼法,非手术治疗包括药物治疗、放射疗法、冷冻疗法、光动力疗法及其他综合疗法等.手术是治疗Bowen病的首选方法,对于不适合手术的患者或特殊部位的病变可考虑药物治疗、光动力治疗等.     

阿维A联合手术治疗多发性Bowen病并发鳞状细胞癌一例

报道1例多发性Bowen病并发鳞癌.患者男,61岁,全身出现多处红褐色斑块13年.患者既往养鸡多年,双上肢经常被划伤或啄伤,部分皮疹发病前有明确的外伤史.患者体质较弱,患有多种系统性疾病,间断服药治疗.皮肤科检查:全身见40余处大小不等红褐色斑片及斑块,最小约黄豆大小,最大位于右侧锁骨区,约10 cm×4 cm,表面粗糙,覆油腻性痂皮,边界清楚,部分形状不规则.右手拇指背见一处约2 cm×2 cm大小肿物,表面有黄白色痂皮,呈砺壳状,质硬.右手拇指背肿物全切,组织病理检查:高分化鳞状细胞癌.左侧胸部红褐色斑块活检,组织病理检查为:Bowen病.我们将鳞状细胞癌皮损手术切除后植皮,余皮疹给予阿维A口服治疗,所有皮疹均明显好转,部分完全消退.     

p73蛋白在正常人皮肤和表皮肿瘤中的表达

目的 探讨p73蛋白在正常人皮肤和不同表皮肿瘤皮损中的表达及意义。方法 应用免疫组化方法检测19例脂溢性角化病、16例基底细胞癌、11例Bowen病、5例鳞状细胞癌及10例正常人皮肤p73、p53、Ki67的表达。结果 在正常人表皮基底层、毛囊外毛根鞘最外层基底样细胞和皮脂腺生发细胞有p73的表达;在基底细胞癌和脂溢性角化病的基底样细胞、Bowen病中异形性明显的瘤细胞p73呈高表达,鳞状细胞癌和脂溢性角化病中的鳞状细胞呈弱阳性或不表达。脂溢性角化病、Bowen病、基底细胞癌、鳞状细胞癌之间p73蛋白表达差异有统计学意义(H=12.71,P<0.01),其中基底细胞癌的表达最强。Ki67在皮肤肿瘤之间差异也有统计学意义(H=14.12,P<0.01),但p53差异无统计学意义(H=2.058,P>0.05)。在各组样本中,p73的表达与p53、Ki67无显著相关性(P>0.05)。结论 p73蛋白可能在皮肤分化中起重要作用。     

光动力治疗炎症性及感染性皮肤病的进展

光动力治疗在皮肤科领域应用广泛,如治疗鳞状细胞癌、基底细胞癌、Paget病、Bowen病、光线性角化病、痤疮、鲜红斑痣及尖锐湿疣等取得了满意疗效.目前关于光动力治疗适应证的研究已扩展到银屑病、口腔扁平苔藓及部分局部感染性皮肤病中,取得了一定的疗效,尤其是对面部扁平疣及皮肤利什曼病等几种炎症/感染性皮肤病,更显示出高效率、低复发及美容效果好等优点,值得进一步研究.     

银屑病并发砷角化症、Bowen病及多发性鳞状细胞癌一例

[摘 要] 报道1例银屑病并发砷角化症、鲍温病及多发性鳞癌。患者男,55岁,患寻常型银屑病25年,口服砷制剂治疗8年,出现右大腿肿物3年,周身多处角化性丘疹2年,加重5个月,手术切除10处皮损组织后病理检查显示,1处皮损证实为鲍温病,4处皮损为鳞癌,其余符合砷角化症。值得临床医生警惕含砷制剂的远期效应及避免不规范治疗。     

Differential expression of ezrin in epithelial skin tumors: cytoplasmic ezrin immunoreactivity in squamous cell carcinoma

Background Ezrin is a cytoskeleton linker protein that is actively involved in regulating the growth and metastatic capacity of cancer cells. The purpose of the study was to assess the expression pattern of ezrin in normal skin and various epithelial neoplasms. Methods We used immunohistochemical techniques to examine the expression of ezrin in paraffin‐embedded tissues of squamous cell carcinoma (n = 23), basal cell carcinoma (n = 10), Bowen’s disease (n = 10), actinic keratosis (n = 10), keratoacanthoma (n = 9), seborrheic keratosis (n = 5), psoriasis vulgaris (n = 5), and normal control skin (n = 5). Results In Bowen’s disease, actinic keratosis, keratoacanthoma, and seborrheic keratosis, ezrin was dominantly expressed in the cell membrane except for the cornified layer. In squamous cell carcinoma (SCC) specimens, the percentage of ezrin‐positive cells was increased compared with Bowen’s disease, actinic keratosis, keratoacanthoma, and seborrheic keratosis. Especially in SCC samples, ezrin expression was markedly expressed in the cytoplasm. In addition, there was a correlation between the pattern of ezrin expression and tumor differentiation in SCC. Basal cell carcinoma showed intense and diffuse staining especially in the solid growth pattern. Conclusions Our findings suggest that dysregulation of ezrin may be important in the development of cutaneous epithelial malignancies and tumor grade. We suggest that the cytoplasmic localization of ezrin may be useful in the diagnosis of skin SCC.     

Detection of human papillomavirus type 16 in Bowen's carcinoma of the toe

Background Human papillomavirus (HPV) is known to cause cervical cancer. Because it has been detected in lesions of Bowenoid papulosis, Bowen’s disease, and Bowen’s carcinoma, HPV infection has been implicated in the pathogenesis of these diseases. Methods A 44‐year‐old man was diagnosed clinicopathologically with Bowen’s carcinoma of the right great toe. He developed multiple organ metastases and died. We examined HPV DNA in skin biopsy specimens from the primary and skin metastatic lesions by polymerase chain reaction (PCR) and in situ hybridization (ISH). The PCR assay was carried out using primer sets specifically designed for detecting the E6 and E7 genes of the HPV types associated with malignancy. Purified and cloned PCR products were subjected to DNA sequence analysis. The ISH studies used INFORM^® HPV III probes. Results We found HPV DNA in specimens from both the primary and the skin metastatic lesions. DNA sequencing detected HPV type 16. We compared the base sequences of viral DNA from the primary and metastatic lesions. Point mutations of the base sequences of the E6 and E7 genes were observed in viral DNA from metastases but not in that from primary lesions. The E6 gene had mutated from G to A in the 383rd base sequence, causing a Glu‐to‐Lys amino acid change. Results of ISH showed punctuate signals in the nuclei of tumor cells. Conclusions We suspect an association between HPV 16 infection and the development of this malignant occurrence.     

1333例皮肤恶性肿瘤回顾性分析

目的了解重庆地区皮肤恶性肿瘤的发病情况及特点。方法收集和回顾性分析第三军医大学西南医院皮肤科1991年～2010年经组织病理确诊的皮肤恶性肿瘤患者临床资料。结果共统计1333例皮肤恶性肿瘤患者,男女之比为1．26：1,其中基底细胞癌454例（占34．06％）、鳞状细胞癌235例（占17．63％）、鲍恩病136例（占10．20％）、恶性黑素瘤133例（占9．98％）、乳房及乳房外Paget病104例（占7．80％）。临床诊断与组织病理诊断符合率为72．4％,符合率最高的是乳房及乳房外Paget病（93．27％）。基底细胞癌主要发生于头面部和颈部,鲍恩病多见于躯干部位,恶性黑素瘤的主要发病部位在足跖。结论相对于国内外其他研究资料,重庆地区的皮肤恶性肿瘤发病情况具有一定的自身特点。     

鲍温病和皮肤鳞状细胞癌皮损中ΔNp63的表达

目的观察ΔNp63在鲍温病和皮肤鳞状细胞癌中的表达情况。方法应用免疫组化Envision法检测10例正常皮肤、30例鲍温病及30例皮肤鳞状细胞癌组织中ΔNp63的表达水平,并对该3组标本ΔNp63的表达水平进行比较。结果在鲍温病的皮损组织中,ΔNp63主要在表皮全层细胞中弥漫性表达;在皮肤鳞状细胞癌中,ΔNp63表达与其分化程度相关(P=0.004),即在高分化鳞状细胞癌中,ΔNp63在癌巢外周基底样细胞表达,在中分化鳞状细胞癌中,ΔNp63在癌巢中有弱弥漫性表达。ΔNp63在鲍温病、皮肤鳞状细胞癌及正常皮肤中的阳性表达率差异有统计学意义(P<0.05);但不同部位的鲍温病和皮肤SCC组组织中,ΔNp63表达差异均无统计学意义(P均>0.05)。结论ΔNp63多考虑是未分化及低分化上皮来源肿瘤的标记物。     

The haptoglobin phenotype influences the risk of cutaneous squamous cell carcinoma in kidney transplant patients

Background Cutaneous squamous cell carcinoma (SCC) is the most frequent skin cancer after organ transplantation. Currently, the pre‐identification of transplant patients at increased risk for non‐melanoma skin cancer remains difficult. Objective To investigate the Hp polymorphism as a marker for the identification of a subset of patients with an increased susceptibility to develop SCC/Bowen’s disease. Methods Haptoglobin phenotyping was performed with haemoglobin‐supplemented starch gel electrophoresis in 300 kidney transplant patients. High‐performance gel permeation chromatography was used in case of low serum haptoglobin concentration. Results Cox regression analysis (adjusted for age, gender and Mediterranean origin) showed a significant association of the Hp 1‐1 phenotype with a higher risk of SCC/Bowen’s disease (P = 0.035) and multiple primary SCCs (P = 0.002). No significant difference between the Hp phenotypes was found for the development of Bowen’s disease and SCCs in the first 10 years following renal transplantation. However, after a follow‐up of >10 years, a significant association between the Hp 1‐1 phenotype and the occurrence of Bowen’s disease and SCC was reported (P = 0.002 and P = 0.001 respectively). Conclusions This study shows an increased risk for the development of (multiple) SCCs in kidney transplant patients with the Hp 1‐1 phenotype. This finding points to the role of Hp 1‐1 phenotype as an important predictor in identifying a subset of patients with an increased need for preventive measures and is in agreement with the decreased anti‐inflammatory capacity of this phenotype.     

Pigmented lesion in the inguinal region

Pigmented Bowen disease (PBD) is a rare tumor characterized by increased melanin pigment in the epidermis or papillary dermis in addition to the typical findings of Bowen disease. We report the case of a 60-year-old woman who presented with a 6-month history of a gradually enlarging solitary dark brown plaque in her right inguinal region. Histopathology showed hyperkeratosis with parakeratosis, acanthosis, disorganization of epidermal architecture, atypical keratinocytes, and increased melanin pigment of the papillary dermis. Considering the clinical and the histological evidence, a diagnosis of PBD was established. Complete resection confirmed the diagnosis. Pigmented Bowen disease is an unusual form of squamous carcinoma in situ. Other tumors in the differential diagnosis include pigmented basal cell carcinoma and superficial spreading melanoma.     

5-氨基酮戊酸光动力疗法治疗鲍温病10例疗效观察

目的观察5-氨基酮戊酸光动力疗法治疗鲍温病的临床疗效。方法将20例鲍温病患者分为两组,各10例。治疗组予5-氨基酮戊酸外涂于皮损处,3h后予红光照射20min,能量密度100～120J/cm2,1次/周,共4周。对照组外涂5-氟尿嘧啶软膏皮损处,2次/d,共4周。结果治疗组完全缓解率为90.00%,对照组为30.00%,两组间完全缓解率比较,差异有统计学意义(P<0.05)。且治疗组均未见严重不良反应,对照组有溃疡及瘢痕等不良反应。结论 5-氨基酮戊酸光动力疗法治疗鲍温病临床疗效较好,且无严重不良反应,值得临床推广应用。     

Bowen’s disease of the penile shaft presenting as a pigmented macule: dermoscopy,reflectance confocal microscopy and histopathological correlation

The penile localization of pigmented Bowen’s disease has been rarely reported and has been mostly related to human papillomavirus infection. Early diagnosis and treatment are important to prevent progression to invasive squamous cell carcinoma. However, diagnosis can be challenging because it may be difficult to distinguish from melanoma, even using dermoscopy. Reflectance confocal microscopy may be useful in suggesting the bedside diagnosis before the histopathological confirmation. A case of penile pigmented Bowen’s disease is described along with its dermoscopy and reflectance confocal microscopy findings and their correlation with histopathology.     

Extramammary Paget's Disease of External Genitalia with Bowenoid Features

Extramammary Paget''s disease (EMPD) is an uncommon intraepithelial adenocarcinoma, primarily affecting the apocrine-bearing skin. Bowen disease is an intraepithelial squamous cell carcinoma having the potential to become invasive carcinoma. The histopathological concomitant features between EMPD and Bowen disease have been described. One theory is that primary EMPD arises multicentrically, within the epidermis from the pluripotent stem cells. Herein, we describe a case of EMPD that had bowenoid features, and review the previous cases associated with the origin of EMPD.