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.     

Incidence and risk factors associated with a second squamous cell carcinoma or basal cell carcinoma in psoralen + ultraviolet a light-treated psoriasis patients

Psoralen + ultraviolet A-treated psoriasis patients are at increased risk for squamous cell carcinomas and basal cell carcinomas; however, the incidence and risk factors associated with second squamous cell carcinomas and basal cell carcinomas in this population are not well qualified. Incidence and risk factors for second squamous cell carcinomas and basal cell carcinomas were studied in a cohort of 1380 psoralen + ultraviolet A-treated psoriasis patients prospectively followed for over 20 y; 264 had a squamous cell carcinoma and 258 a basal cell carcinoma after beginning psoralen + ultraviolet A therapy. After a first squamous cell carcinoma, the risk of a second squamous cell carcinoma was 26% at 1 y, 62% at 5 y, and 75% at 10 y. Risk increased with high psoralen + ultraviolet A exposure prior to the first squamous cell carcinoma (hazard ratio 3.32, 95% confidence interval 1.53, 7.18). Higher rates of post-first squamous cell carcinoma psoralen + ultraviolet A treatment also were associated with greater risk (hazard ratio 1.56 for every additional 10 treatments per year for patients with low pre-first squamous cell carcinoma psoralen + ultraviolet A exposure, 95% confidence interval 1.35, 1.81). Patients exposed to high levels of tar and/or ultraviolet B before a first squamous cell carcinoma were also at higher risk (hazard ratio 1.72, 95% confidence interval 1.14-2.60). Risk of a second basal cell carcinoma was 21% at 1 y, 49% at 5 y, and 61% at 10 y. There was some evidence that high exposure to psoralen + ultraviolet A before a first basal cell carcinoma was associated with increased risk of second basal cell carcinoma (hazard ratio 1.45, 95% confidence interval 0.97-2.17). Higher post-first tumor psoralen + ultraviolet A treatment rates also increased risk (hazard ratio 1.24 for every additional 10 treatments per year, 95% confidence interval 1.06-1.47). Psoralen + ultraviolet A-treated psoriasis patients appear to have a greatly increased incidence of second squamous cell carcinoma compared with the general population. Patients who develop a squamous cell carcinoma after starting psoralen + ultraviolet A therapy should be closely monitored for a subsequent squamous cell carcinoma.     

Basaloid squamous cell carcinoma of the nasal septum presenting as a primary cutaneous lesion

Background:Basaloid squamous cell carcinoma is a rare aggressive variant of squamous cell carcinoma, with a predilection for the head and neck region. There are only two case reports in the literature documenting a nasal cavity squamous cell carcinoma presenting as a primary cutaneous lesion.Objective:We report a rare case of nasal cavity basaloid squamous cell carcinoma presenting initially as a nasal bridge mass. Two initial biopsies revealed features consistent with basal cell carcinoma and basosquamous cell carcinoma, respectively.Result:Final surgical pathology showed extensive invasive squamous cell carcinoma with basaloid differentiation arising from the nasal septal mucosa with extension to the overlying skin. The clinicopathologic features were interpreted as basaloid squamous cell carcinoma.Conclusion:We discuss the difficulties in pathologic diagnosis of this condition given its varied phenotypical expression. As well, this case emphasizes the necessity for diagnostic vigilance when assessing a primary cutaneous lesion as it may be a rare presentation of an underlying malignancy extending to the skin.     

PTCH mutations in squamous cell carcinoma of the skin

Ultraviolet light exposure is the major risk factor for the development of squamous cell carcinoma in Caucasians. Mutations in the tumor suppressor gene p53 have been identified in both squamous cell carcinomas and basal cell carcinomas. The human homolog of the Drosophila patched gene, has been shown to be mutated in sporadic basal cell carcinomas; however, mutations in the patched gene have not been found in squamous cell carcinoma. In this study, we screened a total of 20 squamous cell carcinoma samples for mutations in the patched gene. Using polymerase chain reaction-single strand conformation polymorphism as an initial screening method, we identified one non-sense mutation, two mis-sense mutations and three silent mutations in five squamous cell carcinoma samples. In one squamous cell carcinoma sample, we identified a tandem GG-->AA transitional change at nucleotide 3152 in exon 18 of the patched gene that resulted in a premature stop codon at codon 1051. The three squamous cell carcinoma samples containing non-sense and mis-sense mutations were isolated from individuals with histories of multiple basal cell carcinoma. Sequence analysis of the p53 gene in these five squamous cell carcinoma samples identified one CC-->TT and three C-->T ultraviolet-specific nucleotide changes. Our study provides evidence that the patched gene is mutated in squamous cell carcinoma from individuals with a history of multiple basal cell carcinoma. The identification of ultraviolet-specific nucleotide changes in both tumor suppressor genes supports the notion that ultraviolet exposure plays an important part in the development of squamous cell carcinoma.     

Merkel cell carcinoma co-existent with sebaceous carcinoma of the eyelid

Merkel cell carcinoma is occasionally associated with other types of cutaneous malignancies including squamous cell carcinoma, basal cell carcinoma and lentigo maligna. We report a case of Merkel cell carcinoma co-existent with sebaceous carcinoma in the right upper eyelid of a 61-year-old Japanese man. Histopathologically, the resected tumor consisted of three nodules located in the tarsal plate, showing two distinct histopathological types. Two nodules were Merkel cell carcinoma and located in the proximal part of the palpebral conjunctiva. The third was sebaceous carcinoma located in the distal transitional zone between the epidermis and the conjunctiva. No features of transition between these two components were noted. Metastatic deposits were identified in the regional lymph nodes, which solely consisted of Merkel cell carcinoma without sebaceous carcinoma. This is the first report of such co-existent lesions.     

Merkel细胞癌合并原位鳞状细胞癌一例并文献复习

Merkel细胞癌是一种罕见的、具有高度侵袭性的皮肤神经内分泌癌,好发于老年人的日光暴露部位,尤其是头颈部(41%～50%),其次是四肢(32%～38%)。Merkel细胞癌可与鳞状细胞癌、鲍温病、基底细胞癌等皮肤肿瘤合并发生。我们报道一例发生在非光暴露部位的Merkel细胞癌合并原位鳞状细胞癌,并对相关文献进行复习。     

Carcinoma de células de Merkel y linfoma no Hodgkin

.—Merkel cell carcinoma is a neoplasm of poorly known histogenesis that affects patients over the sixth decade of life. It usually localizes on photoexposed zones. Merkel cell carcinoma has been associated to many different cancers as, for example, chronic lymphocytic leukaemia, basal cell carcinoma or squamous cell carcinoma.We present a 61-year-old woman with a non-Hodgkin lymphoma and a Merkel cell carcinoma in her right arm and a 87-year-old man who presented during three years four lesions of type B cutaneous non-Hodgkin lymphomas located on his arm, forearm, axilla and eyelid. He presented on his right buttock a tumour that was diagnosed of Merkel cell carcinoma. This is to our knowledge the second time that an association of Merkel cell carcinoma and non-Hodgkin lymphoma is described in the literature.     

Invasive squamous cell carcinoma after treatment of carcinoma in situ with 5% imiquimod cream

Squamous cell carcinoma in situ has the potential to progress to invasive squamous cell carcinoma. This report presents two cases of punch biopsy-proven squamous cell carcinoma in situ, treated with once-daily application of 5% imiquimod cream for 6 weeks. Both patients developed moderate local inflammatory reactions during treatment. The first patient demonstrated clinical clearance of the scalp lesion after treatment. Two months later, he re-presented with a subcutaneous nodule at the same site. Histology was consistent with recurrent squamous cell carcinoma. Five months following excision of the recurrent tumour, he presented with metastatic squamous cell carcinoma to a cervical lymph node. The second patient had low-grade chronic lymphocytic leukaemia and presented with squamous cell carcinoma in situ of the leg that failed to clear clinically after treatment with imiquimod. He presented 4 months later with a focus of invasive squamous cell carcinoma within the lesion.     

Pulmonary Metastasis of Basal Cell Carcinoma

Although basal cell carcinoma is the most common skin cancer, it rarely metastasizes. Metastatic basal cell carcinoma may, therefore, initially elude diagnosis and management. We describe the case of a patient with a metastatic basal cell carcinoma present in the lungs. The differential diagnosis of suspected metastatic lesions should include metastases from a cutaneous basal cell carcinoma, in addition to those from more commonly metastasizing carcinomas, especially in patients with a history of a large basal cell carcinoma that has involved the head and neck regions, and was refractory to treatment.     

Fine needle aspiration cytology of basal cell carcinoma of the skin: a clinical and cytopathological appraisal.

This report describes the fine needle aspiration cytologic findings of 22 cases of basal cell carcinoma of the skin. The series consisted of 17 men and 5 women with a mean age of 60.7 years (range, 35-80). All the patients were from south of Xinjiang and were outdoor workers with histories of prolonged exposure to strong sunlight. Histopathologic study was performed in all cases. Using fine needle aspiration cytology (FNAC) in evaluating basal cell carcinoma, there were no false-positive cases, but one false-negative one giving a diagnostic accuracy of 95.65%. Cytologic features suggestive of basal cell carcinoma included increased numbers of small, uniform hyperchromatic, relatively little cytoplasmic cell clusters. The peripheral cells appeared in monolayer form as a papillated outline with very strong cellular cohesion. Scattered tumor cells were seldom seen. The differential diagnosis of basal cell carcinoma in FNAC includes poorly differentiated squamous cell carcinoma, eccrine gland carcinoma, and neuroendocrine carcinoma of the skin. FNAC diagnosis of basal cell carcinoma is essential in order to ensure proper treatment.     

Cutaneous basosquamous carcinoma infiltrating cerebral tissue

Basosquamous carcinoma of the skin is a rare malignancy with specific histopathological features of both basal cell carcinoma and squamous cell carcinoma. Some authors believe that basosquamous carcinoma is a variant of basal cell carcinoma, while others suggest that this tumour may behave more aggressively. We present a 44-year-old female patient who was diagnosed with a basosquamous carcinoma histopathologically. She had extensive ulcero-vegetative lesions, involving the anterior half of the scalp, the left orbit and the left side of the face. With this case we aim to emphasize the aggressive nature of basosquamous carcinoma and review the literature.     

Bowen's diseases and basal cell carcinomas in a patient.

Bowen's disease is a well-known precancerous lesion, in which invasive squamous carcinoma may develop. However, it is rare that Bowen's disease, basal cell carcinoma, and internal malignancy develop in a single patient. We report a case of a 54-year-old male patient with Bowen's disease, basal cell carcinoma of the skin, and squamous cell carcinoma of the lung. Multiple scaly erythematous patches had developed several years earlier and were diagnosed as Bowen's disease by skin biopsy. The number of lesions increased and, five months ago, a right lower lobectomy was done for squamous cell carcinoma which was detected on a chest X-ray. Skin biopsies of two different sites revealed Bowen's disease and basal cell carcinoma. The arsenic level was increased in his hair specimen. Cryotherapy was applied.     

基底细胞癌和鳞状细胞癌中转化生长因子βⅠ型和Ⅱ型受体表达

目的探讨转化生长因子β(TGFβ)受体在基底细胞癌和鳞状细胞癌中表达水平的变化及其意义。方法采用实时定量PCR和SP免疫组化技术分别检测基底细胞癌、鳞状细胞癌及正常人对照皮肤中Ⅰ型和Ⅱ型TGFβ受体(TGFβRⅠ,TGFβRⅡ)mRNA和蛋白的表达。结果对18例基底细胞癌、24例鳞状细胞癌患者的皮损及正常人对照皮肤的研究显示,基底细胞癌和鳞状细胞癌皮损TGFβRⅠ和TGFβRⅡ的mRNA表达水平均显著低于正常人对照皮肤。免疫组化试验结果显示;TGFβRⅠ染色强度在基底细胞癌组、鳞状细胞癌组较正常人对照皮肤组显著降低(P<0.001);TGFβRⅡ在二组表皮肿瘤与正常人对照皮肤组问表达差异也有统计学意义(P<0.01)。结论基底细胞癌和鳞状细胞癌中TGFβ受体表达下调可能有助于这些上皮细胞起源的表皮肿瘤的形成。     

Development of neuroendocrine (Merkel cell) carcinoma mixed with squamous cell carcinoma in erythema ab igne

Squamous cell carcinoma and neuroendocrine (Merkel cell) carcinoma are cutaneous neoplasms that have only occasionally been reported to coexist. Squamous cell carcinoma, but not neuroendocrine (Merkel cell) carcinoma, is a rare complication of erythema ab igne. This report describes the development of both neoplasms arising within the same tumor mass in an area of erythema ab igne.     

Merkel cell carcinoma in situ: New insights into the cells of origin

We report a case of a 71-year-old male who presented with a small skin-coloured plaque on his cheek. Histopathology demonstrated an intraepidermal carcinoma with follicular involvement. No evidence of dermal invasion was seen. Immunohistochemical studies showed areas of positive staining for CK20, EMA and synaptophysin. Histopathology findings were found to be most consistent with a diagnosis of intraepidermal carcinoma with features of Merkel cell carcinoma in situ, in combination with a squamous cell carcinoma in situ, with follicular involvement. Recent advances and findings suggest Merkel cell polyomavirus MCPyV-positive Merkel cell carcinoma and MCPyV-negative Merkel cell carcinoma have different cells of origin from different germ layers.     

Ulcerative pigmented squamous cell carcinoma in a 101-year-old Japanese woman

Pigmented squamous cell carcinoma is a rare variant of squamous cell carcinoma. We report a case of pigmented squamous cell carcinoma with dermoscopic examination probably arisen from actinic keratosis in a 101-year-old woman who was surgically treated under general anesthesia. In addition, we discuss indications of general anesthesia in elderly patients with skin cancer, differential diagnosis and dermoscopic features of pigmented squamous cell carcinoma.     

抗角蛋白自身抗体对体外培养鳞癌细胞端粒酶活性的影响

目的　研究抗角蛋白自身抗体对鳞癌细胞端粒酶活性的影响 ,探讨抗角蛋白自身抗体抑制鳞癌细胞增殖的机制。方法　分别以 4mg/L、8mg/L、16mg/L抗角蛋白自身抗体作用于鳞癌细胞株Tca 3 6h ,应用端粒重复序列扩增 ELISA(TRAP ELISA)和非变性聚丙酰胺凝胶电泳方法检测鳞癌细胞端粒酶活性的改变。结果　TRAP ELISA结果显示体外培养的鳞癌细胞具有较高水平的端粒酶活性 (t=3 .53 7,P <0 .0 1) ,电泳结果显示鳞癌细胞PCR产物为显色较深的多个梯形条带 ;抗角蛋白自身抗体在浓度为 4mg/L、8mg/L、16mg/L时 ,TRAP ELISA显示鳞癌细胞株Tca端粒酶的活性显著降低 ,该抑制作用呈剂量依赖性 (r =-0 .83 58,P <0 .0 1) ,电泳结果显示梯形条带数量减少 ,信号减弱。结论　抗角蛋白自身抗体可以呈剂量依赖的抑制体外培养鳞癌细胞端粒酶的活性 ,可能在抗角蛋白自身抗体抑制鳞癌增殖机制中起着一定的作用     

Clear cell basal cell carcinoma with pulmonary metastasis: case report and literature review

Clear cell basal cell carcinoma is a rare histological variant of basal cell carcinoma, which has been well described in the literature. We herein report a case of a 56-year-old man who developed lung metastasis from a rather aggressive tumor that grew very rapidly to involve the parotid gland, the mandibular bone, and even the petrous portion of the temporal bone, the middle ear, and the dura mater. Histological diagnosis was clear cell carcinoma, and initially a salivary origin was suspected. Only in the resection specimen, we found areas of more conventional basal cell carcinoma, and final diagnosis was clear cell basal cell carcinoma. We herein report a case of this rare variant and comment on the histopathological differential diagnosis and the possible relation between these tumors and Gorlin-Goltz syndrome.     

Granular cell basal cell carcinoma. A distinct histopathologic entity.

In two cases of basal cell carcinoma with prominent granular cell features, light microscopic examination showed a tumor with the general configuration of a nodular basal cell carcinoma. Focally, there were masses of cells with eosinophilic, granular cytoplasm and large cytoplasmic inclusions, strongly suggestive of granular cell myoblastoma. Ultrastructural observations in one case showed numerous lysosome-like organelles that were similar to those described for granular cell myoblastoma, but were identical to those described for the granular cell variant of ameloblastoma, a tumor that frequently resembles basal cell carcinoma. Additional features included tonofilaments and desmosomes, both of which support an epithelial origin for the granular cells in this rare variant of basal cell carcinoma.