毛发上皮瘤12例临床病理学观察

目的：探讨毛叟皮瘤与皮肤附属器结构的关系。方法：观察与分析12例毛发上皮瘤的临床表现及组织形态学结构。结果：多发性毛发上皮瘤10例（83．3％），20岁以下发病9例（75％），组织病理学改变主要是基底细胞样细胞增生，向毛囊及皮腺脂导管分化。结论：毛发上皮瘤是一种向毛囊分化为主的皮肤附属器错构瘤。     

角化型基底细胞癌与毛发上皮瘤细胞形态定量分析

角化型基底细胞癌为皮肤的一种恶性肿瘤，毛发上皮瘤为良性肿瘤，两者在光镜下的组织病理具有形态相似的基底样细胞团索，有时易于混淆，给病理诊断带来困难。本研究采用大型自动化多功能图像分析仪（ＩＡＩ），以角化型基底细胞癌及毛发上皮瘤的石蜡组织切片进行细胞形态学的计量分析，利用形态计量的某些参数，将这两种组织病理易于混淆的良、恶性肿瘤进行比较和鉴别，以寻求一种较为客观的病理诊断方法。一、资料和方法标本收集：选择我科历年来经临床及组织病理确诊的角化型基底细胞癌及毛发上皮瘤各５例患者的蜡块，将各蜡块制成４ｕｍ…     

角化型基底细胞癌与毛发上皮瘤细胞核DNA含量测定

利用图像分析技术对３０例角化型基底细胞癌及３０例毛发上皮瘤组织病理相似部分基底样细胞瘤块进行细胞核ＤＮＡ含量分析。结果显示角化型基底细胞部组有异倍体１６例，毛发上皮瘤组３０例均为二倍体。前者显示恶性生物学行为，而后者呈良性生物学行为。     

毛发上皮瘤与角化型基底细胞癌细胞形态及DNA含量定量分析

目的利用体视学技术对毛发上皮瘤及角化型基底细胞癌组织病理相似部分基底样细胞瘤块进行细胞形态及细胞核ＤＮＡ含量分析。方法每组各选５例进行细胞及细胞核形态及大小的测定,各选３０例进行细胞核ＤＮＡ含量定量分析。结果细胞形态及大小两组无差异（Ｐ＞０．０５）,细胞核形态及大小的各参量值两组有显著性差异（Ｐ＜０．０５）。毛发上皮瘤组３０例均为二倍体,角化型基底细胞癌组有异倍体１６例。结论两组肿瘤细胞的形态及大小相似,但角化型基底细胞癌的细胞核相对较大,且不规整,显示了恶性肿瘤的形态学特征。角化型基底细胞癌呈恶性生物学行为,而毛发上皮瘤则呈良性。     

正常皮肤毛囊中朗格汉斯细胞的定位,定量观察

运用抗ＣＤ１ａ单克隆抗体免疫组化方法检测了１０例正常皮肤毛囊皮脂腺单位中朗格汉斯细胞（ＬＣ）的定位和定量情况，结果显示ＬＣ主要集中于毛囊上中部；如漏斗部平均１９．８７个／毛囊（范围８￣５４个）、皮脂腺导管和腺上皮中平均１６．３５个（范围７￣３４个），其分布密度类似于表皮，相反，在毛囊下部ＬＣ数量明显减少，平均４．１６个／毛囊，且主要见于其上段的隆突部附近，毛囊部几乎见不到ＣＤ１ａ阳性ＬＣ。这种分布     

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.     

CD44V6在表皮肿瘤及亚性黑素瘤的表达

目的 研究ＣＤ４４Ｖ６在鳞状细胞癌、基底细胞癌黑素瘤的表达。方法 免疫组织化学对石蜡包埋组织进行检测。结果 １０例鳞状细胞癌ＣＤ４４Ｖ６膜表达阳性，且随癌细胞分化程度降低ＣＤ４４Ｖ６表达下调，１０例基底癌和８例恶性黑素瘤不表达ＣＤ４４Ｖ６。结论 ＣＤ４４Ｖ６的表达与皮肤肿瘤的类型有关。     

凋亡抑制蛋白Bcl—2在两种皮肤肿瘤中的表达

为进一步了解Ｂｃｌ－２在基底细胞癌和鳞状细胞癌发生中的作用，作者应用免疫组织化学方法观察了４例ＢＣＣ和４例ＳＣＣ冰冻组织内Ｂｃｌ－２的表达。在４例ＳＣＣ中２例组织内肿瘤细胞见有明显的阳性染色，而ＢＣＣ阳性染色主要在间质的炎细胞中，瘤细胞末见确切的阳性染色。作者认为这些瘤组织内Ｂｃｌ－２阳性表达不同，可能是不同瘤组织自身抑制肿瘤细胞凋亡的一种自动平衡反应。     

β-连环蛋白在毛母质瘤及毛发上皮瘤中的表达

目的: 检测β-连环蛋白(β-catenin)在毛母质瘤及毛发上皮瘤中的表达.方法: 应用免疫组织化学法检测20例正常皮肤、20例毛母质瘤及10例毛发上皮瘤中β-连环蛋白的表达.结果: β-连环蛋白在正常皮肤角质形成细胞中主要表达于细胞膜, 15例毛母质瘤和8例毛发上皮瘤的表达位于胞质和/或胞核.结论: β-连环蛋白可能参与毛基质细胞的增殖和成熟的调控,它的异常表达在毛囊发育和向毛囊分化肿瘤的发生中可能起重要作用.     

在线形表皮痣上发生基底细胞上皮瘤

本文报告一例线形表皮痣上发生基底细胞上皮瘤的病人.患者,男性,42岁.因先天性痣出血,长大而来治疗.近10年来发生多发性结节,缓慢增大,刺激后出血.体检:疣状痣自右胁到脐和耻骨,沿右腿内侧向下发展呈带形分布.伴散在粉红到黑色结节,其中最大2×2cm.几个结节有蒂.先天性痣组织象显示典型的表皮痣特征.结节组织象显示:表皮基底细胞层有几处发生肿瘤.周围呈栅状排列的细胞,在肿瘤和间质之间有收缩空隙.先天性错构瘤伴发上皮瘤是众所周知的事实.上皮瘤通常发生于皮脂腺痣.痣样基底细胞综合征、伴有黑头粉刺的线形单侧基底细胞痣,毛囊性基底细胞痣上也均可发生基底细胞上皮瘤.而在线形表皮痣上发生基底细胞上皮瘤是罕见的.Pack等复习     

Bcl-2、CD10、CD34、CK15表达在基底细胞癌和毛发上皮瘤鉴别诊断中的意义

目的:观察Bcl-2、CD10、CD34、CK15在基底细胞癌(BCC)和毛发上皮瘤(TE)中的表达,探讨其在两种肿瘤诊断和鉴别中的作用。方法:对确诊的36例BCC和16例TE石蜡包埋标本行Bcl-2、CD10、CD34、CK15免疫组化染色,观察其在肿瘤细胞及其周围间质中的表达。结果:在BCC和TE中表达的阳性率分别为Bcl-2(栅栏状模式):0、68.75%;CD10(肿瘤细胞染色):72.22%、12.50%;CD10(间质染色)2.78%、62.50%;CD34:0、12.5%;CK15:5.56%、56.25%,其中Bcl-2、CD10、CK15表达差异有统计学意义(P值均<0.01),而CD34表达差异无统计学意义(P>0.05)。灵敏度:CD10(肿瘤细胞染色)72.22%>Bcl-2(68.75%)>CD10(间质染色)62.50%>CK15(56.25%)。特异性:Bcl-2(100%)>CD10(间质染色)97.22%>CK15(94.44%)>CD10(肿瘤细胞染色)87.50%。准确度:Bcl-2(90.38%)>CD10(间质染色)86.54%>CK15(82.69%)>CD10(肿瘤细胞染色)65.38%。阳性预测值:Bcl-2(100%)>CD10(肿瘤细胞染色)92.86%>CD10(间质染色)90.91%>CK15(81.82%)。阴性预测值:Bcl-2(87.80%)>CD10(间质染色)85.37%>CK15(82.92%)>CD10(肿瘤细胞染色)58.33%。结论:Bcl-2、CD10在BCC和TE中表达模式的差异,以及CK15在TE中高表达,有助于这两种肿瘤的鉴别诊断,CD34对于鉴别BCC和TE意义不大。     

CD10 expression in trichoepithelioma and basal cell carcinoma

BACKGROUND: Trichoepithelioma (TE) is a benign neoplasm that shares both clinical and histologic features with basal cell carcinoma (BCC). However, it is important to distinguish these neoplasms. Limited immunohistochemical stains are available to separate these two tumors. METHODS: CD10 protein immunohistochemistry was performed on paraffin-embedded biopsies of 13 TE and 23 BCC diagnosed by routine microscopy. Cases were analyzed for pattern of CD10 expression by tumor cells and surrounding stroma. RESULTS: Twelve of 13 (92%) TE showed positive stromal immunoreactivity. Of these, eight cases also demonstrated positivity of the papilla, and two also showed positivity of the basaloid cells. No TE demonstrated epithelial expression alone. On the other hand, expression of CD10 by basaloid cells was identified in 20 (87%) cases of BCC. Stromal positivity was also identified in three cases of BCC. Condensation of CD10-positive stromal cells around basaloid nests was statistically significant in differentiating TE from BCC (p < 0.0001). Conversely, CD10-positive basaloid cells were seen predominantly in BCC (p < 0.0001). CONCLUSIONS: This study demonstrates a statistically significant difference in CD10 staining pattern between TE and BCC. Thus, CD10 may be a useful adjunct marker in distinguishing these tumors.     

Use of CD34 in assessing the relationship between stroma and tumor in desmoplastic keratinocytic neoplasms

It has been hypothesized that the ability for neoplastic growth of epithelial-derived neoplasms depends upon the stroma. There are currently some studies which show that the stroma surrounding basal cell carcinomas (BCC) is derived from the tumor. In contrast, other studies provide evidence that the stroma is a host-derived response to the tumor. In order to further examine the nature of stroma enveloping cutaneous epithelial neoplasms, we examined a series of tumors which contain abundant stroma, including morpheic type BCC (MBCC), desmoplastic trichoepitheliomas (DTE), and microcystic adnexal carcinomas (MAC). The spindle-shaped cells surrounding the epithelial islands of the two malignant tumors, MBCCs and MACs, were negative in 70% and 100% of cases, respectively, for CD34. In contrast, the spindle-shaped cells surrounding the islands of the benign DTEs were positive for CD34 in 80% of cases. The results suggest that whereas stromal cells surrounding DTEs resemble the CD34-positive perifollicular cells, the spindle-shaped stromal cells surrounding MBCC and MAC are CD34 negative, and may be derived from sources other than the normal mesenchymal tissue surrounding cutaneous appendages.     

Multiple Familial Trichoepithelioma with Malignant Transformation

Trichoepithelioma (TE) is a benign tumor of follicular origin that presents as small, skin-colored papules predominantly on the face. When more than one family member is affected, the disease is known as multiple familial trichoepithelioma (MFT). It is a rare autosomal dominant (AD) skin disease. Malignant transformation is very rare. We present a case of MFT in a female patient and her father with malignant transformation to basal cell carcinoma (BCC) in the father. We summarized the main histological differential parameters between TE and BCC and applied immunophenotyping for both by administration of Bcl2, CD34, CD10 and androgen receptor (AR) antibodies.     

Diagnostic value of CD34 immunostaining in desmoplastic trichilemmoma

Desmoplastic trichilemmoma (DT) is a variant of trichilemmoma, characterized by a central prominent desmoplastic component which may simulate invasive carcinoma. We have studied the morphologic and immunohistochemical features of seven cases of DT. Immunohistochemistry was performed on paraffin sections using monoclonal antibodies to CD34 (QBEND/10), vimentin and GCDFP-15. CD34 was also tested in seven cases of basal cell carcinoma (BCC), three with outer root sheath differentiation and four with morphea-form features, and five squamous cell carcinomas. Histologically, features of conventional trichilemmoma were seen at the periphery of the seven lesions. In contrast, at the center, the epithelial cells tended to cluster in narrow irregular cords and nests entrapped in a dense collagenous stroma. One case of DT coexisted with a BCC. In all cases of DT, epithelial tumor cells showed CD34 immunostaining. All cases of BCC, including the one contiguous to a DT, were CD34 negative. CD34 immunodetection in the epithelial cells of the pseudoinvasive component of DT may be of great value in the differential diagnosis with other desmoplastic tumors of the skin, and particularly with BCC.     

Expression of the hair stem cell-specific marker nestin in epidermal and follicular tumors

Nestin, a marker of neural stem cells, is expressed in the stem cells of the mouse hair follicle. The nestin-expressing hair follicle stem cells give rise to the outer-root sheath. Nestin-expressing hair follicle stem cells that are negative for the keratinocyte marker keratin 15 (K15) can differentiate into neurons, glia, keratinocytes, smooth muscle cells, and melanocytes in vitro. Recent studies suggest that the epithelial stem cells are important in tumorigenesis. In this study, we immunohistochemically examined the expression of three hair follicle stem cell and progenitor cell markers, nestin, K15, and CD34, in normal human epidermis and hair follicles and in epidermal and follicular tumors, trichilemmoma, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC). In normal human skin, the cells in the epidermal basal layer were positive for K15 and negative for nestin and CD34. The hair follicle cells below the sebaceous glands were also positive for nestin and K15 and negative for CD34. The outer-root sheath cells under this area could be divided into three parts: an upper part of the outer-root sheath cells that was partially positive for nestin and positive for K15 and negative for CD34; a middle part that was CD34-positive and K15-negative; and a lower part that was positive for K15 and negative for CD34. In the tumor tissues, nestin immunoreactivity was observed in trichilemmoma but not in BCC. Also, immunoreactivity for K15 was strong in BCC and weak in trichilemmoma, and SCC was negative for nestin and partially positive for K15. No CD34 immunoreactivity was observed in any of the cases. These results suggested that trichilemmoma originates in the nestin-positive/K15-positive/CD34-negative outer-root sheath cells below sebaceous glands, BCC tumor cells from the more mature nestin-negative/K15-positive/CD34-negative outer-root sheath cells, and SCC from the nestin-negative/K15-positive/CD34-negative keratinocytes of the basal cell layer in the epidermis.     

Myoepithelial differentiation in basal cell carcinoma

Five cases of basal cell carcinomas (BCC) of the skin are described showing morphologic and immunohistochemical features of myoepithelial differentiation. Histologically, they were characterized by a dermal proliferation of tumor cells connected with the epidermis by areas showing the features of conventional BCC, with the deeper portions of the lesion showing a population of oval to spindle cells with eccentric nuclei and homogeneous, ground-glass, or hyaline eosinophilic cytoplasm characteristic of the so-called hyaline cell of myoepithelial tumors of salivary glands. Additionally, scattered cells showing a signet ring configuration were present, and in two cases, focal areas displaying chondromyxoid elements were also seen that appeared to merge imperceptibly with the surrounding spindle cell population. By immunohistochemistry, the tumor cells in the spindle cell component showed strong, diffuse positivity for CAM 5.2 and muscle specific actin, and variable expression of keratin AE1/AE3, vimentin, glial fibrillary acidic protein, and S-100 protein, these findings being consistent with the immunostaining pattern of myoepithelial cells and their neoplasms. A brief review of the literature on the topic is presented, along with a discussion of the possible pathogenesis of this process.     

皮肤鳞状细胞癌和基底细胞癌癌细胞表达CD54抗原的免疫电镜研究

为探讨皮肤鳞状细胞癌（鳞癌）和基底细胞癌（基癌）癌细胞上是否低水平表达CD54抗原,应用低温聚合、包埋后染色的胶体金免疫电镜技术,对3例鳞癌和3例基癌CD54免疫组化色阴性的癌细胞进行了研究。在3例鳞癌和3例基癌中,各2例癌细胞表面及突起处观察到CD54胶体金颗粒的存在;其中1例鳞癌张力微丝－桥粒复合体处还可见CD54胶体金颗粒分CD54抗原。该结果可解释皮肤鳞癌和基癌临床上可发生转移,但发生率较低的机理,值得进一步研究。     

Squamous cell carcinoma of the skin: dual differentiations to rare basosquamous and spindle cell variants

Basosquamous carcinoma (BSC) is defined as a tumor containing the areas of both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) with a transition zone linking the two. Spindle cell squamous carcinoma (SCSC) may have a variable component of conventional SCC and spindle cells. We present a case of an 89-year-old woman with an eruption on the scalp for several decades. Grossly, the lesion measured 8.5 x 6.0 x 1.8 cm and consisted of a gray-white and focally black tumor. Microscopically, a non-ulcerated upper part of the tumor consisted of large polygonal squamoid cells with occasional keratinization (SCC), trabecular growth of basaloid cells with peripheral palisading (BCC), and an area in which both the components were intermingled. The rest of the tumor was a myxoid area with elongated fusiform spindle cells, which appeared to arise from conventional SCC. Immunohistochemically, the tumor cells in the SCSC (both conventional and spindle cell) area co-expressed CAM5.2, and vimentin. Ber-EP4 was positive in the BCC area with the transition zone of SCC and BCC showing diminished staining. Epithelial membrane antigen was focally positive in the conventional SCC area. To our knowledge, this is the first case report of SCC of the skin that has dual differentiations to BSC and SCSC.     

In vivo characterization of the inflammatory infiltrate and apoptotic status in imiquimod-treated basal cell carcinoma

Background Imiquimod use in the treatment of basal cell carcinoma (BCC) has proven to be successful in a large percentage of cases, inducing tumor regression; however, the exact cellular mechanism has not been fully clarified. Aim To measure the morphological changes in the tumor microenvironment and the markers of apoptosis in skin biopsies from patients with BCC before and after imiquimod treatment. Methods In this open label study, skin biopsies obtained from 11 patients with BCC were evaluated before and after imiquimod treatment for: (i) morphological changes in the tumor microenvironment, with specific emphasis on the immunophenotype of inflammatory cells around the tumor; and (ii) markers of apoptosis, including expression of death receptors. Results Imiquimod treatment induced a significant increase in the mononuclear inflammatory response. In the majority of cases, the cellular infiltrate was predominantly composed of CD3⁺/CD4⁺ T cells, suggesting that the effector response is mediated by CD3⁺/CD4⁺ lymphocytes, with a minor cytotoxic and natural killer (NK) component. An increase in the cytotoxic CD3⁺/CD8⁺ T‐cell population was also observed. Imiquimod treatment was associated with a marked increased in CD20⁺ B cells, and a less pronounced enhancement in cells of monocyte–macrophage origin (CD68⁺) surrounding, or within, the tumor. This finding indicates either that macrophages play a minor role in the imiquimod‐induced response, or the recruitment of these cells is related to time and dose. Imiquimod treatment decreased CD1A⁺ Langerhans cells in the epidermis and increased the number of CD1A⁺ dendritic cells within the tumor aggregates. Imiquimod reduced Bcl‐2 expression, but no difference was found in Bax, Fas/FasL, and p53 expression in BCC cells. Conclusions Our results support the hypothesis that imiquimod activity in the treatment of BCC is partly a result of a pro‐inflammatory action mediated by CD3⁺/CD4⁺ lymphoid cells and of a pro‐apoptotic activity associated with decreased Bcl‐2 expression.