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目的探讨良、恶性汗孔肿瘤的临床病理特征、诊断与鉴别诊断。方法对19例汗孔瘤(EP)和6例汗孔癌(EPC)进行临床特点和病理形态学观察,对6例EPC行免疫组化染色,并文献复习。结果良、恶性汗孔肿瘤发病部位相似,好发于下肢皮肤,其次为躯干和头面部;存在显著的年龄差异,临床容易误诊为色素痣、血管瘤、鳞状细胞癌或脂溢性角化病等。EP镜下由增生一致的基底细胞样立方形细胞组成,伴导管分化,偶尔形成囊肿,可见小灶坏死和核分裂,EPC镜下表现为肿瘤细胞显著异型性和核高分裂和/或有间质浸润。免疫组化示EPC肿瘤细胞p53阳性率10%~90%,Ki-67阳性指数10%~80%,p16(-);肿瘤内导管结构CEA和EMA(+),间质血管平滑肌SMA(+)。结论汗孔肿瘤的诊断主要依靠组织病理学,肿瘤细胞有异型性和/或浸润性生长是EPC诊断的主要依据,免疫组化可辅助鉴别诊断;局灶核高分裂、灶状肿瘤细胞坏死及p53阳性均不能作为EPC的独立诊断指标;病史较长的汗孔瘤短时间内快速生长、自发出血或瘙痒、表面溃疡或多结节出现均提示恶变风险。
Objective To investigate the clinicopathological features, diagnosis and differential diagnosis of benign and malignant sweat pores. Methods The clinical features and histopathological features of 19 cases of sweat cell tumor (EP) and 6 cases of stomatal cancer (EPC) were observed. Immunohistochemical staining was performed on 6 cases of EPC and the literature review. The results of benign and malignant sweat pore tumor site similar to occur in lower extremity skin, followed by the trunk and head and face; there are significant differences in age, clinically easily misdiagnosed as pigmented nevus, hemangioma, squamous cell carcinoma or seborrheic keratosis Sick and so on. EP under the microscope by the hyperplasia of basal cell-like cubic cells, with catheter differentiation, and occasionally the formation of cysts, necrosis and mitral tuberculosis can be seen, EPC microscopic manifestations of atypical tumor cells and high nuclear fission and / or interstitial infiltration . Immunohistochemistry showed that the positive rate of p53 in EPC tumor cells was 10% -90%, the positive rate of Ki-67 was 10% -80%, p16 (-); CEA and EMA (+), interstitial vascular smooth muscle SMA (+ ). Conclusions The diagnosis of sweat pore tumor depends mainly on histopathology, atypia and / or invasive growth of tumor cells is the main basis of EPC diagnosis, and immunohistochemistry can assist in the differential diagnosis; focal nuclear fission, focal necrosis of tumor cells and p53 positive can not be used as an independent diagnosis of EPC indicators; a long history of rapid growth of short-term sweat pores, spontaneous bleeding or itching, surface ulcers or multiple nodules are prompted the risk of malignant transformation.