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目的探讨增生性外毛根鞘肿瘤(PTT)的临床病理特征、诊断及鉴别诊断要点、组织发生。方法对3例PTT进行临床病理学观察、免疫组化研究,其中2例做人乳头状瘤病毒(HPV)原位杂交。结果1例组织学良性,肿瘤位于真皮内,不与表皮相连,伴有外毛根鞘囊肿,肿瘤小叶及囊壁上见散在挖空细胞,HPV原位杂交挖空细胞核阳性;2例组织学恶性,头皮蕈样肿块,均在多处与其上覆盖的表皮相连,其中1例伴有外毛根鞘囊肿及外毛根鞘分化。镜下PTT最重要病理特征为棘细胞样鳞状细胞形成多小叶结构及其中央的外毛根鞘型角化,常伴有1个至数个外毛根鞘囊肿。免疫组化:肿瘤细胞CD34(-),AE14弥漫(+)。结论PTT为真皮及皮下结节或皮肤表面外生性肿块,其病理形态存在从良性到恶性的一个连续的形态学谱系,生物学行为与其组织学表现不完全一致。HPV感染与肿瘤发生有关。鉴别诊断主要包括皮肤分化好的鳞状细胞癌(SCC)和外毛根鞘癌等,AE14免疫组化检测有助于鉴别PTT和SCC。
Objective To investigate the clinicopathological characteristics of proliferative external hair root sheath tumors (PTT), the diagnostic and differential diagnosis points and the occurrence of tissue. Methods Three cases of PTT were observed by clinicopathology and immunohistochemistry. Two of them were human papillomavirus (HPV) in situ hybridization. Results One case was histologically benign. The tumor was located in the dermis but not connected with the epidermis. The outer hair root sheath cyst, lobular lobes and scattered hollow cells in the cystic wall were observed. The nuclei were knocked out by HPV in situ hybridization. Two cases were histologically malignant , Scalp mycosis-like lumps, are in many places connected with the epidermis covered on them, including 1 case of external hair root sheath cyst and outer root sheath differentiation. Microscopically the most important pathological features of PTT is the formation of spinous cell-like squamous cells and the central structure of the hairy root sheath keratosis, often accompanied by one to several outer root sheath cysts. Immunohistochemistry: tumor cells CD34 (-), AE14 diffuse (+). Conclusions PTT is an exudative mass on the surface of dermis, subcutaneous nodules or skin. The pathological appearance of PTT is a continuous morphological lineage from benign to malignant, and its biological behavior is not completely consistent with its histological findings. HPV infection and tumorigenesis. Differential diagnosis include well-differentiated squamous cell carcinoma (SCC) and outer hair root sheath cancer, AE14 immunohistochemical detection can help identify PTT and SCC.