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目的:总结口腔黏膜疣状黄瘤(Verruciform Xanthoma,VX)的临床病理特点、诊断及发病机制。方法:收集35例口腔黏膜VX,复习临床资料,行光镜和免疫组织化学观察。结果:35例VX中,男20例,女15例,年龄19~68岁,平均44.9岁。发生于牙龈15例(42.9%)、舌7例(20.0%)、腭5例(14.3%)。镜下病变上皮可分为疣状型(48.6%)、乳头状型(34.3%)、平坦型(17.1%),上皮钉突间真皮乳头层内见大量的泡沫细胞聚集。免疫组织化学染色示泡沫细胞CD68阳性,CK(AE1/AE3)和S-100阴性,提示为单核-巨噬细胞系统来源。临床诊断易与乳头状瘤、白斑、疣状癌或鳞状细胞癌相混淆,35例病理确诊的VX病例中,临床上仅4例诊断为VX。结论:VX临床上易误诊,确诊主要依据组织病理学检查,认识其临床病理特点有利于正确诊治。
Objective: To summarize the clinicopathological features, diagnosis and pathogenesis of oral mucosa verruciform xanthoma (VX). Methods: 35 cases of oral mucosa VX were collected and reviewed clinical data, light microscope and immunohistochemical observation. Results: 35 cases of VX, 20 males and 15 females, aged 19 to 68 years, mean 44.9 years. Occurred in the gums in 15 cases (42.9%), the tongue in 7 cases (20.0%), the palate in 5 cases (14.3%). Microscopic lesion epithelium can be divided into verrucous type (48.6%), papillary type (34.3%), flat type (17.1%), a large number of foam cells in the dermal papillary layer of epithelial nail burst aggregation. Immunocytochemical staining revealed positive for CD68 positive cells, CK (AE1 / AE3) and S-100 negative cells, suggesting a monocyte-macrophage system origin. Clinical diagnosis is easily confused with papilloma, leukoplakia, verrucous carcinoma or squamous cell carcinoma. Of the 35 pathologically confirmed VX cases, only 4 clinically diagnosed as VX. Conclusion: VX is easy to be misdiagnosed clinically. The diagnosis is mainly based on histopathological examination, and its clinicopathological features are conducive to the correct diagnosis and treatment.