角化棘皮瘤恶变1例诊断体会（Diagnostic experience of 1 cases of malignant change of hyperkeratosis）

角化棘皮瘤恶变1例诊断体会（Diagnostic experience of 1 cases of malignant change of hyperkeratosis） 角化棘皮瘤恶变1例诊断体会(Diagnostic experience of 1 cases of malignant change of hyperkeratosis) Diagnostic experience of 1 cases of malignant change of hyperkeratosis Update Date: 12-07 #e# Acanthosis is a benign lesion of the skin. Because oneself subsidise, can not do any treatment, also can choose an operation to undertake local excision, but very little case can have canceration, should cause clinical attention. Our hospital from August 2000 to August 2004, a total of 54 cases of pathological diagnosis of acanthosis, including 1 cases of malignant change of acanthosis, and this case is reported as follows, and analyzed. 1 Summary of patient history The patient, male, aged 56, was found to have a small nodule on the left cheek for 3 years without any symptoms. Outpatient surgical resection. Biopsy specimens: spindle organization with a part of the skin, the skin a lung tumor, the size of 2cm * 2cm, elevated 0.5cm, see a volcano shaped central mass gap, with a few gray white loose, fine granular sphacelus, on both sides of skin is pale red and dark red lip uprift. Microscope: exogenous epidermal cell hyperplasia, obvious lip lip two central uplift, obvious keratosis, basal side of epidermal cell is flat, eosinophilic and hyaline degeneration, and obvious infiltration of inflammatory cells, showed lesions subsided; on the other side near the basal margin (and therefore unable to understand epithelial cell proliferation, a) surrounded keratin, focal epidermal growth activity, but the base is still intact, no invasion phenomenon. Pathological diagnosis: acanthosis. 18 months after the operation, the patient had a small nodular protuberance on the side of Yu Yuan's incision. The biopsy showed that the epidermis of the local lesion was sunken to the dermis, the cavity was filled with keratinized substance, and the basal cells were infiltrating and growing. The keratin and some cell keratosis were seen, and the pathological mitotic figures were seen. Pathological diagnosis: keratinization of acanthosis. 2 discussion Keratoacanthoma is a benign lesion in the source of spinous cells, occur in the exposed parts of the skin, face the most common wrist and forearm extensor also occur, people over the age of 50 to see more, more men than women, self healing is an important characteristic of keratoacanthoma. The etiology of this disease is unknown and may be related to viral infection. 2.1 patients were divided into three types: (1) the most common single hair, manifested as skin nodular protrusion, burst into the top of the volcano, there are horny plugs, the edge is the lip shaped uplift characteristic 1, resembling molluscum contagiosum. Self healing can leave scars. (2) more hairstyles: this type is rare. The earlier age of onset (20 ~ 30), is also more men than women, in addition to occur in the exposed parts of the skin, mucosa and skin transitional cell lesions can also occur, similar to that of the single hair, natural extinction time, lesions can be kept stable for a long time. (3) rash type: this type of multiple lesions, hard like papules, top ulceration with angle of thrombus. The whole course of disease can be divided into 3 stages: growth phase, stationary phase and natural extinction stage. When subsided, the tumor gradually absorbed, the angle plug discharged pigment scarring left behind. 2.2 malignant (well differentiated squamous cell carcinoma) and the possible mechanism of a handful of keratoacanthoma to malignant transformation, so the basic image of keratoacanthoma, but some epithelial cell atypia, and obvious infiltration can be considered as keratoacanthoma canceration. The pathology of keratoacanthoma and keratoacanthoma (i.e. malignant differentiated squamous cell carcinoma) were identified from the constant growth rate, self limiting, activity, ulceration, boundaries, volcano like appearance, like lip edge, differentiated epithelial hyperplasia and 2 angle. In the course of natural regression, a few cases of malignant change may be caused by the obstruction of local apoptosis signal. Li Li used terminal specific DNA markers (TUNEL) and immunohistochemical method in situ detection of apoptotic cells, the expression of Bax and Bcl-2 gene and nucleic acid antigen Ki-6 as keratoacanthoma and cancer (squamous cell carcinoma) on apoptosis and proliferation of patients, found that apoptosis angle of the acanthoma the rate (48.83%) was significantly higher than that of squamous cell carcinoma (26.08%), the proliferation rate (9. (03%) significantly lower than the latter (27.20%) [3], which suggests that apoptosis is an important pathological mechanism leading to two different outcomes, namely, self-healing and malignant transformation. In short, whether it is clinically or pathologically, keratoacanthoma and keratoacanthoma carcinogenesis are very similar, namely the use of immunohistochemical methods can distinguish typical cases and cannot distinguish between similar cases 4. Therefore, the suspect should be treated for resection and biopsy, or radiotherapy and chemotherapy (should not allow the lesion to subside). There are two advantages of surgical removal: first, it is possible to detect a very small number of malignant cases; and two, the surgical scars are often smaller and more smooth than those left after self healing, which is beneficial for facial cosmetology. At the time of biopsy, the pathologist should pay attention to whether the margins of the lesion, especially the basal part, are intact. If the basal layer cells are active and the local canceration should be treated, the surgeon is advised to perform the resection of the lesion.