摘要
目的:描述眼睑皮脂腺癌(sebaceous carcinoma,SC)的临床病理特征,探讨其诊断及鉴别诊断。方法:借助光镜观察及免疫组化染色,分析我院2007-2012年收治的52例眼睑SC患者的形态学特点。结果:男性21例,女性31例,患者年龄37-87岁,平均年龄65岁。影像学显示眼睑结节状肿块,界限模糊或累及眼周组织。巨检:睑缘部或睑板内可见黄白色质硬结节,貌似霰粒肿,边界不清。镜下肿瘤组织排列成小叶状或巢状,伴粉刺样坏死。根据成熟性皮脂腺细胞所占比例(临界值20%),将SC分为皮脂腺分化型(SDT)及非皮脂腺分化型(SNDT)。SDT主要由大而淡染位于中央的圆形或多边形成熟性皮脂腺细胞和小的原始生发细胞组成,皮脂腺细胞具有泡状胞质及偏位的核;而SNDT呈鳞状细胞样、基底细胞样、腺样或梭形细胞分化,或多或少含有胞质透明的皮脂腺细胞,为鉴别诊断提供了重要的线索。两型临近表皮均可见Paget样扩散。免疫组织化学标记:与分化型中CK5/6阳性率较高不同,非分化型肿瘤细胞中CK8/18表达率较高。除5例失访外,其余均获得随访,其中17例术后复发,14例死于复发或转移。结论:眼睑SC较少见,易误诊。需与基底细胞癌及鳞状细胞癌等相鉴别。一旦确诊,推荐术中冷冻切片检测下的标准切除,尤其Mohs微创术。
Objective：To investigate the clinicopathologic features, diagnosis and differential diagnosis of seba- ceous carcinoma （SC） of the eyelid. Methods： By means of light microscopic observation and immunohistochemistry stainings,the morphological characteristics of 52 patients who were diagnosed as SC of eyelid in our hospital from 2007 to 2011 were analyzed. Results： The patients included 21 males and 31 females average age 65 years old （ranged from 37 to 87 years）. Image revealed a nodular mass of the eyelid with indistinct boundary and even with periocular involvement. Grossly, the tumor was depicted as a yellow - white and firm nodular or chalazion - like lesion with ill - circumscribed borders within the meibomian or palpebral rims. Microscopically, the tumor ceils arranged in a lobular or nest pattern with comedo necrosis. Based on the percentage of mature sebocytes （critical value ：20% ）, they were classified as two kinds of subtypes ： Sebaceous differentiation type （SDT） and sebaceous non - differentiation type （SNI）T）. SDT was predominantly composed of round or polygonal large pale cells i. e. mature sebocytes （ more located in center） and small primitive germinal cells. With multivacuolated or bubbly cytoplasm and eccentric nuclei, the well - developed sebocyte displayed a unique profile. In SNDT, however, cell polymorphism and nuclear atypia was more obvious than its counterpart. Meanwhile, some SC exhibited squamous, basaloid, adenoid or spindle cell differen- tiation admixing more or less of mature sebocytes with clear cytoplasms,which provided an important clue for their dif- ferential diagnoses. Within the adjacent epithelia, pagetoid spread were seen in both subtypes. Immunohistochemical- ly,instead of more positive for CK5/6 in SDT,the tumor cells in SNDT were more expressed for CK8/18. In addition to the five cases were lost, the rest were followed up for 2 to 72 month. And 17 cases recurrenced including 14 patients died from metastasis. Conclusion： SC is rare b
出处
《现代肿瘤医学》
CAS
2014年第7期1557-1561,共5页
Journal of Modern Oncology
关键词
眼睑肿瘤
皮脂腺癌
临床病理
鉴别诊断
eyelid neoplasm
sebaceous carcinoma
clinicopathology
differential diagnosis
