外阴部、阴囊疣状黄瘤临床病理特点及文献复习

vulval and scrotal verruciform xanthoma:A report of three cases and review of literature

目的探讨外阴部、阴囊疣状黄瘤(verruciform xanthoma,VX)的临床病理学特征、诊断、鉴别诊断及发病机制。方法对1例阴囊VX、2例外阴VX进行光镜、免疫组化、特殊染色、HPV原位杂交观察并结合文献分析。结果VX表皮疣状增生,棘层增厚,钉突延长位于真皮同一水平;表面过度角化伴角化不全,内有中性粒细胞浸润;真皮乳头层内上皮钉突间见黄色瘤样细胞(泡沫细胞)浸润。免疫组化标记黄色瘤样细胞CD68、α1-AT、Mac387阳性,CK(AE1/AE3)弱阳性,S-100、Ki-67、HPV阴性。PAS阳性。原位杂交HPV6/11呈阴性。结论外阴部、阴囊VX与发生于口腔黏膜的VX临床病理学特征相似,黄色瘤样细胞来源于单核/巨噬细胞。

Purpose To study the clinicopathologic features, diagnosis of vulval and scrotal verruciform xanthoma （VX）, and to discuss the differential diagnosis and pathogenesis. Methods A case of scrotal VX and two cases of vulval VX were observed under light microscope and analyzed by immunohistochemical staining, histochemical staining and insitu hybridization （HPV）. Results The histological features included verrucous epithelial hyperplasia and acanthosis with elongation of the rete ridges to a uniform level; hyperkeratesis with parakeratosis and a massive neutrophilic infiltration; the hallmark xanthoma cells deposited in the papillary dermis between the rete ridges. Immunohistochemically, xanthoma cells were positive for CD68, α1-AT and Mac387, and weakly positive for cy- tokeratin, but negative for S-100, Ki-67 and HPV. PAS-stain showed many of the xanthoma cells contained granules in the cytoplasm. Insitu hybrinization for HPV6/11 was negative. Conclusions Vulval and scrotal VX have identical histological features to VX at other sites such as oral cavity. The xanthoma ceils may derive from the monocyte/macrophage lineage.