伴类癌样结构的皮脂腺瘤1例及文献复习

Carcinoid-like pattern in sebaceoma:A case report and review of literature

目的探讨伴类癌样结构的皮脂腺瘤的临床病理学特征及诊断和鉴别诊断。方法对1例伴类癌样结构的皮脂腺瘤进行临床、组织病理学和免疫组化观察,并复习相关文献。结果患者头皮处见一1cm×1cm×0.5cm结节状肿物,全身检查未见内脏器官病变。镜检:肿瘤位于真皮,呈境界清楚的多结节状分布。肿瘤大部分排列成片状、腺样、筛孔状,部分区域细胞形成类癌样结构,大多数肿瘤细胞呈基底样细胞改变,可见散在明确的皮脂腺细胞分化,核分裂象偶见,未见明显异型性和坏死。免疫表型:肿瘤细胞AE1/AE3、MLH1、MSH2、皮脂腺细胞EMA均阳性,CgA、Syn、NSE均阴性。结论皮脂腺瘤中的类癌样结构是最近才认识的少见组织学结构,病理诊断中应注意与转移性类癌、其他皮肤附属器肿瘤和Muir-Torre综合征相鉴别。

Purpose To report a very rare case of carcinoid-like pattern in sebaceoma and to investigate its clinieopathologic features, diagnosis and differential diagnosis. Methods One case of carcinoid-like pattern in sebaceoma was studied histopathologically and immunohistochemically,followed by discussion through review of the literature. Results A 73-year-old man presented with a 1 cm ×1 cm × 1.5 cm nodular mass on the scalp. No visceral malignancy was found after overall examination. Microscopically, the neoplasm was composed of multiple well-circumscribed lobules located in the dermis. The neoplastic cells were arranged in a sheet, cribriform and glandular pattern. In some areas carcinoid-like arrangement was formed. Cytologically the neoplasm was comprised predominantly of basaloid cells with scattered unequivocal sebaceous differentiation. Rare mitoses were seen, however, there was no obvious atypia and necrosis. Tumor cells were positive for AE1/AE3, MLH1 and MSH2, and negative for CgA, Syn and NSE. Tumor cells with sebaceous cell differentiation were positive for EMA. Conclusions Carcinoid-like pattern is another distinctive, previously under - recognized pattern in sebaceoma. More attention should be paid in the differential diagnosis of this tumor from metastatic carcinoid and other cutaneous adnexal tumors and Muir-Torre syndrome.