硬化性萎缩性苔藓并发鳞状细胞癌临床病理分析——附2例报告

Squamous Cell Carcinoma Arising on Vulvar Lichen Sclerosus Et Atrophicus——the Clinnical and Pathological Analysis of Two Cases

目的:探讨外阴硬化性萎缩性苔藓(Lichen sclerosus et atrophicus,LSA)癌变的早期诊断线索。方法:回顾性分析两例外阴硬化性萎缩性苔藓并发外阴鳞状细胞癌的临床病理特点。结果:病例1患者龟头瓷白色斑片3年,肿物1年。瓷白色斑片病理诊断为LSA;肿物病理示增生的鳞状细胞呈现异形性,突破基底膜,符合局部癌变。病例2患者外阴瘙痒、白斑10余年,阴蒂肿物1年,白斑出现溃疡。白斑病理诊断为LSA;溃疡病理示增生的鳞状细胞呈现异形性。肿物病理符合中分化鳞状细胞癌。结论:硬化性萎缩性苔藓的皮损出现角化、增厚或溃疡,同时病理表现为显著角化、棘层肥厚,应高度警惕恶变可能,需连续追踪、复查病理,一旦增生的鳞状细胞突破基底膜,并出现细胞异形性可诊断癌变,应尽早手术切除。

Objective：To discuss and summarize the early diagnostic clues of the malignancy or the predictor for premalignancy and microinvasive malignancy arising on vulvar lichen sclerosus et atrophicus （LSA）. Methods： A retrospective analysis of clinical and pathological characteristics of two patients with squamous cell carcinoma （SCC） arising on vulvar LSA was conducted. Results： Case 1 had a three-year history of porcelain white patch and a one-year history of mass on the glans. The pathology of the white patch accorded with the diagnosis of LSA. Pathological examinations of different parts of the mass in case 1 showed nest-like concentration of atypical squamous epithelial cells that had pleomorphic nuclei, large nucleoli and pathologic mitosis. The atypical cells broke through the basement membrane. The profile of case 1 was compatible with the diagno- sis of microinvasive SCC. Case 2 presented with a more than ten-year history of vulvar pruritus, white patches, which was followed by ulcer and a one-year history of clitoral mass. The diagnosis of LSA was made on the pathology of the white patch. The pathology of the ulcer showed atypical epithelial cells. Histologic changes of mass were compatible with the diagnosis of moderately differentiated SCC. Conclusion：The keratinization, thickening or ulcer appearing in the base of LSA and the histology of hyperkeratosis with acanthosis instead of atrophy, indicated malignancy, which required attention and a follow-up. The pathology shouht be reexamined and checked again. The diagnosis of SCC can be made and a surgery should be proposed if the pathology shows the proliferation of atypical squamous epithelial cells that break through the basement membrane.