单发型角化棘皮瘤57例临床及组织病理分析

Clinical and pathological analysis of 57 cases of solitary keratoacanthoma and review of the literarature

目的：分析角化棘皮瘤的临床及组织病理特征、治疗和预后，以期理解其生物学本质，指导临床诊断及治疗。方法：对57例角化棘皮瘤（KA）患者的临床资料、组织学特征进行分析，大部分患者进行随访。结果：57例KA均为单发结节，男女比例1：1．04。组织病理观察可见84．21％的患者呈“火山口”样，基底部有混合性炎性细胞浸润。71．93％患者见嗜酸性粒细胞，45．61％的患者见浆细胞。89．47％的患者可见角囊肿，54．39％的患者见表皮内微脓肿。92．98％患者的肿瘤基底部不超过真皮汗腺水平。49．12％患者的基底部肿瘤细胞巢见非典型增生，1．75％患者癌变。随访35例患者，期限为1-5年，34例健在，肿瘤无复发，1例KA癌变患者死于原发性肺癌。结论：角化棘皮瘤的诊断需结合临床及组织病理检查。建议手术切除，虽然偶可癌变，但预后较好。

Objective： To analyze the clinical and pathological characteristics, treatment and prognosis of keratoacanthoma （KA） in order to elucidate the nature of the tumor and to facilitate the diagnosis and treatment. Methods： The clinical and histopathological features of 57 cases of KA were analyzed and most of cases were followed-up. Results： All 57 cases of KA were occurred as an isolated nodule with a male-female ratio of 1：1.04. 84.21% of cases were characterized pathologically by vocano-like with mixed inflammatory cell infiltrate at the base of tumor. Eosinophilie granulocytes were found in 71.93% of cases and plasma cells in 45.61% of cases. 89.47% of cases showed keratocytes and 54.39% of cases exhibited epidermal microabscesses. In 92.98% of cases the base of tumor did not protrude below the depth of sweat gland. Atypical hyperprolif- eration in the base of tumor cell nests was observed in 49.12% of cases and 1.75% of cases developed squamous cell carci- noma. 35 cases were followed for one to five years. 34 cases were alive without recurrence and 1 case died of lung cancer. Conclusions： Diagnosis of KA depends on clinical and pathological examinations. Surgical excision is recommended. Generally, prognosis is good even though it can occasionally develop squamous cell carcinoma.