皮角30例临床及其组织病理分析

Clinical and Pathological Features in 30 Cases with Cutaneous Horn

目的探讨皮角的临床和组织病理学特点。方法对30例皮角患者的临床及组织病理学资料进行回顾性分析。结果30例患者中，男18例（60．00％），女12例（40．00％）；平均患病年龄67．9岁（20—94岁）；病程1个月～32年，平均32．7个月。26例（86．67％）发生于曝光部位。组织病理检查均可见高度的角化过度，间有程度不等的角化不全，角质层呈山峰样隆起；基底部原发病变组织学改变：有70．00％为良性病变，30．00％为癌前或癌性病变；在良性病变中，病毒疣占61．90％，脂溢性角化病占33．33％；在癌前或癌性病变中，目光性角化病占77．78％；癌性病变仅1例，为鳞癌。63．33％病例的组织病理可见真皮内有不同程度的胶原纤维日光弹力变性改变。结论皮角好发于老年人，以头面部等曝光部位居多；皮角与癌前或癌性病变相关，完整切除皮损并行组织病理学检查十分重要。

Objective To study the clinical and pathological features of cutaneous horns. Methods Retrospective clinical and pathological study of 30 cases of cutaneous horns. Results The male sex was 18 cases（60.00% ）, and the female sex was 12 cases（40.00% ）. The average age of patients was 67.9 years. The average time of clinical evolution was 32.7 months. Lesions of 26 （86.67%） cases were located on the areas which were more exposed to sun light. Histopathology showed marked hyperkeratosis and different degrees of parakerato sis, stratum corneum looked like the towering peaks. Histopathological analysis of the primary lesions in the base considered 70.00 % of the lesions as benign and 30.00% as pre-malignant or malignant. Within the group of benign lesions, viral wart was found in 61.90% of the cases and keratosis seborrhoeica was found in 33.33% of the cases; within the group of pre-malignant iesions,actinic keratosis was found in 77.78% of the cases ; within the group of malignant lesions, only one case of squamous cell carcinoma was found. Dermal changes included solar elastosis in 63.33% of the cases. Conclusion Cutaneosus horns usually presents in older individuals and be involved sun-exposed areas. Considering the high frequency of pre-malignant lesions and also the presence of malignant lesions, it is suggested surgical exeresis followed by histopathological study of the cutaneous horns for confirmation of specific diagnosis.