肛门乳头状汗腺瘤8例临床病理分析

Hidradenoma papilliferum of the anus:a clinicopathological analysis of eight cases

目的探讨肛门乳头状汗腺瘤的临床特点、病理形态、免疫组化及预后。方法收集8例肛门乳头状汗腺瘤资料,分析其临床特点,观察病理形态及免疫组化表型,通过随访了解预后。结果患者均为女性,中位年龄43岁。肿物位于肛门齿状线附近,均行包块切除,随访1年无复发。肿块最大径0.5～1.5 cm不等,镜下瘤组织呈密集的不规则腺管状,部分腺管折叠形成迷路,部分向腔内形成乳头状结构,上皮均由内层分泌性柱状上皮细胞及外层肌上皮细胞构成。免疫组化：8例内层柱状上皮细胞ER、广谱CK和CK7（＋）,CK20、CEA和villin（-）;外层肌上皮细胞CK和p63（＋）。结论肛门乳头状汗腺瘤非常少见,诊断主要靠病理确诊,免疫组化标记协助诊断,局部肿物切除为首选。

Objective To study the clinical pathologic features,immunohistochemistry and prognosis of hidradenoma papilliferum of the anus. Methods Eight cases of hidradenoma papilliferum of the anus were collected to investigate the clinical pathologic features,immunohistochemical expression and to evaluate the prognosis by follow-up. Results Clinically,patients were all female,the median age was 43 years. Anus dentate line was the main location. Eight cases were all local bag piece resection. Following-up for one year showed that no one had recurrence. Pathological examination showed that the tumors were 0. 5 cm to 1. 5 cm in diameter. Microscopic examination showed that the tumor consisted of dense irregular glandular structures,and the part of them was folded to form a labyrinth and papillary structure within the glandular cavity. Those structures were usually lined with double layers of the inner secretory columnar epithelial cells and the outer myoepithelial cells. Pathological diagnosis was hidradenoma papilliferum of the anus. Immunophenotyping showed that the inner epithelial secretory columnar epithelial cells were positive for ER,Ckpan and CK7,but negative for CK20,CEA and villin. The myoepithelial cells were positive for P63. Conclusion Hidradenoma papilliferum of the anus is quite rare. Diagnosis of the tumor relies largely on histopathology. Immunohistochemical markers assist the diagnosis. Local mass resection is preferred. Patients have been followed up for 1 years without recurrence,suggesting its prognosis is good.