反射式共聚焦显微镜检查在乳房外Paget病诊断与随访中的应用分析

Analysis of the RCM imaging features and the application of RCM in the diagnosis and treatment of extramammary Peget's disease

目的:探讨乳房外Paget病(EMPD)的反射式共聚焦显微镜(RCM)影像特征,分析RCM在EMPD诊断治疗中的临床运用。方法:选取我所2014年5月-2015年8月临床疑诊为EMPD的患者18例,分别行RCM和组织病理检查,确诊为EMPD者予手术治疗后3个月随访复查RCM和组织病理。结果:共有16例经病理检查确诊为EMPD,RCM主要表现为表皮细胞结构紊乱,表皮内可见大而圆的Paget细胞出现,基底层可见巢状的癌细胞结构或高折光的树突细胞,真皮浅层炎症细胞浸润及血管迂曲。组织病理检查表现为表皮内单个或巢状排列的Paget细胞,胞体大,呈圆形或椭圆形,无细胞间桥,胞质丰富淡染,呈空泡状;真皮内伴慢性炎症细胞浸润。16例确诊病例的RCM表现与组织病理检查结果均吻合。所有确诊病例经手术治疗后3个月随访,其中11例RCM检查无异常,3例发现异形细胞,2例发现有癌细胞复发,均与进一步组织病理检查结果一致。结论:RCM检查无创方便,在EMPD的诊断和治疗随访中具有很好的指导意义和应用前景。

Objective：To investigate the RCM imaging features and the application of RCM in the diagnosis and treatment of extramammary Peget＇ s disease （EMPD）. Methods： 18 patients with suspected EMPD in our hospital from May 2014 to August 2015 were examined by RCM and histopathology. Patients final diagnosed with EMPD were followed up for 3 months after surgery. The RCM and histopathology were followed up. Results： A total of 16 cases were final diagnosed with EMPD. The main show of RCM is epidermal cell structure disorder, large and round Paget cells, cancer cells in the base layer structure visible nests or high refractive dendritic cells, dermal inflammatory cell infiltration and vascular circuity. Histopathological examination show that single or nest of Paget cells, with large volume, round or oval, no intercelluar bridges, abundant cyto- plasm stained, vaeuolization, dermis with chronic inflammatory cell infiltration. The RCM features of 16 eases were consistent with the histopathological findings. All the diagnosed patients were followed up 3 months after surgery. There was no abnormality in 11 cases with RCM, abnormal cells were found in 3 cases, and the residual tumor tissues were found in 5 cases. The results of RCM were consistent with histopathology. Conclusion：The RCM examination was noninvasive and convenient. It has very good guidance significance and application prospect in the diagnosis and the follow-up treatment of EMPD.