汗孔肿瘤25例临床病理分析

Tumors with poroid features: a clinicopathologic analysis of 25 cases

目的探讨良、恶性汗孔肿瘤的临床病理特征、诊断与鉴别诊断。方法对19例汗孔瘤(EP)和6例汗孔癌(EPC)进行临床特点和病理形态学观察,对6例EPC行免疫组化染色,并文献复习。结果良、恶性汗孔肿瘤发病部位相似,好发于下肢皮肤,其次为躯干和头面部;存在显著的年龄差异,临床容易误诊为色素痣、血管瘤、鳞状细胞癌或脂溢性角化病等。EP镜下由增生一致的基底细胞样立方形细胞组成,伴导管分化,偶尔形成囊肿,可见小灶坏死和核分裂,EPC镜下表现为肿瘤细胞显著异型性和核高分裂和/或有间质浸润。免疫组化示EPC肿瘤细胞p53阳性率10%~90%,Ki-67阳性指数10%~80%,p16(-);肿瘤内导管结构CEA和EMA(+),间质血管平滑肌SMA(+)。结论汗孔肿瘤的诊断主要依靠组织病理学,肿瘤细胞有异型性和/或浸润性生长是EPC诊断的主要依据,免疫组化可辅助鉴别诊断;局灶核高分裂、灶状肿瘤细胞坏死及p53阳性均不能作为EPC的独立诊断指标;病史较长的汗孔瘤短时间内快速生长、自发出血或瘙痒、表面溃疡或多结节出现均提示恶变风险。

Objective To explore the clinical and pathological features,diagnosis and differential diagnosis of benign and malignant poroid tumor. Methods Clinical characteristics and pathological morphology were analyzed in 19 cases of eccrine poroma（ EP） and 6 cases of eccrine porocarcinoma（ EPC）,with immunohistochemical staining（ 6 cases）,and review of the relevant literature. Results Tumors with poroid features occurred at similar site,first commonly in the lower limb,second trunk and head face,and there was significant age difference. It was easily misdiagnosed as pigment nevus,hemangioma,squamous cell carcinoma or seborrheic keratosis etc. EP microscopically by hyperplasia of basal cell and cuboidal cells with ductal differentiation,occasionally cyst formation,and visible focal necrosis and mitotic activity;EPC microscopically showed the tumor cells were significantly high atypia or mitotic activity and / or interstitial infiltrates.Immunohistochemical staining showed P53 positive tumor cells were positive about 10%- 90%,Ki67 positive rate was about 10%- 80%,but P16（-）; in the tumor cells of ductal structure CEA and EMA were positive,and SMA was positive for interstitial vascular smooth muscle. Conclusions In the umor with poroid features correct diagnosis relies mainly on histopathology observation; tumor cell atypia and / or invasive growth is the main basis of EPC diagnosis.Immunohistochemical staining is auxiliary in the differential diagnosis; focal high mitotic activity,tumor cell necrosis and P53 positive tumor cell are not independent diagnosis index of EPC. Rapid growth in a short period of time in an EP with longer history,spontaneous bleeding or itching,surface ulcers or multiple nodules suggests malignant transformation risk.