脂溢性角化病并发日光性角化病及基底细胞癌1例

A Case of Seborrheic Keratosis Complicated with Solar Keratosis and Basal Cell Carcinoma

患者女,85岁。右前臂伸侧出现一花生米大暗红色结节2年。皮损组织病理示:(1)突起部分:表皮局部糜烂,真皮可见由基底细胞组成的巢状肿瘤团块,癌巢周边的基底细胞呈栅栏状排列;(2)蒂部周围:棘层下方细胞排列紊乱,有异型性,部分区域表皮全层异型,基底层非典型细胞呈芽蕾状增生,伸向真皮上部。真皮浅层胶原纤维嗜碱性变,并有较多的淋巴细胞浸润;(3)外围黑褐色斑块皮损:角化过度、棘层肥厚、基底细胞呈乳头瘤样增生,瘤边界平坦,下界与皮肤基底层相平。诊断:脂溢性角化病并发日光性角化病及基底细胞癌。

A 85-year-old female presented with a peanuts sized dark red nodules on her posterior antebrachial region for 2 years. The histopathological examination of skin showed：①The protrusion：there was epidermal local erosion,and the nest-like tumor mass which composed of basement cell was visible in the dermis.Besides,the basement cell around cancer nests was palisading.②Around the pedicle：below the spinous layer,the cells were arranged irregularly and had atypia.Part of the region was full of abnormal layers of epidermis.The atypical cells in the basal layer presented a bud hyperplasia and proliferated into the upper dermis.In addition,the collagen fiber in the superficial layer of dermis was basophilic,which had more lymphocytes infiltration.③Peripheral dark brown plaque lesions：the symptom showed hyperkeratosis and acanthosis,also with papilloma hyperplasia of the basement cell.Besides,the tumor border was flat and the lower bound was in line with the basal layer of the skin.The diagnosis was seborrheic keratosis complicated with solar keratosis and basal cell carcinoma.