鲍恩病27例临床分析

Retrospective clinical and pathological analysis of Bowen' disease

目的探讨鲍恩病特点,提高其诊疗率。方法收集2010年6月至2017年6月苏州大学附属第一人民医院收治并经病理确诊为鲍恩病的27例患者的临床资料,对其临床表现、病理特点、误诊情况进行回顾分析。结果 27例中,鲍恩病最常见于中老年人,60岁以上者居多,占70.4%。病变可发生于身体各个部位,但多发于躯干和四肢,为单发。临床表现无特异性,极易与神经性皮炎、湿疹、Paget病等疾病相混淆。组织病理学表现为表皮角化过度或角化不全,颗粒层减少,棘层明显增厚,细胞排列紊乱,全层可见异形细胞,真皮浅层有中等密度的淋巴细胞浸润,毛囊、皮脂腺导管及毛囊漏斗部外毛根鞘均可受累。误诊11例,误诊率为40.7%。结论鲍恩病误诊率较高,应尽早做组织病理检查,以便早期诊断,及时治疗。

Objective The etiology,clinicopathologic features and misdiagnosis of Bowen＇ disease were retrospectively analyzed to reduce the misdiagnosis rate and improve the efficiency of diagnosis and treatment. Methods The clinical features,pathological findings and misdiagnoses of 27 patients with pathologically diagnosed Bowen＇s disease from the authors＇ affiliated hospital were retrospectively analyzed. Results Bowen＇s disease was often seen in middle-aged and elderly people,especially older than 60,accounting for70. 4%. Bowen＇ disease occurred in any part of the body,in the cadre and the limbs of the most common,were single lesion. In the clinical manifestations,Bowen＇ disease could be confused with neurodermatitis,eczema,Paget disease and other diseases easily,but its histopathological manifestations showed hyperkeratosis or parakeratosis,decreased granular layer,thickened acanthosis,disordered cell arrangement,abnormal shaped cells in all layers,moderately dense lymphocyte infiltrate in the superficial dermis,hair follicles,sebaceous ducts,and hair follicle infundibulum outer root sheath could be involved. Conclusions Misdiagnosis rate of Bowen＇ disease is relatively high. Once suspected in clinical diagnosis,histopathology should be done to confirm diagnosis timely,early diagnosis and early treatment are crucial.