日光性角化症和脂溢性角化症的临床及病理分析

Clinical and Pathological Analysis of Actinic Keratosis and Seborrheic Keratosis

目的探讨日光性角化症(AK)和脂溢性角化症(SK)的临床及病理特征的差异。方法回顾性分析2015年1月—2018年4月间就诊经手术切除和组织病理检查确诊的61例AK和99例SK患者的临床及病理资料,对数据进行整理分析。结果①AK发病人群以老年人为主,SK发病人群以中老年人为主;②AK与SK的在发病性别构成上差异无统计学意义;③AK皮损好发于头面颈部等暴露部位,而SK皮损可发生于头颈面、躯干、四肢、会阴等全身各个部位;④AK组的组织病理分型以萎缩型和肥厚型为主,SK组的组织病理分型以角化过度型和棘层肥厚型为主;⑤AK误诊率为75.41%,AK误诊为SK占13/23;SK误诊率为46.47%,SK误诊为AK占3/23。结论 AK发病年龄相比SK略晚,在发病性别中差异无统计学意义,SK皮损可发生于体表各个部位,AK则好发于曝光部位;临床上AK的误诊率高于SK,AK与SK易相互误诊,且AK更易误诊为SK;误诊原因主要与皮损临床表现相似及部分医师经验不足有关;病理诊断为AK与SK诊断的金标准,临床诊断需与病理诊断相结合。

Objective In order to discuss the differences of clinical and pathological features of actinic keratosis (AK) and seborrheic keratosis (SK). Methods The clinical and pathological data of 61 AK patients and 99 SK patients who were diagnosed by surgical resection and histopathological examination from January 2015 to April 2018 were analyzed retrospectively. Results ①AK occured in the aged people,while SK occured in the mid-elderly.②There was no statistically significant difference in gender composition of AK and SK.③AK lesions existed in the head,face,neck and other lightexposed parts,while SK in all parts of the body such as the head,face,neck,trunk,limbs and genital.④Most of AK type in the histopathology were atrophic and hypertrophic-based, while keratotic and acanthosis in SK.⑤The misdiagnosis rate of AK was 75.41%,while SK was 46.47%. AK had a 13/23 percent chance of being diagnosised as SK,SK had a 3/23 percent chance of being diagnosised as AK. Conclusion The pathogenic age of AK is slightly later than SK. There is no significant difference in gender composition of AK and SK. The lesions of SK can be found in all parts of the body,however,AK mainly occurs in the light-exposed parts. Misdiagnosis rate of AK is higher than SK. They are easily misdiagnosed for each other,and AK is easily mistaken for SK in clinical. The reasons of the misdiagnosis are the similarity of clinical manifestations of skin lesions,and some doctors are inexperienced. The histopathological diagnosis is the gold standard for AK and SK,clinical diagnosis should be combined with pathological diagnosis.