脂溢性角化病108例临床、病理及误诊分析

Clinicopathological and Misdiagnosis Analysis of 108 Cases of Seborrheic Keratosis

目的探讨脂溢性角化病的临床、病理特征及误诊原因、防范措施。方法对经皮肤活组织病理检查证实为脂溢性角化病108例的临床资料进行回顾性分析。结果本组108例,曾误诊43例,误诊率为39.81%。根据临床表现明确诊断为脂溢性角化病46例,脂溢性角化病待排除19例,误诊43例。误诊为痣(黑色素细胞痣和皮内痣各8例)16例(37.21%),疣(寻常疣12例、病毒疣3例)15例(34.88%),皮肤肿物4例(9.30%),皮脂腺囊肿和基底细胞癌各2例(各占4.65%),皮脂腺痣、化脓性肉芽肿、纤维瘤和皮肤溃疡各1例(各占2.33%)。108例均经皮肤活组织病理检查确诊脂溢性角化病,皆予以手术切除,术后创面愈合良好。对误诊情况分析发现,<50岁和≥50岁者、皮损分布于暴露部位与非暴露部位者误诊情况比较差异无统计学意义(P>0.05);而病理分型乳头瘤型、棘层增厚型和激惹型3型误诊情况比较差异有统计学意义(P<0.05)。结论脂溢性角化病临床及病理表现多样,易误诊。临床医师有必要提高对该病认识,临床接诊类似本文患者时要仔细辨别皮损,及时采取相关检查手段,必要时行皮肤活组织病理检查,以早期明确诊断。

Objective To analyze clinicopathological characteristics,misdiagnosis causes and preventive measures of seborrheic keratosis(SK).Methods The clinical data of 108 cases with SK confirmed by skin biopsy were retrospectively analyzed.Results Of the 108 cases,43 had been misdiagnosed,with a misdiagnosis rate of 39.81%.According to clinical manifestations,46 cases were definitely diagnosed as SK,19 cases had suspected SK,and 43 cases were misdiagnosed.Most were misdiagnosed as nevus(n=16,37.21%),including melanocytic nevus(n=8)and intradermal nevus(n=8),warts(n=15,34.88%),including verruca vulgaris(n=12)and viral warts(n=3),as well as 4 cases(9.30%)of skin masses,2 cases(4.65%)of sebaceous glands cyst,2 cases(4.65%)of basal cell carcinoma,1 case(2.33%)of sebaceous nevus,1 case(2.33%)of pyogenic granuloma,1 case(2.33%)of fibroma,1 case(2.33%)of skin ulcer.The 108 cases were confirmed to have SK by skin biopsy,and all were surgically excised.The wounds healed well after operation.The analysis of misdiagnosis showed that there was no statistically significant difference in the misdiagnosis between those<50 years and those≥50 years,and between those whose skin lesions were distributed at exposed sites and those at non-exposed sites(P>0.05).Significant difference was found in misdiagnosis in terms of pathological classifications,including papillomatosis,acanthosis and hyperkeratosis(P<0.05).Conclusion SK has various clinicopathological manifestations and is easily misdiagnosed,therefore,it is necessary for clinicians to improve their understanding of the disease.When meeting patients similar to those in clinical practices,they should carefully identify the skin lesions,perform relevant examinations in a timely manner,and perform skin biopsy pathological examinations when necessary to make a definite diagnosis of the disease.