颌面结缔组织增生性毛发上皮瘤2例报告及文献复习

Maxillofacial connective tissue hyperplastic trichoepithelioma:report of two cases and a literature review

目的探讨结缔组织增生性毛发上皮瘤的诊断和临床治疗方法。方法对2例颌面部结缔组织增生性毛发上皮瘤临床资料进行总结并结合文献分析。结果2例结缔组织增生性毛发上皮瘤患者均为男性,年龄分别为21岁和30岁,临床表现分别为颌面部无痛性浅褐色及浅白色斑块,病变区质韧、界清,中间凹陷无溃疡,病程10~16个月,就医前1~3个月肿物有明显增大病史。手术行沿瘤体外周3 mm切开皮肤、完整切除肿物,邻近皮瓣修复局部组织缺损手术;术后病理报告镜下见病变肿瘤细胞位于真皮层,呈条索状、小梁状或巢状,可见微小囊腔,上皮巢周围可见纤维结缔组织增生,瘤细胞无异型性,核分裂不明显。免疫组化报告bcl⁃2(⁃)、CK7(⁃)、CK19(⁃)、CD34(+)、P63(+)、CK56(+)、Ki67(±),病理诊断为结缔组织增生性毛发上皮瘤。患者术后随诊24个月,期内未见肿物复发、手术疤痕不明显、颌面无畸形或功能障碍。结论病理和免疫组化检查是确诊结缔组织增生性毛发上皮瘤的依据,手术切除肿物是有效的治疗方法。

Objective To investigate the diagnosis and clinical treatment of maxillofacial connective tissue hyper⁃plastic trichoepithelioma.Methods The clinical data of two cases of maxillofacial connective tissue hyperplastic trichoepithelioma were summarized and analyzed along with the literature.Results Two cases of maxillofacial connec⁃tive tissue hyperplastic trichoepithelioma were male,aged 21 and 30 years.The clinical manifestations were painless pale brown and pale white plaques in the maxillofacial region.The lesion was tough and clear,with no ulcers in the mid⁃dle depression.The course was 10⁃16 months,with 1⁃3 months before medical treatment,and the tumor had a signifi⁃cant history of enlargement.After surgery,the skin was cut 3 mm along the outer circumference of the tumor,and local tissue defects were repaired by the adjacent flap.The pathological report showed that the tumor cells were located in the dermis,and were striped,trabecular or nested.The tiny sac contained fibrous connective tissue proliferation.The tumor cells were amorphous without obvious nuclear division.Immunohistochemical analysis reported bcl⁃2(⁃),CK7(⁃),CK19(⁃),CD34(+),P63(+),CK56(+),and Ki67(±).The pathological diagnosis was connective tissue proliferative hair epitheli⁃al tumor.The patient was followed up for 24 months.There was no recurrence of the tumor,no obvious scarring,and no deformity or dysfunction of the maxillofacial region.Conclusion Pathological and immunohistochemical examination is the basis for the differential diagnosis of maxillofacial connective tissue hyperplastic trichoepithelioma,and surgical removal of tumors is an effective treatment.