A 54- year- old man presented with multiple lesions (seven) on the lower extremities and abdomen. These lesions had been present for at least 12 years with gradual growth and some had spontaneously disappeared; all we...A 54- year- old man presented with multiple lesions (seven) on the lower extremities and abdomen. These lesions had been present for at least 12 years with gradual growth and some had spontaneously disappeared; all were asymptomatic. Some of them had been treated with topical steroids and antimycotic creams with poor results. Past personal history was uneventful, but family history revealed the death of a son from metastatic visceral carcinoma. On dermatologic examination, six erythematous plaques of similar appearance were observed on the legs, abdomen and buttocks. All averaged 3 × 4 cm, with welldefined but irregular borders that did not seem to be infiltrated. On the skin surface, thick scales and crusts were present. Areas of spontaneous involution with residual hypopigmentation were present. On the dorsum of the left foot the biggest lesion was observed, measuring 4 × 8 cm. Unlike other lesions this was verrucous in appearance, with peripheral inflammation (Fig. 1). No ulceration or regional lymphadenopathies were present. General physical examination was unremarkable. Histopathology revealed an intraepidermal carcinoma with an intact basal membrane, consistent with Bowen’ s disease. The presence of multiple clear cells was noted. The biopsy of the verrucous lesion showed an extreme thickening of the epithelium with the papilli reduced to very thin strands. The architectural features seemed to be fully disorganized. Numerous cells appeared highly atypical, with large, hyperchromatic nuclei. Multinucleated atypical cells were often present. Dyskeratotic cells with homogenous, strongly eosinophilic cytoplasm were numerous. The most distinctive featurewas, however, the presence of multiple clear cells in the whole thickness of the epidermis. At some points there was effacement of the epidermal/dermal junction because of an intense chronic inflammatory reaction. Nevertheless, no atypicial cells were observed in the dermis (Fig. 2). All lesions were treated with cryosurgery except for the verrucous lesion, which was excised, and a full thickness skin graft was performed, whose donor site was the abdomen. The borders and bottom of the excised skin were free of tumor. The malignancy work- up was negative.展开更多
一、病例介绍 患者女性,45岁。于2008年7月因右腹部疼痛、伴腹胀就诊,行腹部CT检查回报:升结肠占位性病变,大小约6 cm,侵及全层,伴局部淋巴结肿大。肺部CT检查未见转移。结肠镜下病理活检示升结肠腺癌。癌胚抗原( CEA )为67 ng...一、病例介绍 患者女性,45岁。于2008年7月因右腹部疼痛、伴腹胀就诊,行腹部CT检查回报:升结肠占位性病变,大小约6 cm,侵及全层,伴局部淋巴结肿大。肺部CT检查未见转移。结肠镜下病理活检示升结肠腺癌。癌胚抗原( CEA )为67 ng/ml。于2008年7月10日行结肠癌根治术,术中见升结肠肿物侵及肠壁全层,与右侧卵巢及输卵管粘连,遂行右侧卵巢及输卵管切除术。术后病理提示:升结肠低分化腺癌,侵及外膜(肿物大小6 cm ×5 cm ×5 cm ),脉管可见癌侵及,神经及两切缘未见癌,系膜淋巴结3/13枚可见癌,输卵管系膜及卵巢表面可见癌侵及。术后诊断为结肠低分化腺癌ⅢC期(T4bN1bM0),复查CEA恢复正常。术后1个月在外院行辅助化疗,5-氟尿嘧啶联合亚叶酸钙5天方案,应用6个疗程。术后随访14个月,患者病情稳定。2009年9月复查,发现CEA升高为27 ng/ml。行PET-CT检查提示右侧髂血管旁、腹主动脉旁多个淋巴结代谢活跃,最大者约为1.8 cm ×1.9 cm,边界不清;余未见异常,来我科进一步治疗。展开更多
文摘A 54- year- old man presented with multiple lesions (seven) on the lower extremities and abdomen. These lesions had been present for at least 12 years with gradual growth and some had spontaneously disappeared; all were asymptomatic. Some of them had been treated with topical steroids and antimycotic creams with poor results. Past personal history was uneventful, but family history revealed the death of a son from metastatic visceral carcinoma. On dermatologic examination, six erythematous plaques of similar appearance were observed on the legs, abdomen and buttocks. All averaged 3 × 4 cm, with welldefined but irregular borders that did not seem to be infiltrated. On the skin surface, thick scales and crusts were present. Areas of spontaneous involution with residual hypopigmentation were present. On the dorsum of the left foot the biggest lesion was observed, measuring 4 × 8 cm. Unlike other lesions this was verrucous in appearance, with peripheral inflammation (Fig. 1). No ulceration or regional lymphadenopathies were present. General physical examination was unremarkable. Histopathology revealed an intraepidermal carcinoma with an intact basal membrane, consistent with Bowen’ s disease. The presence of multiple clear cells was noted. The biopsy of the verrucous lesion showed an extreme thickening of the epithelium with the papilli reduced to very thin strands. The architectural features seemed to be fully disorganized. Numerous cells appeared highly atypical, with large, hyperchromatic nuclei. Multinucleated atypical cells were often present. Dyskeratotic cells with homogenous, strongly eosinophilic cytoplasm were numerous. The most distinctive featurewas, however, the presence of multiple clear cells in the whole thickness of the epidermis. At some points there was effacement of the epidermal/dermal junction because of an intense chronic inflammatory reaction. Nevertheless, no atypicial cells were observed in the dermis (Fig. 2). All lesions were treated with cryosurgery except for the verrucous lesion, which was excised, and a full thickness skin graft was performed, whose donor site was the abdomen. The borders and bottom of the excised skin were free of tumor. The malignancy work- up was negative.
文摘一、病例介绍 患者女性,45岁。于2008年7月因右腹部疼痛、伴腹胀就诊,行腹部CT检查回报:升结肠占位性病变,大小约6 cm,侵及全层,伴局部淋巴结肿大。肺部CT检查未见转移。结肠镜下病理活检示升结肠腺癌。癌胚抗原( CEA )为67 ng/ml。于2008年7月10日行结肠癌根治术,术中见升结肠肿物侵及肠壁全层,与右侧卵巢及输卵管粘连,遂行右侧卵巢及输卵管切除术。术后病理提示:升结肠低分化腺癌,侵及外膜(肿物大小6 cm ×5 cm ×5 cm ),脉管可见癌侵及,神经及两切缘未见癌,系膜淋巴结3/13枚可见癌,输卵管系膜及卵巢表面可见癌侵及。术后诊断为结肠低分化腺癌ⅢC期(T4bN1bM0),复查CEA恢复正常。术后1个月在外院行辅助化疗,5-氟尿嘧啶联合亚叶酸钙5天方案,应用6个疗程。术后随访14个月,患者病情稳定。2009年9月复查,发现CEA升高为27 ng/ml。行PET-CT检查提示右侧髂血管旁、腹主动脉旁多个淋巴结代谢活跃,最大者约为1.8 cm ×1.9 cm,边界不清;余未见异常,来我科进一步治疗。