日光性角化病90例临床及病理特征分析  

Clinical and pathological features in 90 cases with actinic keratosis

作　　者：龙庭凤[1] 刘流[1] 何黎[1] 沈丽达[2] 柴燕杰[1] 袁瑞红[1] 杨亚萍[3] 

机构地区：[1]昆明医学院第一附属医院皮肤及医疗美容科、云南省皮肤病研究所,云南昆明650032 [2]昆明医学院第三附属医院、云南省肿瘤研究所肿瘤化疗研究中心,云南昆明650032 [3]青海医学院附属医院皮肤科,青海西宁810001

出　　处：《临床皮肤科杂志》2010年第5期286-289,共4页Journal of Clinical Dermatology

基　　金：国家自然科学基金(30860257)资助项目

摘　　要：目的:探讨日光性角化病的临床及组织病理特点。方法:采用回顾性分析,选取门诊患者中病历资料保存完整,经组织病理检查确诊的日光性角化病患者90例,对苏木精-伊红染色的组织切片进行观察并分析其组织病理特征。结果:90例患者平均患病年龄(65.94±10.46)岁,病程(26.63±27.50)个月,男:女为1:1.5,皮损发生于面部占92.2%。临床表现为红褐色斑片46例(51.1%),黑褐色斑片23例(25.6%),黑色丘疹8例(8.9%),皮角7例(7.8%),糜烂性斑片4例(4.4%),并发溃疡2例(2.2%)。组织病理上可见表皮不典型角质形成细胞增生、排列紊乱。病理分型为肥厚型36例(40%),萎缩型22例(24.4%),鲍恩样型15例(16.7%),棘层松解型5例(5.6%),苔藓样型6例(6.7%),色素型6例(6.7%。进展为侵袭性鳞状细胞癌2例(2.2%)。18例(20%)伴有毛囊受累,11例(12.2%)伴有汗腺导管受累。复发2例(2.2%)。84例(93.3%)有真皮日光弹性纤维变性,其中Ⅰ级39例(43.3%),Ⅱ级18例(20%),Ⅲ级27例(30%);6例(6.7%)未见明显日光弹性纤维变性。结论:日光性角化病好发于老年人,面颊部最多发;组织病理示表皮不典型角质形成细胞增生、排列紊乱,以肥厚型、萎缩型、鲍恩样型常见。该病临床易误诊,临床医师应高度警惕。Objective：To study the clinical and pathological features of actinic keratosis （AK） ,and discuss its diagnosis and differential diagnosis. Methods： Ninety cases of AK were collected. The paraffin sections of this disease were checked and some samples sliced again, and their clinical features analyzed with pathological aspects observed. Results： The median age of patients in this group were 65.94±10.46 years, the course of disease 26.63±27.50 months. The ratio of male/female was 1：1.5. The most frequent sites were the face （83 cases, 92.2%）. Among these 90 cases,46（51.1%）cases were reddish brown macules,23（25.6%）blackish brown macules, 8（8.9%）black papules,7（7.8%） cutaneous horn,4 （4.4%） erosive patches,2 combined with ulcer. Six histopathology types of AK were included： hypertrophic（40%）,atrophic（24.4%）,bowenoid （16.7%）,acantholytic （5.6%）, pigmented（6.7%）and lichenoid（6.7%）.Two cases developed to invasive squamous cell carcinoma. Some lesions （20%）showed the spread into the infundibular and isthmic segments of follicles or less commonly along eccrine ducts （12.2%）. Two cases relapsed. Dermal changes included solar elastosis （84 cas-es,93.3%）, I grade 39 cases （43.3%）,Ⅱ grade 18 cases （20%）, 1 grade 27 cases （30%）, 6 cases had no obvious solar elastosis, dermal changes also showing an infiltrate of lymphocytes and plasma cells and increased vascularity. The diagnose accordance rate of clinic and pathological was only 42.2%.The cases were previously misdiagnosed as seborrheic keratosis,melanocytic nevus,basal cell carcinoma, Bowen＇s disease and so forth. Conclusions： AK usually presents in older individuals and be involved sun-exposed areas. Under the situation of patient＇s senior age,slow progression of the disease course and the non-typical clinical presentations, AK might be misdiagnosed. Pathological examination is important to improve accuracy of diagnosis and to differential diagnosis from other diseases.

关 键 词：角化病 日光性 临床分析 病理特征 误诊 

分 类 号：R758.19[医药卫生—皮肤病学与性病学]