皮肤基底细胞癌364例临床病理分析  

Clinical pathological analysis of 364 cases of basal cell carcinoma

作　　者：缑文斌[1] 于涛[1] 张巍[2] 

机构地区：[1]新疆生产建设兵团第六师医院病理科,五家渠市831300 [2]新疆医科大学第一附属医院病理科

出　　处：《实用皮肤病学杂志》2017年第5期280-283,共4页Journal of Practical Dermatology

摘　　要：目的探讨皮肤基底细胞癌的临床特点及组织病理学类型,提高基底细胞癌诊断准确率,为临床诊治提供一定理论指导。方法收集新疆医科大学第一附属医院2002年9月—2014年2月,对经手术切除和组织病理证实的364例皮肤基底细胞癌患者的临床及组织病理资料进行回顾性分析。结果 364例患者中浅表型10例,结节型280例,微结节型8例,浸润型7例,基底细胞癌伴附属器分化7例,鳞状细胞基底细胞癌10例,角化型9例,腺样型28例,色素性4例,硬化型1例。结节型基底细胞癌患者中3例为多发性基底细胞癌,7例侵及骨骼肌,1例侵犯骨骼肌及软骨。1例复发性鳞状细胞基底细胞癌,侵犯皮下骨骼肌组织,并可见明确神经侵犯。364例均未见远处转移。5例基底细胞癌复发中的3例位于鼻部,均为鳞状细胞基底细胞癌。其中1例肿瘤侵犯皮下骨骼肌组织,并可见明确神经侵犯。1例位于右筛窦、眼眶部,肿瘤侵及邻近骨组织。1例位于右下眼睑,未见肿瘤侵犯周围组织。在9例侵袭性患者中,4例为复发性肿瘤。结论基底细胞癌组织学亚型较多,形态多样,易误诊。治疗以手术完整切除为主,5年生存率高,局部复发及周围组织侵犯可能与不能完整切除肿瘤及肿瘤距切缘较近有关。Objective To further explore the clinical characteristics of skin basal cell carcinoma（BCC） and pathological types, so as to improve the accuracy in BCC diagnosis and provide a certain theoretical guidance for clinical diagnosis and therapy. Methods Clinical and pathological data of 364 patients with BCC in skin were retrospectively analyzed, whose diagnosis were confirmed by surgery and pathology in the first affiliated hospital of Xinjiang Medical University from September 2002 to February 2014. Results Among the 364 BCC cases, there were 10 cases of superficial type, 280 cases of nodular type, 8 cases of micronodular type, 7 cases of infiltrative type, 7 cases with differentiation towards adnexal structures, l 0 cases of squamous basal, 9 cases of keratinization type, 28 cases of adenoid type, 4 cases of pigmented type, l case of morpheaform BCC. For the cases of nodular type BCC： 3 cases were multiple BCC, 1 case with skeletal muscle invasion and 1 case with skeletal muscles and cartilage invasion. For the 1 case of recurrent basosquamous BCC, subcutaneous skeletal muscle tissue and nerve invasion were clearly visible. Distant metastasis was not found in all the patients. For the 5 cases of recurrent BCC, 3 cases located in the nose were recurrent basosquamous BCC, 1 case with subcutaneous skeletal muscle tissue invasion and clearly visible nerve invasion; 1 case located in right orbital part and ethmoid sinus with adjacent bone invasion; 1 case located in the lower eyelid without surrounding tissue invasion. Among the 9 invasive cases, 4 cases were recurrent. Conclusion The histologic subtype of BCC is various, HE morphology is diversity, which may lead to misdiagnosis easily. Surgical resection is the main treatment, 5 years of survival rate is high, local recurrence and surrounding tissue invasion may be related to incomplete resection of tumor or the incisal margin is too close to the tumor.

关 键 词：癌 基底细胞 皮肤 临床特征 组织学亚型 诊断及鉴别诊断 

分 类 号：R739.5[医药卫生—肿瘤]