鲍温病16例临床病理分析  

Bowen's disease:a clinicopathologic analysis of 16 cases

作　　者：李小强[1] 郁敏[1] 李英凤[1] 孙静[1] 宋梦圆[1] 刘安琪[1] 唐裕丹 LI Xiao-qiang;YU Min;LI Ying-feng;SUN Jing;SONG Meng-yuan;LIU An-qi;TANG Yu-dan(Department of Pathology,First People＇ s Hospital of Shanghai Baoshan Branch,Shanghai 200940,Chin)

机构地区：[1]上海市第一人民医院宝山分院病理科,上海200940

出　　处：《诊断病理学杂志》2018年第7期503-506,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的分析鲍温病(Bowen’s disease)临床误诊情况,探讨其临床病理特征、鉴别诊断及其治疗与预后。方法回顾性分析16例鲍温病的临床表现,病理组织学特征和免疫组化特点及治疗情况,并进行相关文献的复习。结果鲍温病多发于中老年人,可发生于任何部位。本组16例年龄41~88岁,平均年龄68.6岁,分别为面部3例,左上臂2例,左眼睑、左前臂、左手背、右环指、左乳皮肤、背部、腹壁皮肤、左腋下、左臀部、右小腿和会阴皮肤各1例,临床上易误诊为色素痣、脂溢性角化病、日光性角化病、基底细胞癌、Paget病等,但组织病理学上有差异:镜下可见表皮层较多的"风吹状"异型细胞,瘤细胞形态大小不等,核大而深染,或浅染空泡状,内含糖原,可见异常核分裂象。免疫组化:16例肿瘤细胞CKpan、HCK、CK14、CK5/6、p63均(+),Ki-67 30%~50%,p53 30%~60%(+)。结论鲍温病可进展为鳞状细胞癌,且在临床上易误诊,因此早期诊断、规范治疗很有必要,诊断必须结合临床形态和病理组织学检查。Objective To analyze the misdiagnosis of the Bowen＇s disease（ BD）,and to explore its clinicopathological features,differential diagnosis,treatment and prognosis. Methods Clinical manifestations and histopathological,immunohistochemical characteristics and therapeutic features of 16 patients with BD were analyzed retrospectively,with review of the relevant literature. Results BD frequently occurred in middle-age and elder people,anywhere in the body.The age range of 16 cases was 41-88 years,with an average age of 68. 6 years. There were 3 cases on the face,2 cases in left upper arm,and each 1 case in left eyelid,left upper limb,left forearm,left hand back,right ring finger,breast skin,back,abdominal skin,left armpit,left hip,right calf,and perineal skin. It was easily misdiagnosed as pigmented nevus,seborrheic keratosis,solar keratosis,basal cell carcinoma,Paget disease,etc. But in the histopathology there were differences： Microscopically,there were more ＂windblown＂atypical cells,with different morphologies and sizes,large nuclei and deep dysplasia, or shallow vacuoles, containing glycogen, and abnormal mitotic figures. The immunohistochemistry showed positive Ckpan（ 16/16）,HCK（ 16/16）,CK14（ 16/16）,CK5/6（ 16/16） and P63（ 16/16）. Ki67 index was 30%-50% and P53 positive rate was 30%-60%. Conclusion BD can progress to squamous cell carcinoma that is easily misdiagnosed,and so early diagnosis and standardized treatment are necessary,and the diagnosis must be combined with clinical,morphological and histopathological findings.

关 键 词：鲍温病 临床病理特征 鉴别诊断 临床治疗 

分 类 号：R739.5[医药卫生—肿瘤]