反射式共聚焦显微镜在多发性基底细胞癌诊断及治疗随访中的应用  

Application of the reflectance confocal microscopy in the diagnosis and follow-up of multiple basal cell carcinoma

作　　者：邹云敏 夏汝山[1] 赖美玲[1] 顾静 张立银 李凌佳 朱小红[1] ZOU Yunmin;XIA Rushan;LAI Meiling;GU Jing;ZHANG Liyin;LI Lingjia;ZHU Xiaohong(Department of Dermatology,Wuxi No.2 People's Hospital,Wuxi 214000,China)

机构地区：[1]无锡市第二人民医院皮肤科,无锡214000

出　　处：《中国麻风皮肤病杂志》2021年第9期565-567,共3页China Journal of Leprosy and Skin Diseases

摘　　要：目的:观察多发性基底细胞癌反射式共聚焦显微镜(RCM)影像特征,探讨RCM在多发性基底细胞癌诊断及治疗随访中的价值。方法:对在我科就诊的6例疑似多发性基底细胞癌患者64处皮损行RCM检查,62处皮损诊断为基底细胞癌,其中39处行手术切除并行组织病理检查,23处皮损外涂5%咪喹莫特乳膏治疗,治疗后RCM随访。对基底细胞癌的RCM特征进行归纳总结。结果:手术切除行组织病理检查的39处皮损均符合基底细胞癌,与RCM符合率100%,手术切除后3个月、6个月RCM随访,均未发现基底细胞癌RCM特征。外用5%咪喹莫特乳膏的23处皮损,治疗后3个月、6个月、12个月,分别有12处、8处、4处仍有基底细胞癌RCM特征。RCM诊断为基底细胞癌的62处皮损特征:异形角质形成细胞96.8%,与表皮相连90.3%,肿瘤细胞巢96.8%,肿瘤巢周围裂隙样暗区54.8%,肿瘤巢周边细胞栅栏状排列51.6%,肿瘤巢内高折光树枝状结构77.4%,肿瘤间质内血管增生扩张充血95.2%,肿瘤巢内及周围高折光颗粒77.4%。结论:基底细胞癌在RCM下有特征性表现,RCM可作为多发性基底细胞癌诊断及治疗随访的有效手段。Objective:To investigate the image features of multiple basal cell carcinoma(BCC)under reflectance confocal microscopy(RCM),and further assess the application value of RCM in the diagnosis and follow-up of multiple BCC.Methods:Among 6 patients(64 lesions)clinically diagnosed as BCC,62 lesions were diagnosed as BCC by RCM.Of 62 lesions,39 were taken surgical treatment and histopathologic examination,23 were treated with 5%imiquimod cream.62 lesions were re-assessed by RCM during follow-up.The RCM image characteristics of BCC were summarized.Results:The histological features of 39 lesions treated with excision were in accordance with BCC and the coincidence rate of diagnosis was 100%.No RCM evidence of BCC was identified at 3-month and 6-month follow-up.Of 23 lesions treated with 5%imiquimod cream,there were RCM evidence of BCC in 12 lesions,8 lesions and 4 lesions respectively at 3-month,6-month and 12-month follow-up.The RCM characteristics of 62 lesions were keratinocyte atypia(96.8%),tumor islands(96.8%),cords connected to the epidermis(90.3%),bright particles inside and around tumor island(77.4%),peripheral palisading(51.6%),peri-tumoral clefting(54.8%),increased vascularization(95.2%),dendritic cells inside tumor islands(77.4%).Conclusion:There are characteristic RCM features of BCC,and RCM play an important role in follow-up diagnosis.

关 键 词：基底细胞癌 共聚焦显微镜检查 咪喹莫特 

分 类 号：R739.5[医药卫生—肿瘤]