皮肤透明细胞汗腺瘤23例临床病理特征  

Clinicopathological features of clear cell hidradenoma in 23 cases

作　　者：吴玲玲[1] 夏燕[1] 封扬[1] 王雪寒 关静文 吴璇 王小双 Wu Lingling;Xia Yan;Feng Yang;Wang Xuehan;Guan Jingwen;Wu Xuan;Wang Xiaoshuang(Department of Pathology,Suzhou Municipal Hospital,Suzhou 234000,Anhui Province,China)

机构地区：[1]宿州市立医院病理科,宿州234000

出　　处：《中国基层医药》2022年第7期1054-1058,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨皮肤透明细胞汗腺瘤的临床病理特征、免疫表型及鉴别诊断,分析透明细胞汗腺瘤的来源及发生机制。方法回顾性分析宿州市立医院2017年12月至2021年7月行手术切除的皮肤透明细胞汗腺瘤患者23例的临床资料。分析患者的临床表现、影像学特征、病理学特点及预后。采用免疫组织化学EnVision法检测上皮膜抗原(EMA)、细胞角蛋白20(CK20)、细胞角蛋白7(CK7)、细胞角蛋白14(CK14)、癌胚抗原(CEA)、特异性大囊肿病液体蛋白-15(GCDPF-15)等表达情况;过碘酸雪夫染色(PAS)显示糖原。结果23例患者中男性9例,女性14例,年龄范围14~94岁,中位年龄55岁。18例以表皮隆起型肿块为首发症状;影像学超声显示皮下囊实性回声团块,实性部分内血流丰富。组织学肿瘤由两型细胞组成:分泌上皮或腺上皮和透明细胞。其中20例为良性透明细胞汗腺瘤特征;2例表现为非典型透明细胞汗腺瘤:细胞异型、可见核分裂象;1例为恶性透明细胞汗腺瘤。免疫表型显示肿瘤细胞:EMA、CK7、CK14、CEA、GCDPF-15阳性、PAS阳性。23例随访2~36个月,4例失访,其余未见复发。结论透明细胞汗腺瘤比较少见,预后好,恶性罕见,预后较差。确诊主要依据其病理学特征、免疫表型等综合分析,诊断时需与转移性透明细胞癌、螺旋腺瘤、皮质腺瘤、恶性黑色素瘤等肿瘤鉴别。Objective To investigate the clinicopathological features,immunophenotype and differential diagnosis of clear cell hidradenoma,and to analyze the origin of clear cell hidradenoma and the underlying mechanism.Methods The clinical data of 23 cases of clear cell hidradenoma who underwent surgical resection in Suzhou Municipal Hospital between December 2017 and July 2021 were retrospectively analyzed.Clinical manifestation,imaging features,pathological features and prognosis of the 23 cases of clear cell hidradenoma were analyzed.Expression levels of epithelial membrane antigen,cytokeratin 20,cytokeratin 7,cytokeratin 14,carcinoembryonic antigen,and gross cystic disease fluid protein 15 were detected by immunohistochemical staining technique using the EnVision system.Periodic acid-Schiff(PAS)staining was performed to visualize glycogen.Results Among the 23 cases,8 were male and 14 were female,aged 14-94 years,with a median age of 55 years.The first symptom of clear cell hidradenoma was epidermal bulgels in 18 cases.Contrast ultrasonography showed a subcutaneous cystic solid echo mass with abundant blood flow in the solid part.The tumor histologically consisted of two types of cells:secretory epithelial cells or glandular epithelial cells and clear cells.Twenty cases had tumors with the features of benign clear cell hidradenoma.Two cases had atypical clear cell hidradenoma with atypia and mitosis.One case had malignant clear cell hidradenoma.Tumor cells were positive for epithelial membrane antigen,cytokeratin 7,cytokeratin 14,carcinoembryonic antigen,and gross cystic disease fluid protein 15 and they were Periodic acid-Schiff-positive.Twenty-three patients were followed up for 2-36 months,of which 4 were lost to follow-up and the rest had no recurrence of clear cell hidradenoma.Conclusion Clear cell hidradenoma is rare and has a good prognosis.Malignant clear cell hidradenoma is rarer and has a poor prognosis.Diagnosis of clear cell hidradenoma is mainly based on comprehensive analysis of pathological features and im

关 键 词：腺瘤 汗腺 皮肤 腺癌 透明细胞 黏蛋白-1 角蛋白细胞 病理学 临床 诊断 鉴别 免疫组织化学 

分 类 号：R739.5[医药卫生—肿瘤]