透明细胞棘皮瘤12例皮肤影像学特征分析  

Skin imaging features of 12 cases of clear cell acanthoma

作　　者：黄小波 胡彬[1] 姜倩[1] 陈红英[1] 陈柳青[1] Huang Xiaobo;Hu Bin;Jiang Qian;Chen Hongying;Chen Liuqing(Department of Dermatology,Wuhan No.1 Hospital,Hubei Province Key Laboratory of Skin Infection and Immunity,Wuhan 430022,China)

机构地区：[1]武汉市第一医院皮肤科,皮肤感染和免疫湖北省重点实验室,武汉430022

出　　处：《中华皮肤科杂志》2025年第2期132-137,共6页Chinese Journal of Dermatology

基　　金：湖北省重点研发专项(2023BCB132)。

摘　　要：目的探讨透明细胞棘皮瘤(CCA)在皮肤镜和反射式共聚焦显微镜下的影像学特征。方法回顾性分析2020—2024年在武汉市第一医院皮肤科经组织病理学检查确诊为CCA的12例患者的临床资料,总结其皮肤镜和反射式共聚焦显微镜的影像学特征。结果12例CCA患者中,男3例、女9例,年龄(50.08±10.43)岁。CCA临床多表现为红色或棕色丘疹或结节,边界清楚,直径3 mm至2 cm。组织病理学特征:肿瘤呈银屑病样或乳头样增生,棘层增厚,与周围正常皮肤分界鲜明,增生细胞体积较大,胞质淡染,表皮可见嗜中性粒细胞浸润,真皮乳头及浅层血管扩张;过碘酸希夫染色显示细胞内有大量糖原。10例行皮肤镜检查,均可见点状、小球状或肾小球样血管呈串珠样排列,其中6例皮损边缘可见领圈样鳞屑。6例行反射式共聚焦显微镜检查,均可见表皮增生,棘层增厚,角质形成细胞有核,体积大,胞质多,与细胞间的分界融合,表皮蜂窝样结构紊乱,真皮乳头和浅层毛细血管扩张、上顶;4例表皮可见分叶核细胞浸润。经测量,CCA棘层上部细胞长径30.25~35.13μm;CCA毛囊处棘层细胞长径[(19.39±2.93)μm]小于周围棘层细胞长径[(30.95±5.66)μm],差异有统计学意义(t=5.73,P<0.001)。结论CCA在皮肤镜下呈现特殊的血管模式,其多数组织学特征可以在反射式共聚焦显微镜下可视化。皮肤镜和反射式共聚焦显微镜检查可以作为CCA相对可靠的辅助诊断手段。Objective To investigate the imaging characteristics of clear cell acanthoma(CCA)by dermoscopy and reflectance confocal microscopy(RCM).Methods A retrospective analysis was conducted on 12 patients diagnosed with CCA through histopathological examination at the Department of Dermatology,Wuhan No.1 Hospital,from 2020 to 2024.Dermoscopic and RCM features of these cases were summarized.Results Among the 12 CCA patients,3 were males and 9 were females,and they were aged 50.08±10.43 years.Clinically,CCA lesions were typically presented as red or brown papules or nodules with well-defined borders,ranging in diameter from 3 mm to 2 cm.Histopathological examination showed that the tumor manifested as psoriasiform or papillary hyperplasia with a thickened spinous layer and a distinct boundary surrounded by the normal skin;proliferating cells were larger with lightly stained cytoplasm;neutrophil infiltration was observed in the epidermis,and vascular dilation was observed in the dermal papillae and superficial dermis;periodic acid-Schiff staining revealed abundant glycogen in the cells.In 10 patients examined by dermoscopy,dotted,globular,or glomerular vessels were arranged in a beaded pattern in all the 10 patients,and collar-like scales were seen at the edges of the lesions in 6 patients.In 6 patients examined by RCM,RCM images all revealed epidermal hyperplasia,thickened spinous layers,large keratinocytes with enlarged nuclei and abundant cytoplasm that blended in with the intercellular demarcations,disordered honeycomb structure of the epidermis,and dilation and up-thrust of blood vessels in the dermal papillae and superficial dermis;segmented cell infiltration was observed in the epidermis of 4 patients.As measured,the longest diameters of cells in the upper part of the CCA spinous layer ranged from 30.25μm to 35.13μm;the longest diameters of spinous layer cells at the CCA follicles(19.39±2.93μm)were significantly lower than those of the surrounding spinous layer cells(30.95±5.66μm,t=5.73,P<0.001).Conclusions C

关 键 词：棘皮瘤 透明细胞棘皮瘤 皮肤镜检查 反射式共聚焦显微镜 

分 类 号：R758[医药卫生—皮肤病学与性病学]