生殖器硬化性苔藓发生恶性转化的临床病理分析
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摘要
目的分析生殖器硬化性苔藓(LS)发生恶性转化的临床病理特点,提高早期识别LS恶性转化的能力。方法收集本院皮肤科2011年1月-2017年7月间临床、病理资料完整的生殖器LS病例。根据病理学上是否合并有癌变或表皮不典型增生表现,将其分类为普通组及恶性转化组,并分析两组间临床、病理特点差异,识别其与LS恶性转化间可能的相关性。结果共收集31例患者资料(男14例,女17例)及40例病理标本。27例(87.10%)病例表现典型LS皮疹,为白斑、局部萎缩,部分患者在白斑基础上出现瘀点、糜烂或溃疡、角化或增生。仅11例(35.48%)病理标本具LS典型病理模式——"表皮萎缩-胶原透明变性带-炎症细胞浸润带",而超过一半的病例在病理上缺乏典型表现。LS发生恶性转化的临床特征包括长病程(≥2年)、糜烂或溃疡、角化或增生,发生恶性转化的病理特征包括表皮下层细胞不典型性、表皮肥厚、表皮突延长、角化不良。结论 LS病理上常缺乏典型表现,临床结合病理有助于对LS,尤其是发生恶性转化病例的诊断。对生殖器白斑基础上出现糜烂、溃疡或角化增生患者,需高度警惕LS恶性转化可能,必要时多点取材活检确诊。
Objective To analysis the clinicopathologic features of lichen sclerosus. Methods Patients with lichen sclerosus were selected. According to pathology,whether there is carcinogenesis or atypical hyperplasia of epidermis(basal celluar atypia,disordered arrangement,prominent nucleoli,increasing mitoses),they were classified into normal group and malignant group. Results Totally 31 cases of lichen sclerosus were analysed,the main manifestations are white patch and atrophy. Petechia,erosions,ulcers or hyperplastic plaque could also be found in some cases. More than half of the cases lack typical pathological manifestations.The long duration of disease(≥2 years),erosions,ulcers and hyperplastic plaque,and the pathological performance of thick epidermis,elongated rete ridges and dysketatosis were related to the malignant transformation of lichen sclerosus.Conclusion When presenting with erosions,ulcers or hyperplastic plaque under the background of white patch,malignant transformation of lichen sclerosus should be considered.
Objective To analysis the clinicopathologic features of lichen sclerosus. Methods Patients with lichen sclerosus were selected. According to pathology,whether there is carcinogenesis or atypical hyperplasia of epidermis(basal celluar atypia,disordered arrangement,prominent nucleoli,increasing mitoses),they were classified into normal group and malignant group. Results Totally 31 cases of lichen sclerosus were analysed,the main manifestations are white patch and atrophy. Petechia,erosions,ulcers or hyperplastic plaque could also be found in some cases. More than half of the cases lack typical pathological manifestations.The long duration of disease(≥2 years),erosions,ulcers and hyperplastic plaque,and the pathological performance of thick epidermis,elongated rete ridges and dysketatosis were related to the malignant transformation of lichen sclerosus.Conclusion When presenting with erosions,ulcers or hyperplastic plaque under the background of white patch,malignant transformation of lichen sclerosus should be considered.
引文
[1] Fistarol SK,Itin PH.Diagnosis and treatment of lichen sclerosus:an update [J].Am J Clin Dermatol,2013,14(1):27-47.
[2] 杨敏,常建民.女阴硬化性苔藓的病因及临床表现[J].中华皮肤科杂志,2015,48(2):139-141.
[3] Lewis FM,Tatnall FM,Velangi SS,et al.British Association of Dermatologists guidelines for the management of lichen sclerosus 2018 [J].Br J Dermatol,2018,178(4):839-853.
[4] Halonen P,Jakobsson M,Heikinheimo O,et al.Lichen sclerosus and risk of cancer [J].Int J Cancer,2017,140(9):1998-2002.
[5] 李玉湘,傅强,张秀春,等.外阴硬化萎缩性苔藓合并鳞状细胞癌2例[J].中国皮肤性病学杂志,2012,26(12):1151-1158.
[6] Bornstein J,Bogliatto F,Haefner HK,et al.The 2015 International Society for the Study of Vulvovaginal Disease (ISSVD) Terminology of Vulvar Squamous Intraepithelial Lesions [J].Obstet Gynecol,2016,127(2):264-268.
[7] Renaud-Vilmer C,Cavelier-Balloy B,Verola O,et al.Analysis of alterations adjacent to invasive squamous cell carcinoma of the penis and their relationship with associated carcinoma [J].J Am Acad Dermatol,2010,62(2):284-290.
[8] Chaux A,Velazquez EF,Amin A,et al.Distribution and characterization of subtypes of penile intraepithelial neoplasia and their association with invasive carcinomas:a pathological study of 139 lesions in 121 patients [J].Hum Pathol,2012,43(7):1020-1027.
[9] Van de Nieuwenhof HP,Bulten J,Hollema H,et al.Differentiated vulvar intraepithelial neoplasia is often found in lesions,previously diagnosed as lichen sclerosus,which have progressed to vulvar squamous cell carcinoma [J].Mod Pathol,2011,24(2):297-305.
[10] Bigby SM,Eva LJ,Fong KL,et al.The natural history of vulvar intraepithelial neoplasia,differentiated type:evidence for progression and diagnostic challenges [J].Int J Gynecol Pathol,2016,35(6):574-584.
[11] Carlson BC,Hofer MD,Ballek N,et al.Protein markers of malignant potential in penile and vulvar lichen sclerosus [J].J Urol,2013,190(2):399-406.
[12] Micheletti L,Preti M,Radici G,et al.Vulvar lichen sclerosus and neoplastic transformation:a retrospective study of 976 cases [J].J Low Genit Tract Dis,2016,20(2):180-183.
[13] Kravvas G,Shim TN,Doiron PR,et al.The diagnosis and management of male genital lichen sclerosus:a retrospective review of 301 patients [J].J Eur Acad Dermatol Venereol,2018,32(1):91-95.
[14] Jones RW,Scurry J,Neill S,et al.Guidelines for the follow-up of women with vulvar lichen sclerosus in specialist clinics [J].Am J Obstet Gynecol,2008,198(5):496.
[2] 杨敏,常建民.女阴硬化性苔藓的病因及临床表现[J].中华皮肤科杂志,2015,48(2):139-141.
[3] Lewis FM,Tatnall FM,Velangi SS,et al.British Association of Dermatologists guidelines for the management of lichen sclerosus 2018 [J].Br J Dermatol,2018,178(4):839-853.
[4] Halonen P,Jakobsson M,Heikinheimo O,et al.Lichen sclerosus and risk of cancer [J].Int J Cancer,2017,140(9):1998-2002.
[5] 李玉湘,傅强,张秀春,等.外阴硬化萎缩性苔藓合并鳞状细胞癌2例[J].中国皮肤性病学杂志,2012,26(12):1151-1158.
[6] Bornstein J,Bogliatto F,Haefner HK,et al.The 2015 International Society for the Study of Vulvovaginal Disease (ISSVD) Terminology of Vulvar Squamous Intraepithelial Lesions [J].Obstet Gynecol,2016,127(2):264-268.
[7] Renaud-Vilmer C,Cavelier-Balloy B,Verola O,et al.Analysis of alterations adjacent to invasive squamous cell carcinoma of the penis and their relationship with associated carcinoma [J].J Am Acad Dermatol,2010,62(2):284-290.
[8] Chaux A,Velazquez EF,Amin A,et al.Distribution and characterization of subtypes of penile intraepithelial neoplasia and their association with invasive carcinomas:a pathological study of 139 lesions in 121 patients [J].Hum Pathol,2012,43(7):1020-1027.
[9] Van de Nieuwenhof HP,Bulten J,Hollema H,et al.Differentiated vulvar intraepithelial neoplasia is often found in lesions,previously diagnosed as lichen sclerosus,which have progressed to vulvar squamous cell carcinoma [J].Mod Pathol,2011,24(2):297-305.
[10] Bigby SM,Eva LJ,Fong KL,et al.The natural history of vulvar intraepithelial neoplasia,differentiated type:evidence for progression and diagnostic challenges [J].Int J Gynecol Pathol,2016,35(6):574-584.
[11] Carlson BC,Hofer MD,Ballek N,et al.Protein markers of malignant potential in penile and vulvar lichen sclerosus [J].J Urol,2013,190(2):399-406.
[12] Micheletti L,Preti M,Radici G,et al.Vulvar lichen sclerosus and neoplastic transformation:a retrospective study of 976 cases [J].J Low Genit Tract Dis,2016,20(2):180-183.
[13] Kravvas G,Shim TN,Doiron PR,et al.The diagnosis and management of male genital lichen sclerosus:a retrospective review of 301 patients [J].J Eur Acad Dermatol Venereol,2018,32(1):91-95.
[14] Jones RW,Scurry J,Neill S,et al.Guidelines for the follow-up of women with vulvar lichen sclerosus in specialist clinics [J].Am J Obstet Gynecol,2008,198(5):496.