【病理每周一题】No.102（07.6.18－6.24，答案已公布）

p****y

本周病例（07.6.18－6.24），男性，78岁，头皮肿物。既往曾行肺癌切除术。

对站友的回答，不硬性规定加密，若有加密，答案公布后统一解密，:)

1.你考虑什么诊断？
2.需要做何鉴别诊断？
3.预后如何？

[ 本帖最后由 pathology 于 2007-6-24 21:21 编辑 ]
此附件已经损坏等待作者修复

w****9

1考虑什么诊断？
考虑肺腺鳞癌皮肤转移,CK-LMW,CK-HMW阳性表达.
2.需要做何鉴别诊断？
需与恶性间皮瘤鉴别。
3.预后如何？
一般认为是低分化肿瘤，预后差。

[ 本帖最后由 wanghaiyan1199 于 2007-6-22 16:47 编辑 ]

曹*

1.首先肯定一点：癌----鳞癌。腺样鳞状细胞癌可能。
2.看b图有原发可能，看病史不排除转移。须与1.皮肤的原发或转移性腺癌   2.皮肤的真性腺鳞癌  3.表现有鳞状上皮分化的并有腺体分化产或不产粘液的侵袭性肿瘤   4.汗腺肿瘤   5.肺转移等鉴别。
3.预后不良。

z****4

1.考虑为肺的腺鳞癌皮肤转移
2.需要与皮肤的原发性腺样鳞癌相鉴别
3.预后较差

守*人

1.你考虑什么诊断？低分化鳞癌
2.需要做何鉴别诊断？转移性腺样鳞癌
3.预后如何？预后不好

p****y

本周病例（07.6.18－6.24），男性，78岁，头皮肿物。既往曾行肺癌切除术。

1.你考虑什么诊断？
（皮肤）棘层松解型鳞状细胞癌（Acantholytic Squamous Cell Carcinoma，ASCC）

ASCC又被称为腺样鳞状细胞癌（adenoid SCC）、腺棘皮癌（adenoacanthoma）、假腺样鳞状细胞癌（pseudoglandular SCC）。镜下可见鳞癌分化及局灶似腺样分化的假腔隙，往往可见典型鳞癌与腺样分化区域移行，腺样腔隙内可见缺乏黏附性的棘层松解细胞（巨大、怪异、多核细胞，分裂像多见）。本例虽然既往有肺癌病史（腺癌），但免疫组化证实上皮标记阳性（高分子量&低分子量CK），黏卡、AB、PAS阴性。


2.需要做何鉴别诊断？
腺鳞癌、腺样囊性癌、黏液表皮样癌、汗腺腺癌、转移性腺癌、基底样鳞癌、上皮样血管肉瘤

3.预后如何？
尽管最新的WHO分类中提到该亚型鳞癌的预后有赖于其浸润深度，其侵袭性高于传统的鳞状细胞癌，但该病预后尚存在争议。在不同的文献报道中，皮肤棘层松解型鳞状细胞癌发生局部复发和淋巴结转移的差别很大，有人认为ASCC的恶性潜能不高于经典的浸润性鳞状细胞癌。

附上一段英文文献，有兴趣的站友可以一读，:)

Prognosis of acantholytic variants of squamous cell carcinoma of the skin

In a 1966 review of 155 patients with 213 lesions, only three patients died of metastatic disease and two patients died of local invasion. One of the deaths due to local invasion involved a patient who refused treatment. In a review of 20 patients in 1972, no patients were noted to have lymph node metastases, but three patients died of local intracranial extension of tumor. This low propensity to metastasize was disputed in 1989 by Nappi et al. In their review of 36 patients,11 patients had local recurrence, five had visceral metastases, and two died of local intracranial extension of tumor. Another review by Nappi and colleagues in 1992 noted that three out of six patients with ASCC died of lymph node metastasis. However, two of these were immunocompromised. In a review by Toyama et al in 1995, one out of four patients died of lymph node metastases. The lack of data regarding lesion sizes and the circumstances of the patients in several of these reviews makes it difficult to adequately assess the metastatic potential of ASCC. In a more recent review of 18 patients by Petter and Haustein in 1998, only one patient developed a local recurrence. Although the literature has been conflicting, we believe that the malignant potential of ASCC is no higher than that of a typical invasive SCC.

附上文献一篇：
Adenoid squamous cell carcinoma of the larynx: an uncommon histological variant of squamous cell carcinoma. APMIS. 2006 Jun;114(6):470-3.

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本期题目旨在提示此亚型鳞癌的存在，在诊断中不要轻易下腺癌的诊断，不管是转移性还是原发性腺癌，当看到鳞癌与腺样结构出现移行排除此型鳞癌很重要。本期回答基本正确的站友有曹彤，加1分，结合回答先后和原始答案，zcf_314、守岛人鲜花鼓励！

希望大家一如既往的支持病理每周一题，:)

[ 本帖最后由 pathology 于 2007-6-24 21:17 编辑 ]
此附件已经损坏等待作者修复