Basal cell carcinoma arising in a seborrhoeic keratosis
Basal cell carcinoma arising in a seborrhoeic keratosis
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脂溢性角化病引起的基底细胞癌
DOI：
10.1111/j.1365-2230.2009.03323.x
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
G. Murphy
中科院分区：
文献类型：
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作者：
M. Laing;C. O'keane;G. Murphy
脂溢性角化病是临床上最常见的良性表皮肿瘤之一。恶性转化是例外。在最近的两个问题的临床和实验皮肤病学，一个小汗腺汗孔癌SK和恶性黑色素瘤发生在SK的报告发表。我们报告的情况下，基底细胞癌（BCC）内产生的SK。这种情况下强调，恶性肿瘤可能与SK，无论是在SK本身的肿瘤或碰撞肿瘤（两个相邻的不同类型的肿瘤一起发生在同一地点）。一名67岁的男子被称为评价病变对他的左前胸。这已经存在了20年，最近又发炎了。体格检查发现一个扁平的棕色疣状病变，大小为8.10 mm，中央有一个结节（图1a）。鉴别诊断包括色素性基底细胞癌、恶性黑色素瘤或刺激性SK。组织学检查证实病变为SK内的基底细胞癌（图1b）。病变完全切除。碰撞肿瘤的发生是有据可查的，因此SK和恶性雀斑样痣同时发生在同一区域并不罕见。碰撞肿瘤的其他实例包括无色素性黑素瘤和BCC、恶性黑素瘤和非典型纤维黄色瘤、恶性黑素瘤和BCC以及恶性雀斑样痣和BCC。在某些情况下，SK和恶性肿瘤的存在代表了一种细胞类型实际上来自另一种细胞类型的情况。在我们的病人中，从临床和组织学照片可以清楚地看出，肿瘤发生在SK内。BCC和SK似乎都可能来自类似的来源：表皮或毛囊上皮的多能细胞。SK引起的各种恶性肿瘤表明SK内的多能细胞可能突变为各种肿瘤。SK内产生的肿瘤的其他实例包括BCC、SCC、Bowen病、角化棘皮瘤、毛鞘瘤、小汗腺汗孔癌和原发性皮肤节细胞神经瘤。意识到碰撞肿瘤和SK内产生的肿瘤会给穿刺活检带来困难。在可能的情况下，完全切除病变以进行适当的评估是可取的，或者至少应从病变存在变异的> 1个部位进行活检。（一）
A seborrhoeic keratosis (SK) is one of the most common benign epidermal tumours encountered in clinical practice. Malignant transformation is exceptional. In two recent issues of Clinical and Experimental Dermatology, reports of an eccrine porocarcinoma SK and malignant melanoma arising within an SK were published. We report a case of basal cell carcinoma (BCC) arising within an SK. This case emphasizes that malignancies may be associated with SKs, either as tumours within the SK itself or as collision tumours (two adjacent tumours of different types occurring together at the same site). A 67-year-old man was referred for evaluation of a lesion on his left anterior chest. This had been present for 20 years and had recently become inflamed. Physical examination revealed a flat brown warty lesion measuring 8 · 10 mm, with a nodule in the centre (Fig. 1a). The differential diagnosis included a pigmented BCC, a malignant melanoma or an irritated SK. Histological examination confirmed that the lesion was a BCC arising within an SK (Fig. 1b). The lesion was fully excised. The occurrence of collision tumours is well documented, thus SK and lentigo maligna occurring together in the same area are not uncommon. Other examples of collision tumours include amelanotic melanoma and BCC, malignant melanoma and atypical fibroxanthoma, malignant melanoma and BCC, and lentigo maligna and BCC. In some cases the presence of an SK and a malignant tumour represents a situation in which one cell type is actually derived from the other. In our patient, it is clear from the clinical and histological photographs that the tumour arose within an SK. It seems that both BCC and SK may derive from a similar source: pluripotential cells of either the epidermis or hair-follicle epithelium. The wide variety of malignant tumours arising with SK suggests that pluripotential cells within the SK may mutate to a variety of tumours. Other examples of tumours arising within SK include BCC, SCC, Bowen s disease, keratoacanthoma, trichilemmal tumour, eccrine porocarcinoma and primary cutaneous ganglioneuroma. Awareness of collision tumours and tumours arising within SK poses difficulty in taking punch biopsies. Where possible, complete excision of lesions for proper evaluation is advisable or at least biopsies from > 1 site should be taken where variation in a lesion exists. (a)