Cutaneous squamous cell carcinomas are associated with basal proliferating actinic keratoses
Cutaneous squamous cell carcinomas are associated with basal proliferating actinic keratoses
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DOI：
10.1111/bjd.16536
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发表时间：
2019-04-01
影响因子：
10.3
通讯作者：
Dirschka, T.
中科院分区：
文献类型：
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作者：
Schmitz, L.;Gambichler, T.;Dirschka, T.
背景光化性角化病（AK）除了在整个表皮中存在非典型角化细胞外，其组织学特征还包括基底层向下扩张。目前尚不清楚这种生长模式是否与发生浸润性鳞状细胞癌（iSCC）的风险相关。目的描述iSCC附近AK基底层向下扩张的患病率。方法对iSCC上、下表皮进行组织学观察。我们确定了组织学分级（AK I-III），基底生长模式（PRO I-III）和相关参数，如附件受累。结果30 7个病灶中，AK Ⅰ级5 2个，占4%，AK Ⅱ级38个，占1%，AK Ⅲ级6个，占8%（χ 2检验，P < 0.0 0 1）。只有2个中心点6%的相邻表皮样品未显示任何非典型角质形成细胞。邻近iSCC的表皮被分类为在25个中心点7%中具有PRO I基底生长模式，在31个中心点9%中具有PRO II，并且在39个中心点4%中具有PRO III。只有2个中心点9%的AK显示无基底生长（卡方检验，P < 0中心点001）。共有118个AK（48个中心点，8%）延伸至附件结构。这些AK在18个中心点6%的病例中被分级为PRO I，在30个中心点5%的病例中被分级为PRO II，在50个中心点8%的病例中被分级为PRO III。iSCC上方的表皮只能评估向上生长，并且在三个AK等级中没有显示出显著差异（P = 0，中心点42）。结论：基底增生性AK以及局限于表皮下三分之一的非典型角质形成细胞最常见于iSCC附近，全层表皮发育不良的证据较少。我们的研究支持了表皮基底层中发育不良的角质形成细胞的重要作用及其与iSCC的潜在关联。
Background In addition to the extent of atypical keratinocytes throughout the epidermis, actinic keratoses (AKs) are histologically characterized by downward-directed basal-layer expansion. It is not known whether this growth pattern correlates with the risk of developing invasive squamous cell carcinoma (iSCC). Objectives To characterize the prevalence of downward-directed basal-layer expansion of AKs adjacent to iSCC. Methods The epidermis overlying and adjacent to iSCCs was assessed histologically. We determined the histological grade (AK I-III), basal growth pattern (PRO I-III) and accompanying parameters such as adnexal involvement. Results Among 307 lesions, 52 center dot 4% of AKs were histologically classified as AK grade I, 38 center dot 1% as AK II and 6 center dot 8% as AK III (chi(2)-test, P < 0 center dot 001). Only 2 center dot 6% of adjacent epidermal samples did not show any atypical keratinocytes. The epidermis adjacent to iSCCs was classified as having a PRO I basal growth pattern in 25 center dot 7%, PRO II in 31 center dot 9% and PROIII in 39 center dot 4% of cases. Only 2 center dot 9% of AKs showed no basal growth (chi(2)-test, P < 0 center dot 001). In total 118 AKs (48 center dot 8%) showed extension into adnexal structures. These AKs were graded as PRO I in 18 center dot 6% of cases, PRO II in 30 center dot 5% and PRO III in 50 center dot 8%. The epidermis above iSCCs could be assessed only for upwards-directed growth and showed no significant differences in the three AK grades (P = 0 center dot 42). Conclusions Basal proliferative AKs, as well as atypical keratinocytes restricted to the lower third of the epidermis, are most commonly seen adjacent to iSCC, with less evidence for full-thickness epidermal dysplasia. Our study supports the important role of dysplastic keratinocytes in the epidermal basal layer and their potential association with iSCC.