Paul P C, Chattopadhyay A, Dutta S K, Mazumder D N, Santra A
Department of Pathology, University College of Medicine and IPGMER, Calcutta.
Indian J Pathol Microbiol. 2000 Jul;43(3):257-64.
Chronic arsenic toxicity (CAT) manifests predominantly as cutaneous lesions in the form of melanosis, keratosis and neoplastic changes. We have studied skin biopsies from 42 patients of CAT. Histological study of H/E stained sections showed--hyperkeratosis in 13, parakeratosis in 13, acanthosis in 12, papillomatosis in 24, elongation of reteridges in 21, increased basal pigmentation in 27 and dysplastic changes in 8 cases. Squamous cell carcinoma was present in 2, basisquamous in 1 and basal cell carcinoma in 1 case. Changes of skin lesions after drug DMSA and DMPS therapy compared to placebo were studied. The result was inconclusive. Proliferative activity of skin lesions in CAT were studied by AgNOR stain to assess the biological behaviour of the lesions. AgNOR score showed--normal control 1.08, benign changes (e.g. Hyperkeratosis, parakeratosis, acanthosis, papillomatosis etc.) without dysplasia--1.35, mild to moderate dysplasia--1.735, severe dysplasia--3.0 and carcinoma--3.56. Thus, AgNOR score gives some idea on the biological behaviour of CAT lesions. It is suggested that AgNOR staining should be done regularly along with H&E staining for proper assessment of the cases.
慢性砷中毒（CAT）主要表现为以黑变病、角化病和肿瘤性改变形式出现的皮肤损害。我们研究了42例CAT患者的皮肤活检标本。苏木精/伊红（H/E）染色切片的组织学研究显示：13例有角化过度，13例有不全角化，12例有棘层肥厚，24例有乳头瘤样增生，21例有 rete 嵴延长，27例有基底色素沉着增加，8例有发育异常改变。2例存在鳞状细胞癌，1例为基底鳞状细胞癌，1例为基底细胞癌。研究了与安慰剂相比，药物二巯丁二酸（DMSA）和二巯丙磺钠（DMPS）治疗后皮肤损害的变化。结果尚无定论。通过银染核仁组织区（AgNOR）染色研究了CAT患者皮肤损害的增殖活性，以评估损害的生物学行为。AgNOR评分显示：正常对照为1.08，无发育异常的良性改变（如角化过度、不全角化、棘层肥厚、乳头瘤样增生等）为1.35，轻度至中度发育异常为1.735，重度发育异常为3.0，癌为3.56。因此，AgNOR评分能对CAT损害的生物学行为提供一些信息。建议在对病例进行正确评估时，应定期进行AgNOR染色以及H&E染色。
