Terada Tadashi, Yamagami Jun, Fugimoto Atsushi, Tanaka Kyoko, Sugiura Makoto
Department of Pathology, Shizuoka Municipal Shimizu Hospital, Shimizu, Japan.
Pathol Int. 2003 Jul;53(7):468-72. doi: 10.1046/j.1440-1827.2003.01495.x.
We report a rare case of pigmented squamous cell carcinoma (SCC) of the cheek skin probably arising from solar keratosis. An 80-year-old man was referred to our clinic because of a black skin nodule in the right cheek. The nodular lesion was 1 cm in diameter, dome-shaped, hard, sharply demarcated, partially erosive and telangiectatic at the border. The lesion was completely excised under the clinical diagnosis of probable seborrheic keratosis. Microscopically, cutaneous horn and mildly atypical squamous epithelia suggestive of previous solar keratosis were present in the surface of the lesion. The lesion consisted of atypical squamous cells with keratinization and intercellular bridges, and it was regarded as SCC. The SCC cells were seen to invade lightly into the upper dermis, where lymphocytic infiltrations and melanophages were noted. Characteristically, heavy deposition of melanin pigment was recognized in the SCC cells as well as in proliferated dendritic and pigment blockade melanocytes that were scattered or colonized within the SCC cell nests. Masson-Fontana stain revealed numerous melanin granules in the SCC cells, as well as in dendritic and pigment blockade melanocytes. Immunohistochemically, the SCC cells were positive for cytokeratins and epithelial membrane antigen, and negative for S-100 protein and HMB45 antigen. Dendritic and pigment blockade melanocytes were negative for cytokeratins, epithelial membrane antigen, and HMB45 antigen, but positive for S-100 protein. The present case suggests that SCC cells of the skin may induce proliferation of melanocytes. The differential diagnosis and the histogenesis of pigmented SCC of the skin are discussed.
我们报告一例罕见的可能起源于日光性角化病的颊部皮肤色素性鳞状细胞癌（SCC）。一名80岁男性因右颊部黑色皮肤结节被转诊至我院门诊。该结节性病变直径1cm，呈圆顶状，质地硬，边界清晰，部分糜烂，边界处有毛细血管扩张。在临床诊断为可能的脂溢性角化病的情况下，该病变被完整切除。显微镜下，病变表面可见皮肤角化物和提示既往日光性角化病的轻度非典型鳞状上皮。病变由具有角化和细胞间桥的非典型鳞状细胞组成，被诊断为SCC。可见SCC细胞轻度浸润至真皮上层，伴有淋巴细胞浸润和巨噬细胞。其特征为，在SCC细胞以及散在或聚集于SCC细胞巢内的增殖树突状和色素阻断性黑素细胞中均可见大量黑色素沉积。Masson-Fontana染色显示SCC细胞以及树突状和色素阻断性黑素细胞内有大量黑素颗粒。免疫组化显示，SCC细胞细胞角蛋白和上皮膜抗原阳性，S-100蛋白和HMB45抗原阴性。树突状和色素阻断性黑素细胞细胞角蛋白、上皮膜抗原和HMB45抗原阴性，但S-100蛋白阳性。本例提示皮肤SCC细胞可能诱导黑素细胞增殖。本文讨论了皮肤色素性SCC的鉴别诊断和组织发生。
