Wacker J, Hartschuh W
Universitäts-Hautklinik, Heidelberg.
Hautarzt. 2004 Mar;55(3):266-72. doi: 10.1007/s00105-004-0701-z.
Several premalignant and malignant neoplasms clinically appear as chronic eczematous lesions of the perianal region and have to be distinguished from benign processes. Anal intraepithelial neoplasia (AIN) presenting as bowenoid papulosis and perianal Bowen disease is a precursor lesion for invasive squamous cell carcinoma. When AIN is widespread, persistent or progressive, an underlying immunosuppression should get excluded. Verrucous carcinoma of the perianal region is a highly differentiated variant of squamous cell carcinoma characterized as a slowly growing but locally invasive tumor. Extramammary Paget disease (EMP) is an intraepithelial adenocarcinoma of the skin with apocrine differentiation. Along with EMP, basal cell carcinoma, Langerhans cell histiocytosis and cutaneous T-cell lymphoma should be included in the differential diagnosis for lesions simulating chronic perianal dermatitis. In such situations, biopsies and histopathologic examination are imperative to avoid delayed diagnosis and assure prompt therapy.
几种癌前和恶性肿瘤在临床上表现为肛周区域的慢性湿疹样病变，必须与良性病变相鉴别。表现为鲍温样丘疹病和肛周鲍温病的肛管上皮内瘤变（AIN）是浸润性鳞状细胞癌的前驱病变。当AIN广泛、持续或进展时，应排除潜在的免疫抑制。肛周疣状癌是鳞状细胞癌的一种高分化变体，其特征是生长缓慢但局部浸润性肿瘤。乳房外佩吉特病（EMP）是一种具有大汗腺分化的皮肤上皮内腺癌。在鉴别诊断模拟慢性肛周皮炎的病变时，应包括EMP、基底细胞癌、朗格汉斯细胞组织细胞增多症和皮肤T细胞淋巴瘤。在这种情况下，活检和组织病理学检查是必要的，以避免延迟诊断并确保及时治疗。
