Ardigo Marco, Buffon Rosana Bortoli, Scope Alon, Cota Carlo, Buccini Pierluigi, Berardesca Enzo, Pellacani Giovanni, Marghoob Ashfaq A, Gill Melissa
San Gallicano Dermatological Institute, Rome, Italy.
Dermatol Surg. 2009 Jun;35(6):952-9. doi: 10.1111/j.1524-4725.2009.01162.x. Epub 2009 Apr 8.
Clear cell acanthoma (CCA) is a rare, benign neoplasm of unknown etiology, whose dermoscopic and histological features have been previously described. Usually, CCA can be diagnosed by clinical and dermoscopic examination. In some cases, diagnosis remains uncertain, and histological examination is needed. The aim of this paper was to describe the features of reflectance confocal microscopy (RCM) in diagnosing CCA, compare them with findings on dermoscopy and histology, and evaluate their possible usefulness in CCA evaluation.
Five lesions diagnosed clinically as CCA were imaged using dermoscopy and RCM. All lesions were surgically excised to confirm the diagnosis and compare the morphological attributes under light microscopy with in vivo imaging.
RCM showed well-circumscribed lesions, often edged by a hyperkeratotic collarette with parakeratosis; inflammatory cells in the spinous layer; large keratinocytes; acanthosis with papillomatosis; epidermal disarray; and dilated capillaries forming glomeruloid shapes in the upper dermis.
In this small study, RCM was able to identify most of the established diagnostic histological features of CCA. RCM appears to be a useful tool for in vivo diagnosis of CCA and may help avoid unnecessary biopsies.
透明细胞棘皮瘤（CCA）是一种病因不明的罕见良性肿瘤，其皮肤镜和组织学特征此前已有描述。通常，CCA可通过临床和皮肤镜检查进行诊断。在某些情况下，诊断仍不明确，需要进行组织学检查。本文旨在描述反射式共聚焦显微镜（RCM）在诊断CCA中的特征，将其与皮肤镜和组织学检查结果进行比较，并评估其在CCA评估中的可能用途。
对5例临床诊断为CCA的病变进行了皮肤镜和RCM成像。所有病变均通过手术切除以确诊，并将光学显微镜下的形态学特征与体内成像结果进行比较。
RCM显示病变边界清晰，常由伴有角化不全的角化过度衣领样边缘环绕；棘层有炎症细胞；有大的角质形成细胞；伴有乳头瘤病的棘皮症；表皮排列紊乱；真皮上层有扩张的毛细血管形成肾小球样形态。
在这项小型研究中，RCM能够识别CCA大多数已确定的诊断性组织学特征。RCM似乎是一种用于CCA体内诊断的有用工具，可能有助于避免不必要的活检。
