Lee J Y, Tang C K, Leung Y S
Department of Pathology, Presbyterian-University Hospital, Pittsburgh, Pennsylvania.
J Cutan Pathol. 1989 Feb;16(1):31-9. doi: 10.1111/j.1600-0560.1989.tb00005.x.
We report the light and electron microscopic findings of an unusual, locally aggressive cutaneous clear cell carcinoma involving extensively the left cheek and upper lip of a 61-year-old woman. The patient remained free of recurrence 5 years after wide local excision. Microscopically, the tumor was a poorly circumscribed and deeply invasive clear cell neoplasm characterized by large lobules and convoluted trabeculae of polygonal and columnar cells with palisading of the peripheral cells rimmed by thick basement membranes, and horn microcysts with tricholemmal keratinization. The tumor infiltrated the muscle and the salivary glands. Only slight cytologic atypia and a few mitotic figures were present. No definite ductal differentiation was found. Immunoperoxidase staining for carcinoembryonic and epithelial membrane antigens was negative. Ultrastructurally, the tumor cells were joined by desmosomes, and surrounded by thick basal lamina. The cytoplasm contained large pools of glycogen. Peculiar whorls of tonofilaments and aggregates of needle-shaped and club-shaped structures were observed in a small keratinizing focus. The tumor showed features resembling the outer root sheath of the hair follicle microscopically. Furthermore, the lack of duct-like structures and immunoreactivity of carcinoembryonic antigen tend to favor tricholemmal over sweat gland differentiation in this tumor which possibly represents a rare example of tricholemmal carcinoma.
我们报告了一例罕见的、具有局部侵袭性的皮肤透明细胞癌的光镜和电镜检查结果，该肿瘤广泛累及一名61岁女性的左脸颊和上唇。患者在广泛局部切除术后5年无复发。镜下，肿瘤边界不清，呈浸润性生长，为透明细胞肿瘤，其特征为大的小叶以及由多边形和柱状细胞构成的迂曲小梁，外周细胞呈栅栏状排列，周围有厚的基底膜，还有具毛透明角化的角微囊肿。肿瘤浸润肌肉和唾液腺。仅见轻微的细胞异型性和少量核分裂象。未发现明确的导管分化。癌胚抗原和上皮膜抗原的免疫过氧化物酶染色均为阴性。超微结构上，肿瘤细胞通过桥粒连接，周围有厚的基膜。细胞质内含有大量糖原。在一个小的角化灶中观察到角蛋白丝的特殊涡旋以及针状和棒状结构的聚集。该肿瘤在镜下表现出类似于毛囊外根鞘的特征。此外，缺乏导管样结构以及癌胚抗原的免疫反应性倾向于支持该肿瘤为毛透明细胞而非汗腺分化，这可能是毛透明细胞癌的一个罕见病例。
