Watanabe Isabela C, Magalhães Renata F, de Moraes Aparecida M, Stelini Rafael F, Cintra Geórgia F, Metze Konradin, Cintra Maria L
From the Department of Pathology (ICW, RFS, GFC, KM, MLC); Department of Dermatology (RFM, AMM), Medical Sciences School, State University of Campinas, Campinas, Brazil.
Medicine (Baltimore). 2015 Jun;94(23):e934. doi: 10.1097/MD.0000000000000934.
Differential diagnosis between keratoacanthoma (KA) and squamous cell carcinoma (SCC) is difficult due to their similarities. The mechanisms that drive their distinct biological behavior are poorly understood. To investigate whether the assessment of microvessel density (MVD) could be helpful in KA and SCC differential diagnosis and to gain insight into the pathogenesis of KA-like neoplasms, we compared the density of CD105- and CD34-stained vessels in KAs and SCCs and their relation to the expression of the p53 oncoprotein and proliferation marker Ki67. This is an observational retrospective cohort study. Forty lesions with clinical appearance of KAs (29 KAs and 11 SCCs) entered the study. A biopsy was taken from each lesion at presentation and the natural clinical course was monitored for at least 1 month. Growing or minimally regressing lesions were submitted to complete surgical excision. The diagnoses were established on combined clinical, histological, and follow-up evaluations. The MVD and p53 or Ki67 expression in neoplastic cells were assessed through morphometry. The MVD did not show discriminating power between KAs and SCCs. The Ki67 proliferation rate was significantly higher in SCCs. Although neoangiogenesis (CD105-MVD) in KAs was associated with cell proliferation, in SCCs it was not. There was significant correlation between p53 expression and neoplasia size in SCCs but not in KAs. From our results, we may conclude that KA and SCC have similarities, as CD105- and CD34-MVD. However, the low Ki67 proliferation index and the positive correlation between Ki-67 index and neovascularization in KA suggest a dependence in neovascularization to grow in KA, pointing to involvement of distinct pathogenesis.
由于角化棘皮瘤（KA）和鳞状细胞癌（SCC）存在相似性，二者的鉴别诊断较为困难。目前对驱动它们不同生物学行为的机制了解甚少。为了研究微血管密度（MVD）评估是否有助于KA和SCC的鉴别诊断，并深入了解KA样肿瘤的发病机制，我们比较了KA和SCC中CD105和CD34染色血管的密度，以及它们与p53癌蛋白表达和增殖标志物Ki67的关系。这是一项观察性回顾性队列研究。40个临床表现为KA的病变（29个KA和11个SCC）纳入研究。每个病变在就诊时进行活检，并对其自然临床病程进行至少1个月的监测。对生长或仅有轻微消退的病变进行完整手术切除。通过综合临床、组织学和随访评估来确立诊断。通过形态计量学评估肿瘤细胞中的MVD以及p53或Ki67表达。MVD在KA和SCC之间未显示出鉴别能力。SCC中的Ki67增殖率显著更高。尽管KA中的新生血管形成（CD105-MVD）与细胞增殖相关，但在SCC中并非如此。SCC中p53表达与肿瘤大小之间存在显著相关性，而在KA中则没有。从我们的结果可以得出结论，KA和SCC在CD105和CD34-MVD方面存在相似性。然而，KA中较低的Ki67增殖指数以及Ki-67指数与新生血管形成之间的正相关性表明，KA的生长依赖于新生血管形成，这表明其发病机制不同。
