Wollina Uwe, Schönlebe Jacqueline, Heinig Birgit, Nowak Andreas, Chokoeva Anastasiya Atanasova, Tchernev Georgi
Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstraße 41, 01067, Dresden, Germany.
Institute of Pathology "Georg Schmorl", Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany.
Wien Med Wochenschr. 2017 Apr;167(5-6):104-109. doi: 10.1007/s10354-016-0510-x. Epub 2016 Sep 8.
Non-melanoma skin cancer is the most common type of cutaneous neoplasm worldwide. While basal cell carcinoma is the most common tumor, squamous cell carcinoma (SCC) causes higher morbidity and has a risk of metastatic spread, depending on immune status, tumor size, and desmoplastic growth. We reported the case of a 77 year old male patient with retroauricular tumor, which started growing 3 years ago and was excised, buth relapsed three times. The initial diagnosis was infundibular cyst. Delayed Mohs surgery was performed, as was an additional open lymph node biopsy of the patient's right groin, on the occasion of an indolent swelling of the same which developed within 3 months. The first histopathological report confirmed the diagnosis of a cystic squamous cell carcinoma. The histopathologic evaluation of the groin tumor revealed a small lymphocytic B cell lymphoma (BCL). The patient fulfilled the following criteria for high-risk SCC: tumor size ≥2 cm (or 1 cm on the head and 6 mm on the genitals, hands, and feet), tumor thickness ≥4 mm, recurrent tumor, rapid growth. Therefore, lymph node metastasis had to be considered. High-risk SCC has a propensity to metastasize. In cases of primary tumor, Mohs surgery is the most effective treatment, particularly in relapsing tumors. The combination of cystic SCC with a small-sized BCL is very rare. The differential diagnosis and treatment may be challenging. In high-risk SCC, lymph node enlargement warrants histologic evaluation. However, not all suspicious lymph node lesions corroborate as metastatic.
非黑色素瘤皮肤癌是全球最常见的皮肤肿瘤类型。虽然基底细胞癌是最常见的肿瘤，但鳞状细胞癌（SCC）导致的发病率更高，并且根据免疫状态、肿瘤大小和促结缔组织增生性生长情况，存在转移扩散的风险。我们报告了一例77岁男性患者，其耳后肿瘤3年前开始生长，曾接受切除，但复发了三次。最初诊断为漏斗状囊肿。进行了延迟莫氏手术，并在患者右腹股沟出现无痛性肿胀（在3个月内出现）时，对其进行了额外的开放性淋巴结活检。第一份组织病理学报告证实诊断为囊性鳞状细胞癌。腹股沟肿瘤的组织病理学评估显示为小淋巴细胞性B细胞淋巴瘤（BCL）。该患者符合高危SCC的以下标准：肿瘤大小≥2 cm（或头部为1 cm，生殖器、手部和足部为6 mm）、肿瘤厚度≥4 mm、复发性肿瘤、生长迅速。因此，必须考虑淋巴结转移。高危SCC有转移倾向。对于原发性肿瘤，莫氏手术是最有效的治疗方法，尤其是对于复发性肿瘤。囊性SCC与小尺寸BCL的组合非常罕见。鉴别诊断和治疗可能具有挑战性。在高危SCC中，淋巴结肿大需要进行组织学评估。然而，并非所有可疑的淋巴结病变都能证实为转移性病变。
