Brooke J D, Fitzpatrick J E, Golitz L E
Department of Pathology, Fitzsimons Army Medical Center, Aurora, CO 80045-5000.
J Am Acad Dermatol. 1989 Sep;21(3 Pt 1):523-8. doi: 10.1016/s0190-9622(89)70220-6.
To distinguish a basal cell carcinoma (BCC) from a trichoepithelioma can be difficult even for an experienced dermatopathologist. Previously reported differentiating histologic features are relative criteria that may be shared by both tumors. In a review of 30 consecutive cases each of trichoepitheliomas, keratotic BCC, and routine BCC, classic criteria were compared with papillary mesenchymal body formation. Papillary mesenchymal bodies are distinct fibroblastic aggregations that represent abortive attempts to form the papillary mesenchyme responsible for hair induction. Papillary mesenchymal bodies were observed in 93% of all trichoepitheliomas, 7% of all keratotic BCC, and 0% of all routine BCC. Hair bulb formation was observed in 30% of trichoepitheliomas and in none of the BCC. We conclude that papillary mesenchymal body formation is an easily recognizable histologic criterion that is more reliable in differentiating these two tumors than standard criteria, including epidermal connections, keratinization, calcification, foreign body reaction, fibrosis, stromal retraction, tumor mucin, ulceration, frondlike epithelial pattern, and the inflammatory response.
即使对于经验丰富的皮肤病理学家而言，区分基底细胞癌（BCC）和毛发上皮瘤也可能存在困难。先前报道的鉴别组织学特征是相对标准，这两种肿瘤可能都具备。在一项对30例连续的毛发上皮瘤、角化性基底细胞癌和普通基底细胞癌病例的回顾中，将经典标准与乳头间充质体形成进行了比较。乳头间充质体是独特的成纤维细胞聚集物，代表了形成负责毛发诱导的乳头间充质的失败尝试。在所有毛发上皮瘤的93%、所有角化性基底细胞癌的7%以及所有普通基底细胞癌的0%中观察到了乳头间充质体。在30%的毛发上皮瘤中观察到了毛球形成，而在基底细胞癌中均未观察到。我们得出结论，乳头间充质体形成是一种易于识别的组织学标准，在区分这两种肿瘤方面比包括表皮连接、角化、钙化、异物反应、纤维化、间质退缩、肿瘤黏液、溃疡、叶状上皮模式和炎症反应在内的标准标准更可靠。
