Carrasquillo Osward Y, Cruzval-O'Reilly Estefanía, Sánchez Julio E, Valentín-Nogueras Sheila M
Department of Dermatology, University of Puerto Rico School of Medicine, San Juan, PR ; and.
Universidad Central del Caribe School of Medicine, Bayamon, PR.
Am J Dermatopathol. 2021 Mar 1;43(3):191-197. doi: 10.1097/DAD.0000000000001783.
Basal cell carcinoma (BCC) is the most common malignancy of the skin. It is an epithelial neoplasm with origin in the precursor cells of the interfollicular epidermis. Even though it has low metastatic potential, delay in management may lead to local destruction and morbidity. In contrast, trichoepithelioma (TE) is a benign tumor originating from the outer root sheath of the hair follicle. Similar to BCC, TE tends to affect the head and neck region. Both neoplasms may exhibit clinical and histopathological similarities, making them prone to misdiagnosis. Multiple immunomarkers have been used to distinguish among these entities, but so far, no single agent or combination of agents appear to be neither sensitive nor specific enough to differentiate between them. This study was divided into 2 parts. First, 17 cases of BCC and 14 cases of TE were stained with androgen receptor and bcl-2. Then, 27 cases of borderline/equivocal of BCC and 13 cases of borderline/equivocal TE were stained with the same protocol. Sensitivity and specificity were calculated for each individual immunomarker and for the combination of them. Androgen receptor positivity was 100% specific for BCC and borderline/equivocal BCC, whereas bcl-2 diffuse staining pattern demonstrated a sensitivity of 82.4% for BCC and 88.9% borderline/equivocal BCC. When both immunomarkers were combined, the sensitivity for BCC decreased (70.6%) but the specificity remained high (100%). Similarly, the sensitivity for borderline/equivocal BCC was 55.6%, whereas the specificity was 100%. Although moderately sensitive, combining both immunomarkers showed an excellent specificity to discriminate between BCC and TE.
基底细胞癌（BCC）是最常见的皮肤恶性肿瘤。它是一种起源于毛囊间表皮前体细胞的上皮性肿瘤。尽管其转移潜能较低，但治疗延迟可能导致局部破坏和发病。相比之下，毛发上皮瘤（TE）是一种起源于毛囊外根鞘的良性肿瘤。与基底细胞癌相似，毛发上皮瘤倾向于累及头颈部区域。这两种肿瘤在临床和组织病理学上可能表现出相似性，容易导致误诊。多种免疫标志物已被用于区分这些实体，但到目前为止，没有单一的试剂或试剂组合似乎既不够敏感也不够特异，无法区分它们。本研究分为两部分。首先，对17例基底细胞癌和14例毛发上皮瘤病例进行雄激素受体和bcl-2染色。然后，对27例基底细胞癌临界/疑似病例和13例毛发上皮瘤临界/疑似病例采用相同方案进行染色。计算每个单独免疫标志物及其组合的敏感性和特异性。雄激素受体阳性对基底细胞癌和基底细胞癌临界/疑似病例具有100%的特异性，而bcl-2弥漫性染色模式对基底细胞癌的敏感性为82.4%，对基底细胞癌临界/疑似病例的敏感性为88.9%。当两种免疫标志物联合使用时，基底细胞癌的敏感性降低（70.6%），但特异性仍然很高（100%）。同样，基底细胞癌临界/疑似病例的敏感性为55.6%，而特异性为100%。虽然联合使用这两种免疫标志物的敏感性中等，但在区分基底细胞癌和毛发上皮瘤方面显示出极好的特异性。
