Zhang Z C, Hu J, Kong Y Y, Ren M, Cai X
Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
Zhonghua Bing Li Xue Za Zhi. 2021 Apr 8;50(4):376-381. doi: 10.3760/cma.j.cn112151-20200722-00587.
To study the utility of immunohistochemistry (IHC) in differential diagnosis between trichoblastoma (TB) and basal cell carcinoma (BCC). Fifty-eight cases of TB and 40 cases of BCC were collected at Fudan University Shanghai Cancer Center from January 2009 to December 2019 and retrospectively analyzed by IHC for bcl-2, Ber-EP4, CD10, CK20 and Ki-67. Fisher exact test was performed for statistical analysis. Twenty-five (43.1%) TBs and 5 (12.5%) BCCs showed bcl-2 staining in the outermost layer of the epithelial nests, the difference was statistically significant (<0.01). The proportion of cases with bcl-2 staining>75% of epithelial cells in BCC group was much higher than that in TB group (40% 12.1%; <0.01). BCC group showed larger proportions with Ber-EP4 staining>75%, 51%-75% of epithelial cells than TB group (12.5% 1.7%, 37.5% . 8.6%;<0.05). Fifty-five (94.8%) TBs demonstrated CD10 expression in the follicular stroma, while only 16 (40.0%) BCCs showed focal or scattered CD10 expression in reactive fibrous stroma (<0.01). CK20 expression was present in 37 (63.8%) TBs with scattered pattern, but BCCs exhibited no CK20 staining except for only one case (2.5%) showing focal staining (<0.01). Compared with TB group, the BCC group included more cases with Ki-67 labeling index ≥15% on average and ≥25% in hotspot areas (<0.05). IHC is helpful in differential diagnosis between TB and BCC. Scattered CK20 staining pattern and stromal CD10 expression support the diagnosis of TB. Bcl-2 staining limited to the outermost layer of the proliferation is more likely to be found in TB. In contrast, Ber-EP4 positivity and higher Ki-67 labeling index tend to be present in BCC.
研究免疫组织化学（IHC）在毛母细胞瘤（TB）和基底细胞癌（BCC）鉴别诊断中的应用价值。2009年1月至2019年12月，在复旦大学附属肿瘤医院收集58例TB和40例BCC病例，采用免疫组织化学方法对bcl-2、Ber-EP4、CD10、CK20和Ki-67进行回顾性分析。采用Fisher确切概率法进行统计学分析。25例（43.1%）TB和5例（12.5%）BCC在上皮巢最外层显示bcl-2染色，差异有统计学意义（<0.01）。BCC组中bcl-2染色上皮细胞>75%的病例比例远高于TB组（40%对12.1%；<0.01）。BCC组中Ber-EP4染色上皮细胞>75%、51%-75%的比例高于TB组（12.5%对1.7%，37.5%对8.6%；<0.05）。55例（94.8%）TB在滤泡性间质中显示CD10表达，而只有16例（40.0%）BCC在反应性纤维间质中显示局灶性或散在性CD10表达（<0.01）。37例（63.8%）TB呈散在性CK20表达，而BCC除1例（2.5%）呈局灶性染色外均无CK20染色（<0.01）。与TB组相比，BCC组平均Ki-67标记指数≥15%及热点区域≥25%的病例更多（<0.05）。免疫组织化学有助于TB和BCC的鉴别诊断。散在性CK20染色模式和间质CD10表达支持TB的诊断。bcl-2染色局限于增殖最外层更常见于TB。相反，Ber-EP4阳性和较高的Ki-67标记指数多见于BCC。
