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罕见原位色素沉着性癌:病例报告及简要综述

Uncommon Pigmented Carcinoma In Situ: Case Report and Brief Review.

作者信息

Soares Andresa Borges, de Araújo Vera Cavalcanti, Passador-Santos Fabricio, Thomaz Luiz Alexandre, de Freitas Andre Luis Santana, Mautoni Mario Claudio, Stelini Rafael Fantelli, Cintra Maria Leticia

机构信息

Department of Oral Pathology, São Leopoldo Mandic Institute and Research Center, Campinas, Brazil.

Department of Stomatology, Universidade São Francisco, Bragança Paulista, Brazil.

出版信息

Clin Pathol. 2021 Apr 20;14:2632010X211009819. doi: 10.1177/2632010X211009819. eCollection 2021 Jan-Dec.

Abstract

Pigmented lesions of the oral mucosa encompass several benign and malignant conditions that may be a matter of concern under both clinical and histopathological views. We reported a case of a 62-year-old woman, presenting with an asymptomatic, deeply pigmented lesion on the soft palate. On examination, it appeared asymmetrical, with irregular borders and an area of ulceration. A biopsy, taken to rule out melanoma, revealed a pigmented carcinoma in situ. Throughout the tumor thickness, numerous interspersed melanocytes were found that did not extend to neighboring epithelium. These were large, richly dendritic, and presented abundance of melanin granules and small nuclei. Mild melanin incontinence was found. Scanty transfer of pigment to dysplastic epithelial cells was found through Fontana Masson staining. On immunohistochemical analyses, there were pancytokeratin-stained tumor epithelial cells; increased cell proliferation throughout the entire thickness of the tumor was emphasized by Ki-67 immunomarking. P16 was negative. The dendritic cells were selectively stained for S-100, HMB45 and Melan A. Wide spectrum in situ hybridization for human papillomavirus (HPV) was negative. Unfortunately, following diagnosis, the patient refused any treatment option. Pigmented squamous cell carcinoma with melanocyte colonization must be taken into account in the differential diagnosis of pigmented lesions of the oral cavity.

摘要

口腔黏膜色素沉着病变包括多种良性和恶性情况,从临床和组织病理学角度来看都可能令人担忧。我们报告了一例62岁女性病例,其软腭出现一个无症状的深色色素沉着病变。检查时,病变呈不对称性,边界不规则,并有一处溃疡区域。为排除黑色素瘤而进行的活检显示为原位色素沉着癌。在整个肿瘤厚度中,发现大量散在的黑素细胞,这些细胞未延伸至邻近上皮。它们体积大,有丰富的树突,含有大量黑色素颗粒和小细胞核。发现有轻度色素失禁。通过Fontana Masson染色发现色素向发育异常的上皮细胞的少量转移。免疫组化分析显示,肿瘤上皮细胞呈全细胞角蛋白染色;Ki-67免疫标记强调了肿瘤全层细胞增殖增加。P16呈阴性。树突状细胞对S-100、HMB45和Melan A呈选择性染色。人乳头瘤病毒(HPV)的广谱原位杂交呈阴性。不幸的是,诊断后患者拒绝了任何治疗方案。在口腔色素沉着病变的鉴别诊断中,必须考虑伴有黑素细胞定植的色素沉着鳞状细胞癌。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c035/8064661/488e9b2d0b37/10.1177_2632010X211009819-fig1.jpg

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