Zhang Jing, Liu Xun, Zheng Mo, Yin Jing, Xing Weibin
Department of Dermatology, The Fifth Central Hospital of Tianjin, Tianjin, China.
Department of Ultrasound, The Fifth Central Hospital of Tianjin, Tianjin, China.
Front Oncol. 2021 Nov 15;11:717581. doi: 10.3389/fonc.2021.717581. eCollection 2021.
This article aims to explain the use of a variety of noninvasive of minimally invasive examinations to obtain reliable diagnostic clues. The choice of treatment methods and repair techniques for wound defects are also critical in terms of the prognosis. Here, we describe the case of a 53-year-old male patient who visited our dermatology clinic due to a red plaque on the inner side of his left nipple without any symptoms for more than 30 years. He was given dermoscopy, high-frequency ultrasound (HFUS), Color Doppler flow imaging (CDFI), and contrast-enhanced ultrasound (CEUS) examinations. Currently, there are no literatures on these auxiliary examinations for this disease. Dermoscopy revealed that there were abundant blood vessels on the periphery of the skin lesion with obvious dilation. HFUS revealed an inhomegeneous hypoechoic solid mass in the dermis with clear borders and irregular shape. CDFI indicated that there are abundant blood flow signals in the periphery and central of the tumor. CEUS showed a mixed inhomogeneous, grid-like high-enhancement pattern. Based on the above auxiliary findings, the possibility of malignant lesion was suspected. Therefore, the patient was given a pathological examination, which showed that many luminal structures of the dermis layer were embedded in the hyperplastic fibrous tissue. The atypical cells were not obvious but showed an infiltrating growth pattern. Immunohistochemistry showed positive reaction for cytokeratin 7 (CK7), epithelial membrane antigen (EMA), and carcinoembryonic antigen (CEA) and a weak positive results was obtained for S-100. There was also a negative result for CK20, gross cystic disease fluid protein 15 (GCDFP-15), and P63. As a result, the patient was diagnosed with "syringoid eccrine carcinoma." The treatment was surgical excision. Mohs microsurgery was combined with the looped, broad, and deep-buried suturing technique (LBD tension-reduced suturing technique). This technique directly sutures the wound instead of carrying out traditional skin grafting or flap transfer. The postoperative follow-up results were satisfactory as no obvious keloid formed on the wound during the follow-ups. In conclusion, ultrasound is greatly advantageous in tumor morphology and hemodynamics. It orients the therapeutic management and assesses the therapeutic efficacy and the tumoral prognosis. In surgical treatments, a less-traumatic operation should be selected to reduce the patient's pain.
本文旨在解释如何运用多种非侵入性或微创检查来获取可靠的诊断线索。伤口缺损的治疗方法及修复技术的选择对于预后也至关重要。在此，我们描述了一位53岁男性患者的病例，该患者因左侧乳头内侧出现红色斑块且30多年无症状而前来我院皮肤科就诊。对其进行了皮肤镜、高频超声（HFUS）、彩色多普勒血流成像（CDFI）及超声造影（CEUS）检查。目前尚无关于该疾病这些辅助检查的文献报道。皮肤镜检查显示皮损周边血管丰富且明显扩张。高频超声显示真皮层内有不均质低回声实性肿块，边界清晰，形态不规则。彩色多普勒血流成像显示肿瘤周边及中央有丰富血流信号。超声造影显示混合性不均质、网格状高增强模式。基于上述辅助检查结果，怀疑为恶性病变。因此，对患者进行了病理检查，结果显示真皮层许多管腔结构嵌入增生的纤维组织中。非典型细胞不明显，但呈浸润性生长模式。免疫组化显示细胞角蛋白7（CK7）、上皮膜抗原（EMA）及癌胚抗原（CEA）呈阳性反应，S-100呈弱阳性结果。细胞角蛋白20（CK20）、大汗腺囊性病液蛋白15（GCDFP-15）及P63均为阴性结果。最终，患者被诊断为“汗腺样小汗腺癌”。治疗方法为手术切除。采用Mohs显微外科手术联合环形、宽幅、深埋缝合技术（LBD减张缝合技术）。该技术直接缝合伤口，而非进行传统的皮肤移植或皮瓣转移。术后随访结果满意，随访期间伤口未形成明显瘢痕疙瘩。总之，超声在肿瘤形态学及血流动力学方面具有很大优势。它为治疗管理提供方向，评估治疗效果及肿瘤预后。在手术治疗中，应选择创伤较小的手术以减轻患者痛苦。
