Maruyama Satoshi, Yamazaki Manabu, Abé Tatsuya, Kato Yusuke, Kano Hiroyuki, Sumita Yoshimasa, Tomihara Kei, Tanuma Jun-Ichi
Oral Pathology Section, Department of Surgical Pathology, Niigata University Hospital, Niigata, Japan.
Division of Oral Pathology, Department of Tissue Regeneration and Reconstruction, Graduate School of Medical and Dental Sciences, Faculty of Dentistry & Niigata University, Niigata, Japan.
Diagn Cytopathol. 2023 May;51(5):E170-E175. doi: 10.1002/dc.25117. Epub 2023 Feb 10.
Pemphigus vulgaris (PV) is a rare autoimmune disease characterized by blisters on the skin and mucous membrane. Since it often appears in the oral mucosa first, it may be diagnosed by oral mucosal cytology. Although the cytologic finding is characterized by acantholytic cells, that is, Tzanck cells, it is important to distinguish PV from neoplastic lesions of the oral mucosal epithelium, including differentiation from atypical parabasal/basal cells, which appear in squamous cell carcinoma (SCC). In this study, we examined the cellular findings in two cases of PV and a case of well-differentiated SCC with loss of epithelial cell cohesion. The samples were prepared using liquid-based cytology, which showed small round-shaped and deeply stained atypical, orangeophilic keratinocytes not only in SCC but also in PV, which made differentiation between the two difficult. However, Tzanck cells found in PV differ from the deep atypical parabasal/basal cells of SCC, suggesting that the cell outline is indistinct and small protrusions and brush-like structures are observed. This feature of Tzanck cells may be useful in cytological judgment.
寻常型天疱疮（PV）是一种罕见的自身免疫性疾病，其特征为皮肤和黏膜上出现水疱。由于它通常首先出现在口腔黏膜，因此可通过口腔黏膜细胞学进行诊断。尽管细胞学检查结果以棘层松解细胞即天疱疮细胞为特征，但将PV与口腔黏膜上皮的肿瘤性病变区分开来很重要，包括与鳞状细胞癌（SCC）中出现的非典型基底旁/基底细胞进行鉴别。在本研究中，我们检查了两例PV病例和一例分化良好但上皮细胞黏附丧失的SCC病例的细胞学检查结果。样本采用液基细胞学制备，结果显示不仅在SCC中，而且在PV中都有小圆形且深染的非典型嗜橙色角质形成细胞，这使得两者之间的区分变得困难。然而，PV中发现的天疱疮细胞与SCC的深部非典型基底旁/基底细胞不同，其细胞轮廓不清晰，可见小突起和刷状结构。天疱疮细胞的这一特征可能有助于细胞学判断。
