Cellular Pathology, South Warwickshire NHS Foundation Trust, Warwick, UK.
Cellular Pathology, South Warwickshire NHS Foundation Trust, Warwick, UK.
Pathology. 2023 Oct;55(6):772-784. doi: 10.1016/j.pathol.2023.07.001. Epub 2023 Jul 20.
Keratoacanthoma (KA) is widely considered a benign, usually self-resolving, neoplasm distinct from cutaneous squamous cell carcinoma (cSCC), while some consider KA to be indistinguishable from cSCC. Published studies indicate utility for p16, p53, Ki-67 immunostaining and elastic van Gieson (EVG) in the assessment of KA and cSCC. We compared clinical features and staining patterns for p16, p53, Ki-67 and EVG in fully excised KA, cSCC with KA-like features (cSCC-KAL) and other cSCC (cSCC-OTHER). Significant differences between KA, cSCC-KAL and cSCC-OTHER were found for head and neck location (20%, 86%, 84%), and duration <5 months (95%, 63%, 36%). KA shows both a mosaic pattern for p16 (>25-90% of neoplasm area) and peripheral graded pattern for p53 (up to 50% moderate and strong nuclear staining) in 92% compared with 0% of cSCC-KAL and 0% of cSCC-OTHER. In contrast, a highly aberrant pattern (usually null) for one or both p16 and p53, was present in 0% of KA, 83.8% of cSCC-KAL and 90.9% of cSCC-OTHER. Abnormal distribution of Ki-67 beyond the peripheral 1-3 cells was uncommon in KA (4.2%) and common in cSCC-KAL (67.6%) and cSCC-OTHER (88.4%). Moderate to striking entrapment of elastic and collagen fibres was present in the majority of KA (84%), cSCC-KAL (81%) and cSCC-OTHER (65%). KA are clinically distinct neoplasms typically of short duration occurring preferentially outside the head and neck and generally lacking aberrations of p16, p53 and Ki-67, compared with cSCC that have high rates of aberrant or highly aberrant p16, p53 and Ki-67, but EVG lacked specificity.
角化棘皮瘤（KA）通常被认为是一种良性、通常可自行消退的肿瘤，与皮肤鳞状细胞癌（cSCC）不同，而有些则认为 KA 与 cSCC 无法区分。已发表的研究表明，p16、p53、Ki-67 免疫染色和弹性 van Gieson（EVG）在评估 KA 和 cSCC 方面具有实用性。我们比较了完全切除的 KA、具有 KA 样特征的 cSCC（cSCC-KAL）和其他 cSCC（cSCC-OTHER）的 p16、p53、Ki-67 和 EVG 的临床特征和染色模式。KA、cSCC-KAL 和 cSCC-OTHER 在头颈部位置（20%、86%、84%）和<5 个月（95%、63%、36%）方面存在显著差异。KA 显示 p16（>25-90%的肿瘤区域）的马赛克模式和 p53（高达 50%的中度和强核染色）的外周分级模式，而 cSCC-KAL 为 0%，cSCC-OTHER 为 0%。相比之下，0%的 KA、83.8%的 cSCC-KAL 和 90.9%的 cSCC-OTHER 存在一种或两种 p16 和 p53 的高度异常模式（通常为阴性）。Ki-67 在外周 1-3 个细胞之外的异常分布在 KA 中不常见（4.2%），而在 cSCC-KAL（67.6%）和 cSCC-OTHER（88.4%）中很常见。弹性纤维和胶原纤维的中度至显著捕获在大多数 KA（84%）、cSCC-KAL（81%）和 cSCC-OTHER（65%）中都有。与具有高异常或高度异常 p16、p53 和 Ki-67 的 cSCC 相比，KA 是临床上明显不同的肿瘤，通常持续时间较短，优先发生在头颈部以外，通常缺乏 p16、p53 和 Ki-67 的异常，而 EVG 缺乏特异性。
