原位鳞状细胞癌——鲍温病、外阴上皮内瘤变、阴茎上皮内瘤变及凯腊增殖性红斑早期诊断的重要性
Squamous Cell Carcinoma In Situ-The Importance of Early Diagnosis in Bowen Disease, Vulvar Intraepithelial Neoplasia, Penile Intraepithelial Neoplasia, and Erythroplasia of Queyrat.
作者信息
Scurtu Lucian G, Scurtu Francesca, Dumitrescu Sebastian Catalin, Simionescu Olga
机构信息
Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Department of Dermatology I, Colentina Clinical Hospital, 020125 Bucharest, Romania.
出版信息
Diagnostics (Basel). 2024 Aug 16;14(16):1799. doi: 10.3390/diagnostics14161799.
Cutaneous squamous cell carcinoma (cSCC) is the second-most-prevalent malignancy in humans. A delayed diagnosis of cSCC leads to heightened invasiveness and positive surgical margins. Bowen's disease (BD) represents an early form of cSCC and presents as a small erythematous, photo-distributed, psoriasiform plaque. Although certain dermoscopy features in BD are quite characteristic, histopathology remains the gold standard for diagnosis and provides a severity-scoring system that assists in guiding appropriate treatment strategies. The classification of precancerous lesions of the vulva and penis has undergone multifarious transformations due to variations in clinical and histopathological characteristics. Presently, erythroplasia of Queyrat is categorized as a clinical variant of penile intraepithelial neoplasia (PeIN). The diagnoses of vulvar intraepithelial neoplasia (VIN) and PeIN present significant challenges and typically necessitate one or more biopsies, potentially guided by dermoscopy. Aceto-white testing demonstrates a notably high negative predictive value for genital precancerous lesions. Histopathological examination represents the gold-standard diagnosis in VIN and PeIN, while p16 and p53 immunostainings alongside HPV testing provide crucial diagnostic clues. The histopathologic features, degree of differentiation, and associations with lichen planus, lichen sclerosus, and HPV guide the selection of conservative treatments or surgical excision.
皮肤鳞状细胞癌(cSCC)是人类第二常见的恶性肿瘤。cSCC的延迟诊断会导致侵袭性增强和手术切缘阳性。鲍温病(BD)是cSCC的一种早期形式,表现为小的红斑,呈光分布,类似银屑病的斑块。尽管BD的某些皮肤镜特征很有特点,但组织病理学仍是诊断的金标准,并提供了一个严重程度评分系统,有助于指导适当的治疗策略。由于临床和组织病理学特征的差异,外阴和阴茎癌前病变的分类经历了多种变化。目前,凯拉特增殖性红斑被归类为阴茎上皮内瘤变(PeIN)的一种临床变体。外阴上皮内瘤变(VIN)和PeIN的诊断面临重大挑战,通常需要进行一次或多次活检,可能在皮肤镜引导下进行。醋酸白试验对生殖器癌前病变显示出显著高的阴性预测价值。组织病理学检查是VIN和PeIN的金标准诊断,而p16和p53免疫染色以及HPV检测提供了关键的诊断线索。组织病理学特征、分化程度以及与扁平苔藓、硬化性苔藓和HPV的关联指导着保守治疗或手术切除的选择。