Sau P, Lupton G P, Graham J H
Department of Dermatology, Walter Reed Army Medical Center, Washington, DC 20307-5001.
Cancer. 1993 Apr 15;71(8):2491-8. doi: 10.1002/1097-0142(19930415)71:8<2491::aid-cncr2820710811>3.0.co;2-i.
Pilomatrix carcinoma, a malignant variant of pilomatrixoma, is extremely rare. The authors report 20 patients with pilomatrix carcinoma and review the pertinent literature.
Tumors showing histologic features of pilomatrix carcinoma were selected from the files of the Armed Forces Institute of Pathology. Clinical data of the 20 selected patients were reviewed, and follow-up information was obtained. Sections stained with hematoxylin and eosin were studied in all patients. Special stains were used in selected patients.
Pilomatrix carcinomas were asymptomatic dermal and subcutaneous masses with a predilection for the posterior neck and back. Tumors varied in size, from 1-10 cm (mean, 4.6 cm), and occurred more often in middle-age men, with a male:female ratio of 4:1 (mean age, 45 years). Histologically, pilomatrix carcinomas are characterized by sheets and islands of proliferating atypical basaloid cells with an infiltrating border. Transition to squamous cells, clear cells, areas of necrosis and mitoses often are seen. Keratinization with formation of keratin cysts, shadow cells, and trichohyalin and keratohyalin granules are found in all tumors, in conjunction with calcification and foreign body giant cell reaction, just as are seen in benign pilomatrixoma. Follow-up of 17 patients revealed local recurrence in 10 (59%), with multiple recurrences in 3. One patient had pulmonary metastasis, and one died of extensive local spread of the tumor.
Pilomatrix carcinomas are locally aggressive tumors that have a tendency to recur, especially when they are incompletely excised. Greater anaplasia and deep soft tissue infiltration were associated with a higher incidence of recurrence and death. Wide excision is the preferred treatment. The role of radiation therapy is unclear.
毛母质癌是毛母质瘤的一种恶性变体，极为罕见。作者报告了20例毛母质癌患者并复习相关文献。
从武装部队病理研究所档案中选取具有毛母质癌组织学特征的肿瘤。回顾了20例入选患者的临床资料，并获取随访信息。对所有患者苏木精和伊红染色切片进行研究。部分患者采用特殊染色。
毛母质癌表现为无症状的真皮和皮下肿物，好发于后颈部和背部。肿瘤大小不一，1至10厘米（平均4.6厘米），中年男性更为多见，男女比例为4:1（平均年龄45岁）。组织学上，毛母质癌的特征为增生的非典型基底样细胞片和岛状结构，边界浸润。常可见向鳞状细胞、透明细胞的转变、坏死区域及核分裂象。所有肿瘤均可见角化形成角质囊肿、影细胞、毛透明蛋白和角透明蛋白颗粒，同时伴有钙化和异物巨细胞反应，这与良性毛母质瘤所见相同。17例患者随访发现10例（59%）局部复发，其中3例多次复发。1例患者发生肺转移，1例死于肿瘤广泛局部扩散。
毛母质癌是具有局部侵袭性、易于复发的肿瘤，尤其是切除不完全时。间变程度越高和深部软组织浸润与复发及死亡发生率越高相关。广泛切除是首选治疗方法。放疗的作用尚不清楚。
