Sau P, Graham J H, Helwig E B
Department of Dermatology and Pathology, Walter Reed Army Medical Center, Washington, D.C. 20307-5001, USA.
J Cutan Pathol. 1995 Oct;22(5):394-406. doi: 10.1111/j.1600-0560.1995.tb00754.x.
Ninety-six proliferating cutaneous epithelial cysts were classified into two subtypes, proliferating trichilemmal cysts (PTC) and proliferating epidermoid cysts (PEC), depending on the mode of keratinization or the origin of the tumors. The clinicopathological features and the biological behavior of these two subtypes were compared. Among 63 patients with PTC, 45 (71%) were women and 18 (29%) were men. The most common site was the scalp (78%), followed by the trunk (13%). These tumors were well circumscribed subepidermal lesions and demonstrated uniform histologic pattern with varying degrees of cytologic atypia. A few tumors extended into the epidermis and occasionally became ulcerated. Follow-up of 59 (94%) PTC for an average of 4 years revealed recurrence in one. Ten tumors demonstrated carcinomatous changes including one with anaplastic carcinoma and regional lymph node metastasis. None of these tumors recurred or developed further metastasis following wide excision. Of 33 PECs, 12 (36%) occurred in women and 21 (64%) in men. These tumors were widely distributed in the pelvic and anogenital areas (36%), followed by the scalp (21%), upper extremities (18%), and trunk (15%). Seventy-nine percent of the PECs were located in areas outside the scalp. The PECs were subepidermal tumors but often communicated to the surface. The histologic pattern of PEC was more variable than that of PTC. Seven tumors exhibited carcinomatous changes. Follow-up of 30 (91%) PEC revealed local recurrences in 6, with multiple recurrences in 3, and extensive local invasion in 2, resulting in death in one. Greater anaplasia, high mitotic rate and deeper invasion were associated with increased incidence of recurrence and aggressive behavior. Although both PTC and PEC were locally aggressive tumors and potentially malignant, distant metastasis was unusual. These tumors should be treated with wide local excision, especially those showing cytologic atypia and carcinomatous changes.
96例增殖性皮肤上皮囊肿根据角化模式或肿瘤起源分为两个亚型，即增殖性毛鞘囊肿（PTC）和增殖性表皮样囊肿（PEC）。比较了这两个亚型的临床病理特征和生物学行为。在63例PTC患者中，45例（71%）为女性，18例（29%）为男性。最常见的部位是头皮（78%），其次是躯干（13%）。这些肿瘤是界限清楚的表皮下病变，表现出均匀的组织学模式，伴有不同程度的细胞异型性。少数肿瘤延伸至表皮，偶尔发生溃疡。对59例（94%）PTC平均随访4年，发现1例复发。10例肿瘤出现癌变，其中1例为间变性癌并伴有区域淋巴结转移。这些肿瘤在广泛切除后均未复发或发生进一步转移。在33例PEC中，12例（36%）发生于女性，21例（64%）发生于男性。这些肿瘤广泛分布于盆腔和肛门生殖器区域（36%），其次是头皮（21%）、上肢（18%）和躯干（15%）。79%的PEC位于头皮以外的区域。PEC是表皮下肿瘤，但常与表面相通。PEC的组织学模式比PTC更具变异性。7例肿瘤出现癌变。对30例（91%）PEC进行随访，发现6例局部复发，3例多次复发，2例广泛局部浸润，其中1例死亡。间变程度更高、有丝分裂率高和浸润更深与复发率增加及侵袭性行为相关。虽然PTC和PEC均为局部侵袭性肿瘤且具有潜在恶性，但远处转移并不常见。这些肿瘤应采用广泛局部切除治疗，尤其是那些表现出细胞异型性和癌变的肿瘤。
