Krunic A L, Garrod D R, Viehman G E, Madani S, Buchanan M D, Clark R E
Dermatologic Surgery Unit, Duke University Medical Center, Durham, North Carolina 27710, USA.
Dermatol Surg. 1997 Jun;23(6):463-8.
Histopathologic differentiation between benign and malignant tissue is of utmost importance for the Mohs surgeon. Folliculocentric basaloid proliferation (FBP) shares many histologic features with basal cell carcinoma (BCC). It is most commonly associated with tumors of areas with abundant hair follicles such as nasal and perinasal skin. Residual BCC incorrectly identified as a horizontally sectioned hair follicle undoubtedly increases the risk of tumor recurrence. Excision of additional layers of normal tissue to remove "funny looking follicles" may have profound impacts on tissue conservation, preservation of function, and cosmesis. Electron microscope studies of BCC revealed a significant reduction of desmosomes compared with normal basal cells and hair follicle keratinocytes.
This study has assessed the potential of rapid staining with monoclonal antidesmoglein antibody (33-3D) to discriminate between BCC, horizontally sectioned hair follicles, and FBP.
A rapid immunoperoxidase technique with 33-3D antidesmoglein antibody was performed on Mohs frozen sections. We selected 18 patients with BCC of nasal and perinasal locations where histologic discrimination between residual tumor and tumor-free margins with FBP or horizontally sectioned hair follicle was equivocal.
Fourteen sections disclosed the preservation of desmoglein marker delineating the cell membranes ("perimembranous" pattern) consistent with normal hair follicles. The sections were identified as tumor-free and no additional stages were performed. The remaining four sections revealed absent perimembranous pattern but presence of diffuse cytoplasmic staining. These were diagnosed as positive for residual BCC requiring the excision of another layer of tissue to obtain tumor-free margins. A follow-up period ranging from 6 to 24 months revealed no instance of recurrent disease.
Rapid detection of desmoglein with 33-3D antibody is a promising tool for discrimination between residual BCC and FBP or horizontally sectioned hair follicles. It may enhance the sensitivity of Mohs surgery by disclosing the hidden foci of BCC, thus preventing tumor recurrence and unnecessary excision of normal tissue.
对于莫氏外科医生而言，良性与恶性组织的组织病理学鉴别至关重要。毛囊中心性基底样增生（FBP）与基底细胞癌（BCC）具有许多组织学特征。它最常与毛囊丰富区域的肿瘤相关，如鼻和鼻周皮肤。残留的BCC被错误地识别为水平切片的毛囊无疑会增加肿瘤复发的风险。切除额外的正常组织层以去除“外观异常的毛囊”可能会对组织保留、功能保存和美容产生深远影响。BCC的电子显微镜研究显示，与正常基底细胞和毛囊角质形成细胞相比，桥粒显著减少。
本研究评估了用单克隆抗桥粒芯糖蛋白抗体（33-3D）快速染色区分BCC、水平切片毛囊和FBP的潜力。
采用33-3D抗桥粒芯糖蛋白抗体对莫氏冰冻切片进行快速免疫过氧化物酶技术检测。我们选择了18例鼻和鼻周部位患有BCC的患者，这些患者残留肿瘤与FBP或水平切片毛囊之间的组织学鉴别不明确。
14个切片显示桥粒芯糖蛋白标记物保留，勾勒出细胞膜（“膜周”模式），与正常毛囊一致。这些切片被确定为无肿瘤，未进行额外阶段的操作。其余4个切片显示无膜周模式，但存在弥漫性细胞质染色。这些被诊断为残留BCC阳性，需要切除另一层组织以获得无肿瘤边缘。6至24个月的随访期内未发现疾病复发实例。
用33-3D抗体快速检测桥粒芯糖蛋白是区分残留BCC与FBP或水平切片毛囊的一种有前景的工具。它可能通过揭示BCC的隐匿病灶来提高莫氏手术的敏感性，从而防止肿瘤复发和不必要的正常组织切除。
