Akasaka T, Kon S
Department of Dermatology, Iwate Medical University, School of Medicine, Morioka, Japan.
J Dermatol. 1997 Oct;24(10):654-61. doi: 10.1111/j.1346-8138.1997.tb02311.x.
An eighty-year-old woman presented with a eccrine poroma that appeared to have arisen in a seborrheic keratosis lesion on the right side of her abdomen. The tumor consisted of a brownish, flat, elevated lesion with an eroded nodule at its periphery. Histopathological analysis of the flat, elevated lesion revealed benign basaloid and squamoid cells that showed acanthotic upward proliferation, suggesting a seborrheic keratosis. The eroded nodule showed irregular proliferation of slight atypical squamoid cells with, in parts, ductal structures in the upper dermis, suggesting that it was an eccrine poroma with partial intermediate malignancy. In addition to the eroded nodule, an occult tumor clinically accompanied the seborrheic keratosis. Histopathology of the occult tumor revealed fenestrated columns and cords of pale epithelial cells attached to the base of the seborrheic keratosis lesion, which was diagnosed as a tumor of the follicular infundibulum. Although reports of seborrheic keratosis transforming into a sweat gland tumor are rare, the present case suggests that seborrheic keratosis may develop into benign or malignant adnexal tumors, including sweat gland and follicular tumors. Thus, seborrheic keratosis should be considered as a possible precursor of adnexal tumor.
一名80岁女性患者，其腹部右侧脂溢性角化病损害内出现了一个小汗腺汗孔瘤。肿瘤表现为褐色、扁平、隆起的损害，其周边有一个糜烂性结节。对扁平隆起损害进行组织病理学分析，发现良性基底样细胞和鳞状细胞呈棘层肥厚性向上增殖，提示为脂溢性角化病。糜烂性结节显示轻度非典型鳞状细胞不规则增殖，部分在上真皮层有导管结构，提示为具有部分中度恶性的小汗腺汗孔瘤。除了糜烂性结节外，脂溢性角化病临床上还伴有一个隐匿性肿瘤。隐匿性肿瘤的组织病理学显示，在脂溢性角化病损害底部有呈窗孔状的柱状和索状淡染上皮细胞，诊断为毛囊漏斗部肿瘤。虽然脂溢性角化病转变为汗腺肿瘤的报道很少见，但本病例提示脂溢性角化病可能发展为良性或恶性附属器肿瘤，包括汗腺和毛囊肿瘤。因此，脂溢性角化病应被视为附属器肿瘤的一个可能前驱病变。
