本文關(guān)鍵詞： 乳房外Paget病　出處：《蘭州大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：回顧乳房外Paget病的診斷和治療。 方法：報(bào)告乳房外Paget病的臨床表現(xiàn)、實(shí)驗(yàn)室檢查、病理檢查、診療及文獻(xiàn)復(fù)習(xí)。 設(shè)計(jì)：病例報(bào)告。 病例：患者男,65歲。右側(cè)陰囊及腹股溝內(nèi)側(cè)出現(xiàn)紅色斑塊伴糜爛滲出、輕度瘙癢2年,加重1月。查體見(jiàn)右側(cè)陰囊及腹股溝內(nèi)側(cè)可見(jiàn)一處約8×5cm大小紅色斑塊,界限較清,滲出明顯,表面附著有少量痂皮。皮損組織病理示：表皮過(guò)度角化,棘層肥厚；表皮見(jiàn)梁索狀、巢團(tuán)狀腫瘤細(xì)胞,突破基底膜,浸潤(rùn)間質(zhì)；部分腫瘤細(xì)胞胞體較大,富含淡染的嗜酸性胞質(zhì),胞核呈空泡樣,核仁明顯,一至數(shù)個(gè)不等。免疫組化示：CKH(2+),c-erbB-2(+),CK7(2+),CEA(2+),EMA(2+)。 干預(yù)：局部切除并送病理檢查。待病理診斷結(jié)果后,進(jìn)行手術(shù)切除治療。 結(jié)果：結(jié)合臨床表現(xiàn)及相關(guān)檢查,患者確診為乳房外Paget病,末伴內(nèi)臟腫瘤。皮損部位行廣泛病灶切除術(shù)并右側(cè)腹股溝淋巴結(jié)清掃,未見(jiàn)遠(yuǎn)處轉(zhuǎn)移病灶。術(shù)后患者恢復(fù)良好,1年后隨訪未復(fù)發(fā)。 結(jié)論：乳房外Paget病是一種罕見(jiàn)的多發(fā)生于頂泌汗腺區(qū)域的表皮惡性腫瘤且易伴發(fā)內(nèi)臟腫瘤,來(lái)源于頂泌汗腺/乳腺導(dǎo)管細(xì)胞。本病常發(fā)生于老年男性患者,首發(fā)常為頂泌汗腺富集區(qū)域單側(cè)性紅色或棕紅色斑塊,診斷需結(jié)合組織病理學(xué)、免疫組織化學(xué)染色來(lái)判斷,CK-7對(duì)本病診斷敏感度高。建議行全身檢查以明確有無(wú)伴發(fā)內(nèi)臟腫瘤。目前國(guó)內(nèi)以傳統(tǒng)手術(shù)治療為主,術(shù)后復(fù)發(fā)率較高,新的治療手段仍在探索中。乳房外Paget病的預(yù)后很大程度上取決于是否有有真皮浸潤(rùn)、淋巴結(jié)節(jié)轉(zhuǎn)移。
[Abstract]:Objective: to review the diagnosis and treatment of extramammary Paget disease. Methods: the clinical manifestation, laboratory examination, pathological examination, diagnosis and treatment and literature review of extramammary Paget's disease were reported. Design: case report. Case: the patient was 65 years old. Red plaques in the right scrotum and the medial groin appeared with erosion and exudation, with mild pruritus for 2 years. Aggravation on January. On the right scrotum and the medial side of the groin, a red plaque of about 8 脳 5 cm in size could be seen, with a clear boundary, obvious exudation and a small amount of escham attached to the surface. The histopathology of the lesions showed that the epidermis was hyperkeratosis. Hypertrophy of spinous layer; In the epidermis, the mesenchymal mesenchymal cells infiltrated the basement membrane and infiltrated the mesenchymal cells. Some of the tumor cells had large cell bodies, rich in light stained eosinophilic cytoplasm, with vacuolated nuclei and obvious nucleoli, ranging from one to several. Immunohistochemical staining showed that the cytoplasm was c-erbB-2 (). CK7(2. Interventions: local resection and pathological examination. After pathological diagnosis, surgical resection is performed. Results: combined with clinical manifestations and related examinations, the patients were diagnosed with extramammary Paget's disease with no visceral tumor. Extensive excision of lesions and right inguinal lymph node dissection were performed in the lesions. No distant metastases were found. The patients recovered well and did not recur after 1 year follow-up. Conclusion: extramammary Paget's disease is a rare epidermal malignant tumor that occurs in the eccrine sweat gland and is easy to be associated with visceral tumor. This disease often occurs in the elderly male patients. The first is the ipsilateral red or brown red plaques in the concentrated areas of the exocrine sweat glands. The diagnosis needs to be combined with histopathology. Immunohistochemical staining to determine the sensitivity of CK-7 to the diagnosis of this disease. It is recommended to do systemic examination to determine if there are visceral tumors. At present, the traditional surgical treatment is the main treatment in China, the postoperative recurrence rate is high. New treatments are still being explored. The prognosis of extramammary Paget disease depends largely on dermal infiltration and lymph node metastasis.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R739.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前6條

1 吳正沐,丁強(qiáng),張?jiān)?姜昊文,童仕俊;陰囊Paget病的診斷與治療(附64例分析)[J];臨床泌尿外科雜志;2004年12期

2 黃邦高;張心男;徐智慧;諸靖宇;倪慶節(jié);周鵬;;陰囊Paget病35例報(bào)告[J];現(xiàn)代泌尿生殖腫瘤雜志;2009年02期

3 冉令軍;;5例陰囊Paget病的診斷與治療[J];現(xiàn)代醫(yī)藥衛(wèi)生;2008年08期

4 黃世俊;潘加忠;吳江鴻;潘源飛;;12例陰囊Paget病臨床診治分析[J];中國(guó)實(shí)用醫(yī)藥;2007年31期

5 張鋼;徐海燕;;24例陰囊Paget病的治療[J];中國(guó)中西醫(yī)結(jié)合皮膚性病學(xué)雜志;2007年03期

6 王成忠,趙偉明,許道中;26例陰囊Paget病的診斷和治療[J];浙江預(yù)防醫(yī)學(xué);2001年05期

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本文編號(hào)：1476767