【摘要】：目的探討外耳皮膚原位及浸潤(rùn)性鱗狀細(xì)胞癌(invasive squamous cell carcinoma,i SCC)的臨床病理學(xué)特征、診斷、鑒別診斷及預(yù)后因素。方法回顧性分析30例外耳皮膚鱗狀細(xì)胞癌(cutaneous squamous cell carcinoma,c SCC)的臨床病理學(xué)特征,并復(fù)習(xí)相關(guān)文獻(xiàn)。結(jié)果 30例外耳c SCC患者男女比為4∶1,平均年齡66.9歲,中位年齡71歲。23例耳廓c SCC,7例外耳道c SCC。鏡檢:22例(73.3%)為浸潤(rùn)性鱗狀細(xì)胞癌(invasive squamous cell carcinoma,i SCC);8例(26.7%)為原位鱗狀細(xì)胞癌(squamous cell carcinoma in situ,SCCIS),其中2例可疑浸潤(rùn)。浸潤(rùn)癌中,19例為混合型c SCC,伴一種或多種特殊組織學(xué)亞型,其中10例伴棘層松解;8例伴梭形細(xì)胞區(qū)域;3例伴透明細(xì)胞區(qū)域;2例伴淋巴上皮瘤樣癌特點(diǎn);7例伴角化棘皮瘤樣特點(diǎn);1例與毛囊相關(guān)。外耳c SCC的首次活檢確診率約80.1%,外耳道c SCC的確診率僅為57.1%。切緣陽(yáng)性病例的局部復(fù)發(fā)率為66.7%(2/3),切緣陰性者局部復(fù)發(fā)率為10%(2/20)。20例隨訪病例中,2例(10%)伴頸部淋巴結(jié)轉(zhuǎn)移,1例(5%)肺轉(zhuǎn)移,5例(25%)死亡。結(jié)論外耳c SCC的組織學(xué)形態(tài)多樣,病理診斷具有一定的局限性,其確診需密切聯(lián)系臨床和影像學(xué)資料。外耳c SCC預(yù)后不良的因素主要包括腫瘤直徑≥2 cm、浸潤(rùn)軟骨、累及顱骨、分期較晚和切緣陽(yáng)性等。
[Abstract]:Objective to investigate the clinicopathological features, diagnosis, differential diagnosis and prognostic factors of (invasive squamous cell carcinoma in situ and invasive squamous cell carcinoma of external ear. Methods the clinicopathological features of 30 cases of (cutaneous squamous cell carcinomatous cell carcinoma (SCC) were retrospectively analyzed and the related literatures were reviewed. Results the male to female ratio of 30 cases with c SCC was 4: 1, with an average age of 66.9 years. The median age was 71 years. Twenty two cases (73.3%) were diagnosed as invasive squamous cell carcinoma (invasive squamous cell carcinoma), 8 cases (26.7%) were (squamous cell carcinoma in situ squamous cell carcinoma (squamous cell carcinoma in), and 2 cases were suspected invasion. In invasive carcinoma, 19 cases were mixed type c SCC with one or more special histological subtypes. Among them, 10 cases with spinous lamina and 8 cases with spindle cell region, 3 cases with clear cell region, 2 cases with lymphoepithelioma-like carcinoma, 7 cases with keratoacanthoma and 1 case with hair follicle. The diagnosis rate of c SCC in external ear was about 80.1%, and that of c SCC in external auditory canal was only 57.1%. The local recurrence rate of positive margin cases was 66.7% (2 / 3). The local recurrence rate of negative margin cases was 10% (2 / 20). Of the 20 cases followed up, 2 cases (10%) were followed up with cervical lymph node metastasis in 1 case (5%) and lung metastasis in 5 cases (25%). Conclusion the histopathology and pathological diagnosis of external ear c SCC are various. The diagnosis of c SCC should be closely related to clinical and imaging data. The main prognostic factors of external ear c SCC included tumor diameter 鈮，

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