乳房外Paget病1例报告并文献复习

发布时间：2018-01-30 17:02

本文关键词： 乳房外Paget病　出处：《兰州大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：回顾乳房外Paget病的诊断和治疗。方法：报告乳房外Paget病的临床表现、实验室检查、病理检查、诊疗及文献复习。设计：病例报告。病例：患者男,65岁。右侧阴囊及腹股沟内侧出现红色斑块伴糜烂渗出、轻度瘙痒2年,加重1月。查体见右侧阴囊及腹股沟内侧可见一处约8×5cm大小红色斑块,界限较清,渗出明显,表面附着有少量痂皮。皮损组织病理示：表皮过度角化,棘层肥厚；表皮见梁索状、巢团状肿瘤细胞,突破基底膜,浸润间质；部分肿瘤细胞胞体较大,富含淡染的嗜酸性胞质,胞核呈空泡样,核仁明显,一至数个不等。免疫组化示：CKH(2+),c-erbB-2(+),CK7(2+),CEA(2+),EMA(2+)。干预：局部切除并送病理检查。待病理诊断结果后,进行手术切除治疗。结果：结合临床表现及相关检查,患者确诊为乳房外Paget病,末伴内脏肿瘤。皮损部位行广泛病灶切除术并右侧腹股沟淋巴结清扫,未见远处转移病灶。术后患者恢复良好,1年后随访未复发。结论：乳房外Paget病是一种罕见的多发生于顶泌汗腺区域的表皮恶性肿瘤且易伴发内脏肿瘤,来源于顶泌汗腺/乳腺导管细胞。本病常发生于老年男性患者,首发常为顶泌汗腺富集区域单侧性红色或棕红色斑块,诊断需结合组织病理学、免疫组织化学染色来判断,CK-7对本病诊断敏感度高。建议行全身检查以明确有无伴发内脏肿瘤。目前国内以传统手术治疗为主,术后复发率较高,新的治疗手段仍在探索中。乳房外Paget病的预后很大程度上取决于是否有有真皮浸润、淋巴结节转移。
[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.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R739.5

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