410例色素痣样皮疹临床及病理分析

发布时间：2018-04-09 23:23

本文选题：色素痣样皮疹　切入点：临床诊断　出处：《浙江大学》2011年硕士论文

【摘要】：目的：通过对色素痣样皮疹临床及病理分析,归纳该类皮疹的发病特点,以期提高临床医师对其诊断及治疗水平方法：收集2008.01-2011.02我院皮肤科门诊与住院患者因色素痣样皮疹行活检病理诊断的病例共410例。拍摄手术部位照片,行手术切除或shave活检,常规HE染色后病理诊断。统计所有患者发病部位、年龄、性别。把全身分为头、颈、躯干、会阴、上肢和下肢6部分,按色素痣、脂溢性角化病、疣、蓝痣和其他分别统计各部位发病例数及所占比例。按20岁1组,分组计算各病种发病例数及所占比例,并计算年龄平均数及标准差。按病种分别计算男女发病例数及所占比例。按病种计算诊断符合率,统计所有临床诊断与病理诊断不符的病例。结果： 410例色素痣样皮疹中,男性217例,女性193例,男女比1.12：1。皮疹分布于躯干184例(44.9%)、头部86例(21.0%)、颈部45例(11.0%)、上肢39例(9.5%)、下肢36例(8.8%)、会阴20例(4.9%)。患者的年龄分布于10～86周岁,平均年龄为43.2±16.3岁。病理诊断为色素痣182例(44.4%),脂溢性角化病159例(38.8%),疣41例(10.0%),蓝痣20例(4.9%),表皮痣3例(0.7%),Spitz痣3例(0.7%),雀斑样痣2例(0.5%),恶性黑色素瘤1例(0.2%),原位恶性黑色素瘤1例(0.2%),发育不良型黑素细胞痣1例(0.2%),上皮样囊肿1例(0.2%)。其中皮内痣伴脂溢性角化病3例,疣伴脂溢性角化病1例。色素痣和蓝痣患者的年龄小于脂溢性角化病和疣的患者,有显著性差异(p0.01)。病理诊断与临床诊断总符合率83.9%。其中各病种符合率分别为表皮痣100%,色素痣96.7%,脂溢性角化病81.8%,疣73.2%,蓝痣45%。结论： 1)表现为色素痣样皮疹的疾病很多,常见的有：色素痣、脂溢性角化病、疣、蓝痣、Spitz痣、表皮痣、黑色素瘤等。 2)病理诊断总符合率83.4%。其中诊断符合率较高的病种为表皮痣、色素痣、脂溢性角化病和疣。 3)临床上色素痣与脂溢性角化病最易混淆,脂溢性角化病与疣也易混淆,蓝痣易误诊为色素痣。 4)难以区别皮疹良恶性时,病理诊断十分必要。
[Abstract]:Objective:Based on the clinical and pathological analysis of pigmented nevus rash, the pathogenesis of this kind of rash is summarized in order to improve the diagnosis and treatment of the rash by clinicians.Methods:A total of 410 patients with pigmented nevus rash diagnosed by biopsy in our department of dermatology were collected from January 2008.01-2011.02.The location of the operation was taken and the pathological diagnosis was performed after surgical resection or shave biopsy and routine HE staining.The location, age and sex of all patients were analyzed.The whole body was divided into six parts: head, neck, trunk, perineum, upper limb and lower extremity. According to pigmented nevus, seborrheic keratosis, verruca, blue nevus and others, the number and proportion of cases were counted.According to 20 years old group, the number and proportion of each disease were calculated, and the average age and standard deviation were calculated.The number and proportion of male and female cases were calculated according to the disease types.The diagnostic coincidence rate was calculated according to the disease type and all the cases whose clinical diagnosis was not consistent with the pathological diagnosis were counted.Results:Of the 410 cases of pigmented nevus rash, 217 were males and 193 females, with a ratio of 1.12: 1.The rash was distributed in 184 cases of trunk (44.9%), 86 cases of head (21.0%), 45 cases of neck (11.0%), 39 cases of upper limbs (9.5%), 36 cases of lower limbs (8.88%), 20 cases of perineum (20 cases).The age of the patients ranged from 10 to 86 years old, with an average age of 43.2 卤16.3 years.There were 182 cases of pigmented nevus, 159 cases of seborrheic keratosis, 41 cases of verruca, 20 cases of blue nevus, 20 cases of blue nevus, 3 cases of epidermal nevus, 3 cases of Spitz nevus, 2 cases of freckle nevus, 2 cases of freckle nevus, 1 case of malignant melanoma, 1 case of malignant melanoma, 1 case of malignant melanoma and 0.2% of dysplasia.Type A melanocytic nevus (n = 1) and epithelioid cyst (n = 1).There were 3 cases of intradermal nevus with seborrheic keratosis and 1 case of verruca with seborrheic keratosis.The age of pigmented nevus and blue nevus was lower than that of seborrheic keratosis and verruca.The total coincidence rate between pathological diagnosis and clinical diagnosis was 83.9%.The coincident rates of each disease were epidermal nevus 100, pigmented nevus 96.7, seborrheic keratosis 81.8, verruca 73.2, blue nevus 45g.Conclusion:1) there are many diseases of pigmented nevus like rash, such as pigmented nevus, seborrheic keratosis, verruca, blue nevus Spitz nevus, epidermal nevus, melanoma and so on.2) the total coincidence rate of pathological diagnosis was 83.4%.Among them, epidermal nevus, pigmented nevus, seborrheic keratosis and verruca were the most diagnosed diseases.3) pigmented nevus is most easily confused with seborrheic keratosis, seborrheic keratosis is easily confused with verruca, and blue nevus is easily misdiagnosed as pigmented nevus.4) when it is difficult to distinguish benign and malignant rash, pathological diagnosis is very necessary.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R758.51

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