cell carcinoma dan ladd d基底细胞癌丹拉德o and bill v way 课件

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1、EpidermalNevi,Neoplasms,andCystsPartIIRickLin,D.O.,MPH,DermatologyResidentTexasDivisionofKCOMDermatologyResidencyProgramBasalCellCarcinomaBasalCellEpitheliomaBasaliomaRodentulcerJacobi’sulcerRodentcarcinomaBCC:Whatarethey?PEARLYPAPULESORNODULESROLLEDBORDERTELANGIECTASESCENTRALULCERCRUSTINGBLE

2、EDEASILYBCC:Wherearethey?HEAD,NECK85%NOSE,30%FOREHEADEARSCHEEKSUPPERTRUNKBCC:When?OFTEN–1/3OFALLCAINUSA.ChronicUVB,X-rayImmunosuppressionRenalTransplantGeneticsBCC:Who?ELDERLY&MIDDLEAGEDAges40-79ANGLO-SAXONBlueEyes,FairSkinX-RayExposure,iePhysicians,Dentists,Technicians,WorkersBCC:How?Arisefrom

3、immaturepluripotentialcells.MutationsintheHEDGEHOGpathway(geneswhichcontrolscellgrowth)PATCHED(tumorsuppressor)inactivated.HEDGEHOGandSMOOTHENED(cellgrowthinhibitors)activated.P53andRASmutationsalsoplayarole.BCClook-alikes:SGHBCClook-alikes:KABCCLookalikes:SCCBCC:VariantsSUPERFICIALBCCMORPHEAFO

4、RMBCCPIGMENTEDBCCCYSTICBCCBASALCELLNEVUSSYNDROME(GORLIN’SSYNDROME)SUPERFICIALBCCPSORIASIFORMTRUNKLIMBSFLATGROWTHSYOUNGERPATIENTSMORPHEAFORMBCCRESEMBLESLOCALIZEDSCLERODERMAALMOSTALWAYSONTHECHEEKSORFOREHEADMOH’SSURGERYAGGRESSIVEPIGMENTEDBCCDARKSKINNEDPATIENTSLATINAMERICANSJAPANESENOTBLACKS(wehav

5、eoneblackpatientintheclinicthough)ARSENICINGESTION6%OFALLBCCBCC–CYSTIC/SOLIDDOMESHAPEDBLUEGRAYCYSTICNODULES4-8%OFALLBCCSFibroepitheliomaofPinkusPremalignantfibroepithelialtumorElevated,skin-coloredsessilelesionsonthelowertrunkHistology:interlacingbasocellularsheetsthatextenddownwardfromsurfacet

6、oformanepithelialmeshworkenclosingahyperplasticmesodermalstromaAcompositescanpowerviewshowinganastomosingbandsofepitheliumseparatedbylargeamountsofstroma.Thestromaaccountsforover50%ofthetotalvolumeofthetumor.Anothercompositescanpowerview.Thisisfromasectiontakenparalleltotheoneabove.Thestrandsof

7、epitheliumaregenerallymoredelicatethanthoseseenabove.Peripheralpalisadingofnucleiisassociatedwithacleftbetweentheepitheliumandthedelicatelyfibrillar,slightlybasophilicstroma.Thiscleftingresemblesthatseeninbasalcellcarcinomas.Amylo