皮肤镜检查在乳腺癌皮肤转移中的诊断价值

Arina A. Vashkevich, Yuliya V. Semiletova, Inna M. Korablina, Elizaveta S. Kalashnikova, Polina A. Reztsova, Liia G. Kvichidze, Rostislav V. Pavlov, Valeriy N. Danilin, Irina A. Pavlikova, Yuliya I. Nikitina
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摘要

介绍。皮肤转移是由远处恶性肿瘤细胞增殖引起皮肤浸润的结果,在各种肿瘤过程中发生的频率为0.6 - 10.4%。它们可能是肿瘤进展的征兆,也可能是新诊断的癌症的表现。由于临床表现的高度可变性导致误诊,有限数量的文章描述了实体瘤转移淋巴结的临床和皮肤镜征象。目的:分析乳腺癌皮肤转移的临床及皮镜特征。材料和方法。女患者主诉头皮病变区有轻微疼痛和瘙痒。根据她的病史,2012年因右侧乳腺癌进行了右侧乳房切除术,随后患者自愿停止了激素治疗。鉴于罕见的定位局限于头皮,鉴别诊断是一个圆筒状瘤,多发性基底细胞癌和转移癌之间的频谱。进行了活检以确认诊断。结果和检查。病理性皮肤过程表现为多个结节,直径达2cm,颜色为粉红色,致密,触诊无痛,界限不清。皮肤镜下:多形态血管,红斑背景,蛹状结构。经组织学和免疫组化检查证实乳腺癌转移。皮肤转移可能是癌症复发的第一个迹象。皮肤镜检查有助于将其与其他皮肤病区分开来。病变血管的密度和直径对预后有重要意义。如果检测到的病变不符合皮肤肿瘤的标准模式,建议对诊断进行组织学验证。
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Dermatoscopy in the Diagnosis of Skin Metastases from Breast Cancer
Introduction. Skin metastases are the result of skin infiltration caused by the proliferation of cells of remotely located malignant tumors occurring with a frequency of 0.6–10.4 % in various oncological processes. They may be a sign of progressive neoplasm or a manifestation of newly diagnosed cancer. Due to a high variability of clinical manifestations leading to misdiagnoses, a limited number of articles describe clinical and dermatoscopic signs of solid tumors metastatic nodes. Aim: to analyze the clinical and dermatoscopic features of skin metastases from breast cancer.Materials and methods. A female patient has complaints of slight pain and itching in the lesions area on the scalp. According to her medical history, a right mastectomy was performed for right breast cancer in 2012, followed by hormone therapy willfully discontinued by the patient. Given the uncommon localization limited with the scalp, the differential diagnosis was made with a spectrum between a cylindroma, multiple basal cell cancer and metastatic carcinoma. A biopsy was carried out to confirm the diagnosis. Results and examination. The pathological skin process revealed itself through multiple nodes up to 2 cm in diameter, pinkish in color, dense, painless on palpation, poorly demarcated. Dermatoscopically: polymorphic vessels on an erythematous background, chrysalis-like structures. Breast cancer metastases were verified by histological and immunohistochemical examination.Conclusion. Skin metastases may be the first sign of cancer recurrence. Dermatoscopy can facilitate differenting them from other skin diseases. Density and diameter of pathological vessels are prognostically significant. Ifdetected lesions do not fit the standard pattern of skin neoplasms, histological verification of the diagnosis is recommended to be carried out.
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