【作者】 赵杰；

【导师】 蔡大幸；

【作者基本信息】 山东大学 ， 皮肤病与性病学（专业学位）， 2022， 硕士

【摘要】 研究背景鲍恩病是一种表皮内鳞状细胞癌,也称为原位鳞状细胞癌。鲍恩病的早期皮损缺乏特异性,临床易被误诊为其他疾病而延误治疗。本病虽可长期局限于表皮内,但仍有可能突破基底膜进展为侵袭性鳞状细胞癌,严重影响患者的生活质量和健康。因此,早期诊断和及时治疗尤为重要。研究目的总结鲍恩病的临床、皮肤影像学和组织病理学特点,提高对鲍恩病的认识;分析影响鲍恩病临床误诊的因素,降低误诊率;分析和对比影响治疗方案选择的因素,对比手术治疗和光动力治疗的疗效,为临床提供一定的参考。研究方法收集2019年1月至2021年12月间就诊于山东大学齐鲁医院皮肤科并经组织病理学检查确诊为鲍恩病的64例患者的病例资料,对患者的性别、年龄、皮损特点、皮肤影像学表现、组织病理、治疗及预后等情况进行回顾性分析。研究结果1.一般资料:64例鲍恩病患者中,男性29例,女性35例,男女比例为1:1.21,发病年龄25-94岁,中位发病年龄61.50岁,平均发病年龄(60.69±16.18)岁。皮损位于曝光和非曝光部位比例为1:1.21(29:35),曝光部位男性11例,女性18例,非曝光部位男性18例,女性17例,男女发病部位的差异有统计学意义(P<0.05)。病程最短3个月,最长达40年,平均病程(63.36±91.46)个月,中位病程为24个月。2.皮肤影像学:行皮肤镜检查的26处皮损背景棕色到红色,有76.92%(20/26)的皮损见肾小球状血管或点、球状血管,80.77%(21/26)的患者皮损表面鳞屑结痂;有3例患者为色素型鲍恩病,皮肤镜下均可见到棕褐色点、球状结构。行反射式共聚焦显微镜检查的6处皮损均可见角质层细胞排列紊乱、棘细胞层呈非典型蜂窝状,见中央高折光、外周低折光的靶形细胞。3.临床与病理诊断符合率:64例鲍恩病患者中,临床与病理诊断符合率为56.25%(36/64)。临床与病理诊断一致的患者中有10例位于曝光部位,26例位于非曝光部位,临床与病理诊断不一致的28例患者中,19例位于曝光部位,9例位于非曝光部位,差异有统计学意义(P<0.05);临床诊断为日光性角化病的患者中,其皮损均发生于曝光部位,差异具有统计学意义(P<0.001)。4.治疗方法:64例患者中有49例行手术治疗,14例患者行光动力治疗,1例患者行冷冻治疗,手术治疗与光动力疗法的治疗效果相比,差异无统计学意义(P>0.05)。49例手术治疗的患者中,21例皮损位于曝光部位,28例位于非曝光部位,14例光动力治疗的患者中,12例皮损位于曝光部位,2例位于非曝光部位,差异有统计学意义(P<0.05)。结论1.鲍恩病主要发生于50岁及以上人群,女性略多于男性,皮损较多发生于非曝光部位。2.鲍恩病临床与病理诊断符合率为56.25%,误诊率高达43.75%。发病部位会影响临床诊断符合率。3.鲍恩病皮肤镜下表现为红色背景,主要血管形态为肾小球状血管或点、球状血管,见黄色或白色鳞屑。4.鲍恩病治疗方法的选择与皮损发生部位相关,而与性别、年龄、皮损大小、病程无显著相关性。5.手术切除和光动力疗法对鲍恩病均有较好的治疗效果,美观要求不高时可选择手术切除,当皮损发生于曝光部位,患者对美容要求较高时,可选择光动力疗法。更多还原

【Abstract】 BackgroundBowen’s disease is a squamous cell carcinoma occurring in epidermis,also called squamous cell carcinoma in situ.Early lesions of Bowen’s disease lack specificity and are easily misdiagnosed as other diseases and delayed treatment.Although Bowen’s disease can be confined to the epidermis for a long time,it is still possible to break through the basement membrane and progress into invasive squamous cell carcinoma,which deteriorates patient’s quality of life and health.So early diagnosis and timely treatment are important.ObjectiveTo summarize the clinical,skin imaging and histopathological features of Bowen’s disease and raise awareness of Bowen’s disease.To analyze factors affecting clinicalmisdiagnosis of Bowen’s disease and reduce misdiagnosis rate.To analyze and compare the factors influencing the choice of therapeutic methods,and provide some reference for clinical work.MethodsThe clinical data of 64 patients diagnosed with Bowen’s disease by histopathological examination in dermatology Department of Qilu Hospital of Shandong University from January 1 2019 to December 31 2021 were collected.The gender,age,skin lesion characteristics,skin imaging findings,histopathology,treatment and prognosis of the patients were retrospectively analyzed.Results1.General information:Among the 64 patients,29 were male and 35 were female and the ratio was 1:1.21,the onset age was 25-94 years old,the median onset age was 61.50 years old,and the average onset age was(60.69±16.18)years old.The ratio of skin lesions in exposed and non-exposed sites was 1:1.21(29:35),There were 11 males and 18 females at the exposed site,18 males and 17 females at the non-exposed site.and the difference between male and female was statistically significant(P<0.05).The course of disease ranged from 3 months to 40 years,the mean course was(63.36±91.46)months,the median course was 24 months.2.Skin imaging:Among the 26 lesions examined by dermatoscopy,the background was brown to red,and 76.92%(20/26)of the lesions showed glomerular vessels or dots or globular vessels,and 80.77%of the lesions showed scabby surface.There were 3 cases of pigmented Bowen’s disease with brown spots and spherical structures under dermatoscopy.In the 6 lesions examined by Reflectance Confocal Microscopy,cuticle cells were disordered and the epidermis was atypical honeycomb,and there were target cells with high refraction in the center and low refraction in the periphery.3.Coincidence rate of clinical and pathological diagnosis:The coincidence rate of clinical and pathological diagnosis was 56.25%(36/64).Among the patients with consistent clinical and pathological diagnosis,10 cases were located at the exposed site and 26 cases were located at the non-exposed site;among the 28 patients with clinical misdiagnosis,19 cases were located at the exposed site and 9 cases were located at the non-exposed site,the difference was statistically significant(P<0.05).The lesions of patients with AK were all located at the exposure site,and the difference was statistically significant(P<0.001).4.Treatment:Among the 64 patients,49 patients received surgical treatment,14 patients received PDT,and 1 patient received cryotherapy.The difference between surgical treatment and PDT was not statistically significance(P>0.05).Among the 49 patients underwent surgical treatment,21 patients had skin lesions at the exposed site and 28 at the non-exposed site;among the 14 patients underwent PDT,12 patients had skin lesions at the exposed site and 2 at the non-exposed site,the difference was statistically significant(P<0.05).Conclusions1.Bowen’s disease mainly occurs in people aged 50 and above,with more females than males,and more lesions occur in non-exposed parts.2.The coincidence rate of clinical and pathological diagnosis of Bowen’s disease was 56.25%,and the misdiagnosis rate was as high as 43.75%.The location of the disease affects the clinical diagnosis.3.Under dermatoscopy,bowen’s disease has a red background,and the main vascular morphology is glomerulus or dot or globular vessels,with yellow or white scales.4.The choice of treatment for Bowen’s disease was correlated with the site of lesions,but not with gender,age,lesions size and course of disease.5.Both surgical resection and photodynamic therapy have good therapeutic effect on Bowen’s disease.When the aesthetic requirements are not high,surgical resection can be selected.更多还原