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Squamous cell carcinoma: pain as a clue to increased tumour diameter, increased invasion depth, the grade of differentiation, acantholysis and perineural invasion.

鳞状细胞癌: 疼痛作为肿瘤直径增加、浸润深度增加、分化分级、棘层松解和神经周围浸润的线索。

  • 影响因子:1.09
  • DOI:10.1111/ced.14066
  • 作者列表:"Pyne JH","Myint E","Clark SP","Clifopoulos C","Fishburn P","Gorji M","Hou R
  • 发表时间:2020-03-01

BACKGROUND:Pain may be associated with actinic keratosis (AK), intraepidermal carcinoma (IEC) and invasive squamous cell carcinoma (SCC), which may all display high-risk features. AIM:To examine variation in pain frequency associated with these three conditions, and assess their invasive SCC surface diameter, invasion depth, grade of differentiation, presence of acantholysis and perineural invasion (PNI). METHODS:Pain was prospectively recorded for consecutive cases of AK, IEC and SCC from three institutions in Australia during the period 2016-2018. RESULTS:Pain with palpation was recorded with 15.8% of AK (n = 30/190), 15.1% of IEC (n = 345/299) and 29.0% invasive SCC (n = 247/853). Pain without palpation was respectively 1.1% (2/190), 4.0% (12/299) and 6.7% (57/853). Invasive SCC with increased surface diameters and deeper invasion recorded increased pain frequency. Pain did not vary significantly by the grade of differentiation in males. In females, well-differentiated SCC recorded more pain (45.4%; n = 473) than poorly differentiated SCC (9.1%; n = 11). Acantholytic SCC recorded more pain 48.7% (n = 29) than nonacantholytic SCC 35.2% (n = 824). Three out of five cases of PNI recorded pain. Pain intensity was not recorded, which was a limitation. CONCLUSION:Pain presence increases from AK to invasive SCC. Pain was more frequent in invasive SCC with increased surface diameter, deeper invasion, acantholysis and PNI. Pain frequency did not vary between the grades of differentiation in males. In females, pain was less frequent in poorly differentiated than in well-differentiated SCC.


背景: 疼痛可能与光化性角化病 (AK) 、表皮内癌 (IEC) 和浸润性鳞状细胞癌 (SCC) 有关,它们都可能表现出高风险特征。 目的: 检查与这三种情况相关的疼痛频率变化,并评估其侵袭性SCC表面直径、浸润深度、分化程度、棘层松解症和神经周围浸润 (PNI) 的存在。 方法: 前瞻性记录 2016-2018 期间澳大利亚三家机构的AK、IEC和SCC连续病例的疼痛。 结果: 15.8% 的AK (n = 30/190) 、 15.1% 的IEC (n = 345/299) 和 29.0% 的侵袭性SCC (n = 247/853) 记录了触诊疼痛。无触诊疼痛分别为 1.1% (2/190) 、 4.0% (12/299) 和 6.7% (57/853)。表面直径增加和浸润较深的侵袭性SCC记录到疼痛频率增加。疼痛在男性中的分化程度没有明显变化。在女性中,高分化SCC比低分化SCC (45.4%; n = 11) 记录到更多的疼痛 (473; n = 9.1%)。棘皮溶解型SCC记录的疼痛 48.7% (n = 29) 多于非棘皮溶解型SCC 35.2% (n = 824)。5 例PNI中有 3 例记录疼痛。没有记录疼痛强度,这是一个限制。 结论: 从AK到侵袭性SCC,疼痛存在增加。疼痛在浸润性SCC中更常见,表面直径增加,浸润更深,棘层松解和PNI。疼痛频率在男性分化等级之间没有变化。在女性中,低分化的SCC疼痛频率低于高分化的SCC。



作者列表:["Zhang B","Li L","Zhang N","Zhao M","Liu Y","Wei L","Ma L","Xu Z"]

METHODS::Blue rubber bleb naevus syndrome (BRBNS) is an extremely rare venous malformation that often manifests as multiple haemangioma-like lesions in the skin and gastrointestinal tract. The drug sirolimus plays a key role in the signalling pathway of angiogenesis and subsequent development of BRBNS and its use has been described in several case reports. We present a case series of four patients with BRBNS who exhibited good treatment response to sirolimus. All four patients were administered oral sirolimus at doses of 1.0-1.5 mg/m2 /day with a target drug level of 5-10 ng/mL and median treatment duration of 20 months. All patients had a reduction in the size of the lesions and a normalization of coagulopathy with tolerable drug adverse reactions at follow-up. Sirolimus may be effective and safe in paediatric patients with BRBNS. Further prospective studies are suggested to evaluate the long-term effectiveness of this drug.

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作者列表:["Pham CT","Juhasz M","Sung CT","Mesinkovska NA"]

METHODS:BACKGROUND:Human papillomavirus (HPV) infections are associated with common dermatologic and nondermatologic diseases. Although HPV vaccines are well established as preventive measures for genital warts and cervical neoplasia, their use as therapeutic agents deserves greater attention. OBJECTIVE:To evaluate the use of HPV vaccine(s) as a treatment modality for cutaneous and/or mucosal disease. METHODS:A primary literature search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in January 2019 by using the PubMed and Cochrane databases. RESULTS:A total of 63 articles with 4439 patients were included. The majority of patients with cutaneous warts, recurrent respiratory papillomatosis, and squamous and basal cell carcinomas were successfully treated with HPV vaccination. Preliminary data on patients with pre-existing anogenital warts, cervical intraepithelial neoplasia, anal intraepithelial neoplasia, and vulvar intraepithelial neoplasia is promising. LIMITATIONS:This review was limited by the lack of controls, patients' previous HPV vaccination status, and publication bias. CONCLUSION:The commercially available three-dose, quadrivalent HPV vaccine is a potential therapeutic option for the treatment of cutaneous warts, recurrent respiratory papillomatosis, and squamous and basal cell carcinomas. Noncommercially available HPV vaccines demonstrate therapeutic response for treating anogenital warts, cervical intraepithelial neoplasia, anal intraepithelial neoplasia, and vulvar intraepithelial neoplasia. The vaccine's efficacy as an adjunct therapy for HPV-associated cutaneous and/or mucosal disease warrants further exploration.

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作者列表:["Lang UE","Love NR","Cheung C","McCalmont TH","Kim J"]

METHODS::Our understanding of melanoma precursors and progression to melanoma has developed as a result of advances in the field of molecular diagnostics. We now better understand the potential for genetic heterogeneity within a single lesion. Combined tumors can pose a diagnostic challenge when deciding the line between benign and malignant, which in turn has direct implications for patient management. Primary cilia (PC) are ubiquitous sensory organelles that have essential functions in cellular proliferation, differentiation, and development. The ciliation index (percentage of ciliated melanocytes) has been shown to reliably differentiate melanoma, which fail to ciliate, from melanocytic nevi, which retain PC. We therefore analyzed the potential for using the ciliation index to differentiate benign and malignant components in combined melanocytic lesions. We collected patient samples (n = 10) of unequivocal combined lesions with both melanoma and associated nevus components. Melanocytes were highlighted with SOX10 and costained with gamma-Tubulin and acetylated alpha-Tubulin to highlight the basal body and cilium, respectively. The number of melanocytes retaining cilia under high-power microscopy was examined. The melanoma component had average of 4% ciliation (SD: 7%), whereas the associated nevus component was significantly higher with 59% ciliation (SD: 17%). These data show that PC may be a reliable means of distinguishing benign from malignant components within a single tumor. The ciliation index may be a helpful tool in distinguishing challenging cases of combined lesions of melanoma in situ with a dermal nevus component from invasive melanoma, thus promoting improved staging and clinical management.

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