中华皮肤科杂志 ›› 2021, Vol. 54 ›› Issue (8): 677-682.doi: 10.35541/cjd.20201095

• 论著 • 上一篇    下一篇

204例皮角患者组织病理与临床分析

李婷1    徐明圆2    吴飞2    梁豫琳2    刘业强2   

  1. 1上海市嘉定区南翔医院皮肤科  201802；2上海市皮肤病医院  同济大学附属皮肤病医院病理科  200040
  • 收稿日期:2020-11-16 修回日期:2021-05-26 发布日期:2021-08-02
  • 通讯作者: 刘业强 E-mail:lyqdoctor@163.com
  • 基金资助:
    上海市卫计委中医薄弱领域专科建设项目（BR2K2016014）；上海申康医院发展中心临床科技创新项目（SHDC12020117）；上海市嘉定区医学重点学科建设项目（2020-jdyxzdxk-07）

Histopathological and clinical analysis of 204 patients with cutaneous horns

Li Ting1, Xu Mingyuan2, Wu Fei2, Liang Yulin2, Liu Yeqiang2   

  1. 1Department of Dermatology, Nanxiang Hospital of Jiading District, Shanghai 201802, China; 2Department of Pathology, Shanghai Skin Disease Hospital, Skin Disease Hospital of Tongji University, Shanghai 200040, China
  • Received:2020-11-16 Revised:2021-05-26 Published:2021-08-02
  • Contact: Liu Yeqiang E-mail:lyqdoctor@163.com
  • Supported by:
    Specialty Construction Project of Shanghai Municipal Commission of Health and Family Planning in the Weak Area of Traditional Chinese Medicine （BR2K2016014）; Clinical Science and Technology Innovation Project of Shanghai Shen?kang Hospital Development Center （SHDC12020117）; Shanghai Jiading District Key Medical Discipline Construction Project （2020-jdyxzdxk-07）

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摘要： 【摘要】 目的 分析皮角的组织病理与临床特征，探讨两者的相互关系。方法 回顾分析2014年1月至2020年5月在上海市皮肤病医院病理科经临床和组织病理检查确诊的204例皮角患者的临床和组织病理资料。结果 204例患者中，男88例，女116例，年龄（70.47 ± 14.76）岁，病程［M（P25，P75）］为6（6，24）个月。皮角单发201 例，多发3 例，共207个皮角，位于头面颈部163个（78.74%），躯干18个（8.70%），四肢26个（12.56%）。按皮角基底损害组织病理性质分类，良性皮角154个（74.40%），基底病变包括病毒疣129个，脂溢性角化病15个，内翻性毛囊角化病3个，毛鞘瘤皮角5个，化脓性肉芽肿1个和钙化上皮瘤1个；癌前皮角40个（19.32%），基底病变是光线性角化病；恶性皮角13个（6.28%），基底病变包括鲍恩病5个和鳞状细胞癌8个。癌前及恶性皮角患者平均年龄明显高于良性皮角（H = 4.05、3.16，均P < 0.01）。恶性皮角基底宽度大于癌前皮角及良性皮角（H = 2.74、3.49，P < 0.05、0.01），后两者之间差异无统计学意义（H = 0.73，P > 0.05）。癌前及恶性皮角高基比明显低于良性皮角（H = 4.06、3.72，均P < 0.01）。癌前皮角和恶性皮角基底红晕发生率明显高于良性皮角（χ2 = 29.57、6.23，P < 0.01或0.05）。恶性皮角出血结痂发生率明显高于良性皮角（χ2 = 4.89，P < 0.05）。结论 大部分皮角基底是良性病变，以病毒疣为主，癌前和恶性皮角约占1/4。男性、高龄、宽基底、低高基比、基底红晕、出血结痂可以作为早期识别恶性皮角基底的线索。

关键词: 角, 皮肤表现, 病理过程, 皮肤肿瘤, 疣, 皮角

Abstract: 【Abstract】 Objective To analyze clinical and histopathological features of cutaneous horns, and to explore their relationship. Methods A total of 204 patients with cutaneous horns confirmed by clinical and histopathological examinations were collected from Department of Pathology, Shanghai Skin Disease Hospital between January 2014 and May 2020, and their clinical and histopathological data were retrospectively analyzed. Results Among 204 patients, there were 88 males and 116 females with the age being 70.47 ± 14.76 years and median （P25，P75） course being 6（6, 24） months. Cutaneous horns were solitary in 201 cases, and multiple in 3. There were a total of 207 cutaneous horns, including 163（78.74%）located on the head, face and neck, 18 （8.70%） on the trunk and 26（12.56%） on the extremities. According to histopathological conditions at the base of the cutaneous horns, 154 （74.40%） cutaneous horns were considered to arise from benign lesions （named as benign horns）, including viral warts （n = 129）, seborrheic keratosis （n = 15）, inverted follicular keratosis （n = 3）, trichilemmomas （n = 5）, pyogenic granuloma （n = 1） and calcifying epithelioma （n = 1）; 40 （19.32%）were considered to arise from premalignant lesions （actinic keratosis） and named as premalignant horns; 13（6.28%） were considered to arise from malignant lesions （named as malignant horns）, including Bowen′s disease （n = 5） and squamous cell carcinoma （n = 8）. The average ages of patients with premalignant and malignant horns were significantly higher than those of patients with benign horns （H = 4.05, 3.16, respectively, both P < 0.01）. The base width of the malignant horns was significantly higher than that of the premalignant and benign horns （H = 2.74, 3.49, P < 0.05, 0.01, respectively）, and there was no significant difference between the premalignant and benign horns （H = 0.73, P > 0.05）. The height to base width ratio was significantly lower in the premalignant and malignant horns than in the benign horns （H = 4.06, 3.72, respectively, both P < 0.01）. The incidence rate of basal erythema was significantly higher in the premalignant and malignant horns than that in the benign horns （χ2 = 29.57, 6.23, P < 0.01, 0.05, respectively）, and bleeding and crusting occurred more frequently in the malignant horns compared with the benign horns （χ2 = 4.89, P < 0.05）. Conclusions The base of most cutaneous horns is benign, which mainly includes viral warts, and premalignant and malignant horns account for about a quarter. Male, older age, wide base, low ratio of the height to base width, basal erythema, history of bleeding and crusting can serve as clues to early recognition of malignant lesions at the base of cutaneous horns.

Key words: Horns, Skin manifestations, Pathological processes, Skin neoplasms, Warts, Cutaneous horn