Carcinomul bazocelular vulvar-aspecte histologice-lb engleza

Similar to cutaneous basal cell carcinoma.

Epidemiology

2-8% of all vulvar malignancies
Usually women >60 years of age 
Mean age at diagnosis: 70 years (range 20-96 years)
Development of  BCC correlates to ultraviolet light exposure, but non sun exposed areas can also develop BCC
Caucasian women are affected more than those with pigmented skin
Sites
Tumors usually arise from cutaneous surface, but rarely affect mucosal epithelia of vulva
Pathophysiology
Chronic vulvar irritation (e.g. long term use of diapers) appears to be the most important contributing factor
Other proposed factors: ionizing radiation, arsenic, chronic inflammation, hamartomas, immune deficiency
Molecular alterations:
Activation of the Hedgehog signaling pathway leading to overexpression of GLI1 or GLI2 gene products
Loss of function mutations of PTCH1 or PTCH2 (My Cancer Genome – BCC)
Activating mutations of SMO
p53 mutations identified in many cases
Not related to HPV
Clinical features
Slow growing, painless lesion that may ulcerate
Itching, discomfort, bleeding, mass or swelling, ulcer and pain
Younger women (< 50 years) may not have many symptoms
Often mimics eczema, psoriasis or other inflammatory dermatoses that do not respond to standard therapies
Diagnosis of vulvar BCC almost never made at clinical examination

Gross description: Vegetating, ulcerated, pedunculated, infiltrative, nodular or pigmented lesions.

Micro description
Histologic examination is essential for diagnosis.
Features are similar to BCC elsewhere.
Proliferation of nests of small basal cells with high nuclear to cytoplasmic ratio, peripheral palisading and no obvious intercellular bridges.
Epidermal connection can often be identified.
Mitotic figures and apoptosis are frequently seen within the same nest
The surrounding stroma is loose and mucin-rich (hyaluronic acid), leading to retraction artifacts due to mucin shrinkage during tissue processing.
Presence of perineural infiltration and lymphovascular space involvement should be documented.
A wide variety of histologic types have been described; the following patterns are also clinically significant for management and prognosis:
Nodular/ulcerative
Diffuse (infiltrating, micronodular and morpheaform)
Superficial (multifocal)
Pigmented
Fibroepithelioma of Pinkus

IMAGINI

Atentie!! Din cauza copyright-ului am pus linkurile incomplete. Ca sa vedeti imaginile lipiti in fata linkului www. sau selectati linkul, click dreapta, go to.

flickr.com/photos/40764007@N08/13267198495/

flickr.com/photos/40764007@N08/13267347193/in/photostream/

flickr.com/photos/40764007@N08/13267540644/in/photostream/

flickr.com/photos/40764007@N08/13267344753/in/photostream/

flickr.com/photos/40764007@N08/13267537444/in/photostream/

flickr.com/photos/40764007@N08/13267188795/in/photostream/

flickr.com/photos/40764007@N08/13267533724/in/photostream/

flickr.com/photos/40764007@N08/13267336243/in/photostream/

Adenoid differentiation

ijpmonline.org/viewimage.asp?img=IndianJPatholMicrobiol_2012_55_4_583_107835_f2.jpg

Basophilic nodules with peripheral palisading

escholarship.org/uc/item/5hp4g829/2.jpg

Nodular BCC

http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-0566&html=1

Dermal tumor mases

ncbi.nlm.nih.gov/pmc/articles/PMC2763753/figure/F0002/

Infundibulocystic BCC

ncbi.nlm.nih.gov/pmc/articles/PMC3430110/figure/fig03/

With Paget’s disease

ncbi.nlm.nih.gov/pmc/articles/PMC3430110/figure/fig01/

Diffuse bcl2+

ijpmonline.org/viewimage.asp?img=IndianJPatholMicrobiol_2012_55_4_583_107835_f3.jpg

Differential diagnosis

  • Clinical differential diagnosis:

Bowen’s disease
Contact dermatitis
Lichen sclerosus
Lichen simplex chronicus
Melanoma
Paget’s disease
Psoriasis

  • Histological differential diagnosis:

Adnexal tumors including desmoplastic trichoepithelioma
Trichoblastoma

Anunțuri

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  1. […] că le-ar putea fi de folos și altor studenți. Nu îmi amintesc de unde am copiat acest articol (originalul în engleză), de aceea nu are link către siteul original! Este doar o copie și traducerea mea, NU ÎMI […]

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