A Rare Case Report: Clear Cell Variant of Squamous Cell Carcinoma and Literature Review

罕見病例報告：具有透明細胞特性的鱗狀上皮細胞癌及相關文獻回顧

邱宇任(Yu-Jen Chiu) ； 馬旭(Hsu Ma) ； 廖文傑(Wen-Chieh Liao)

《臺灣整形外科醫學會雜誌》 25卷2期 (2016/06) Pp. 136-143

摘要

背景：鱗狀細胞癌是第二最常見的皮膚癌，佔約20%的非黑素瘤皮膚癌。具有透明細胞特性的鱗狀細胞癌是一種罕見的變種。目的及目標：為了更清楚的了解此罕見變種的相關特性及治療預後，我們報告一個具有透明細胞特性的鱗狀上皮細胞癌的病例，並回顧相關文獻。病例報告：一位66歲的男性患者，因在下巴有個皮膚病灶而至本院門診求診。他抱怨腫瘤周圍有局部壓痛及易接觸性出血的症狀。切除性切片手術後的病理組織學檢查顯示多形癌細胞浸潤至真皮層，細胞質特性是透亮。免疫組織染色方面，過碘酸希夫瓦染色（periodic acid Schiff）和過碘酸希夫瓦澱粉？染色試驗（periodic acid Schiff with diastase）證實細胞質內是含有肝醣的。P40染色是瀰漫性陽性，EMA染色是局部性陽性，而Ber-EP4染色為陰性。因病理報告為惡性腫瘤，此病人又接受了一次廣泛性的腫瘤切除手術，切除的安全距離為5毫米。結論：罕見的透明細胞鱗狀細胞癌與典型鱗狀細胞癌，其識別是臨床意義。目前的文獻表明，此類細胞癌主要發生於頭部和頸部區域。對於初期癌症，單獨的手術切除是足夠。但是，由於現有文獻的非常稀少，明確的治療計劃和病情預後仍不清楚。期待未來有更多的相關文獻報告。

並列摘要

Background: Squamous cell carcinoma (SCC) is the second-most common type of skin cancer, representing about 20% of the non-melanoma skin cancers. Clear cell squamous cell carcinoma is a rare variant of SCC, characterized by keratinocytes that appear clear as a result of hydropic degeneration or glycogen accumulation. Aim and Objective: The purpose of this study was to characterize the clinical presentation and prognosis of the unusual variant of SCC through reporting of a rare case of clear cell SCC of skin on the face. Case presentation: A 66-year-old male patient came to the outpatient department of our hospital arising from a skin tumor on his chin for 2 years. He complained of the tumor as being subject to casual contact bleeding and local tenderness. The lesion was biopsied and sent for histopathological examination, with the clinical impression of BCC. Microscopic examination showed pleomorphic tumor nests infiltrating in the dermis. Clear cytoplasm, focal folliculocentricity and trichilemmal type keratinization were noted. However, peripheral palisading was not obvious. Intracytoplasmic glycogen was demonstrated by periodic acid Schiff (PAS) and periodic acid Schiff with diastase (dPAS) stains. Immunohistochemical stains for p40 was diffusely positive and epithelial membrane antigen (EMA) is focal positive, while for Ber-EP4 the result was negative. Under the preliminary diagnosis of malignancy, wide excision with a safe margin of 5mm was performed. Thereafter, histopathological examination showed that the margins of excised tissue were free of tumor. Conclusion: The recognition of the rare clear cell subtype of squamous cell carcinoma is of clinical significance to avoid misdiagnosis. Current literature reveals that clear cell SCC predominantly presents on the head and neck. In some cases, surgical excision alone might be adequate in the early stage. To characterize the clinical behavior and prognosis of this unusual variant of SCC, more reports on such cases should be documented.

並列關鍵字

clear cell ； squamous cell carcinoma