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目的探讨糖尿病足坏疽合并恶性外周神经鞘瘤、黑色素瘤和鳞状细胞癌的临床病理学特点、诊断及鉴别诊断。方法对确诊为糖尿病足坏疽合并恶性外周神经鞘瘤、黑色素瘤和鳞状细胞癌的临床表现、组织学形态及免疫表型进行分析,并复习相关文献。结果 8例糖尿病足坏疽合并恶性外周神经鞘瘤、黑色素瘤和鳞状细胞癌的患者中,女性3例,男性5例,年龄57~77岁,平均65岁。肿瘤直径1~8 cm,平均5 cm;5例位于左足,3例位于右足。2例恶性外周神经鞘瘤细胞呈栅栏状排列,由纤维肉瘤样密集束状排列的梭形细胞组成,胞质丰富、淡染,核大、梭形;免疫组化:S-100、p53和vimentin(+),AE1/AE3、HMB-45和p16(-)。3例黑色素瘤细胞呈巢状排列,由梭形上皮样细胞组成,胞质较少、嗜酸性,细胞核有较明显的多形性及异染性;免疫组化:HMB45、melan-A、S-100和p53(+),AE1/AE3(-)。3例鳞状细胞癌细胞弥漫排列,由多角形上皮样细胞组成,胞质丰富、呈嗜酸性,细胞核增大、呈泡状,核仁明显;免疫组化:AE1/AE3、CK5/6、CK14、p53和p63(+),collagenⅣ(-)。8例均有皮肤破溃及感染。结论糖尿病足坏疽合并恶性肿瘤非常罕见,恶性程度高,常误诊为糖尿病足坏疽而漏诊,必要时活检行病理检查以期早诊断,早治疗,提高生存率。
Objective To investigate the clinicopathological characteristics, diagnosis and differential diagnosis of diabetic foot gangrene with malignant peripheral schwannoma, melanoma and squamous cell carcinoma. Methods The clinical manifestations, histological features and immunophenotypes of diabetic foot gangrene combined with malignant peripheral schwannoma, melanoma and squamous cell carcinoma were analyzed and relevant literatures were reviewed. Results Among the 8 patients with diabetic foot gangrene who had malignant peripheral schwannoma, melanoma and squamous cell carcinoma, there were 3 females and 5 males, aged from 57 to 77 years (mean, 65 years). The tumor diameter of 1 ~ 8 cm, an average of 5 cm; 5 cases in the left foot, 3 cases in the right foot. Two cases of malignant peripheral schwannoma cells were arranged in a palisading pattern, which consisted of fusiform sarcolemma-like spindle cells. The cytoplasm was abundant, lightly stained, large and spindle-shaped. Immunohistochemistry: S-100, p53 and vimentin (+), AE1 / AE3, HMB-45 and p16 (-). Three melanoma cells were nested and composed of spindle-shaped epithelial-like cells with less cytoplasm, eosinophilia and more obvious polymorphism and heterogeneity in nuclei. Immunohistochemistry: HMB45, melan-A, S -100 and p53 (+), AE1 / AE3 (-). 3 cases of squamous cell carcinoma cells diffusely arranged, composed of polygonal epithelial cells, rich in cytoplasm, eosinophilic, enlarged nucleus, vesicular, nucleolus obvious; immunohistochemistry: AE1 / AE3, CK5 / 6, CK14, p53 and p63 (+), collagenⅣ (-). 8 cases of skin ulceration and infection. Conclusions Diabetic foot gangrene with malignant tumor is very rare and has a high degree of malignancy. It is often misdiagnosed as diabetic foot gangrene and misdiagnosed. If necessary, pathological examination is performed biopsy to early diagnosis and early treatment to improve survival rate.