각화극세포종의 임상 및 병리조직학적 소견과 Ki-67, bcl-2, p53및 involucrin 단백 발현 양상에 관한 연구

초록

Background：Keratoacanthoma(KA) is common, benign cutaneous tumor that is most likely derived from hair follicle cells, and most often occurs on sun-exposed sites in light-skinned persons of middle age or older. Some authors believed that keratoacanthoma is a variant of squamous cell carcinoma(SCC), which it often resembles clinically and histopathologically. So, the distinction between KA and SCC is still debatable and a matter of speculation. Objective：The purpose of this study was to investigate the clinicohistopathologic findings of KA and its expression patterns, compared with SCC, of immunohistochemical staining using Ki-67, p53, bcl-2, and involucrin. Methods：This clinicohistopathologic study included 20 cases that had confirmed to KA. We performed the immunohistochemical staining with Ki-67, p53, bcl-2 in 14 and with involucrin in 13 Kas. Ki-67, p53, bcl-2, and involucrin staining was also performed in 6 SCCs. Results：All of Kas were solitary lesions. The male to female ratio was 1.2:1. The average age was 63.315.1 years and 11 of 20(55.5%) developed in sixth and seventh decades. The site of predilection were sun-exposed areas(85%) such as face, forearm, neck. Histologically, all of Kas were fully-developed lesions, and 17 of 20(85%) were dome or berry-shaped type II Kas. 17 of 20(85%) Kas showed exo-endophytic growth pattern. Common histologic findings in this study were horn-filled crater formation(80%), epidermal collarette(85%), epidermal proliferation in the perilesional area and the base of crater (100%), lateral extension tendency(80%), individual keratinization(75%), intraepithelial neutrophilic microabscess(65%), and eosinophilic glassy appearance in kertinocytic cytoplasm(95%). In immunohistochemical study using Ki-67, p53, bcl-2, and involucrin, there were no significant differences between KA and SCC except of the distribution pattern of Ki-67 positive cells in tumor. Ten of 14(71.4%) Kas revealed the marginal pattern, whereas no SCCs showed marginal pattern in Ki-67 staining. Conclusion：KA is a rapidly growing, cutaneous tumor that most often occurs on sun - exposed sites in sixth and seventh decades. Our results showed that KA is almost similar to SCC immunohistochemically, we suggest that KA is a type of SCC. And also, the characteristic distribution pattern of Ki-67 positve cells is helpful in making differentiation between Kas and SCCs.(Korean J Dermatol 2000;38(12)：1630~1640)

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