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NEJM:你的指甲健康么?甲床鳞状细胞癌-案例报道

2015-12-10 MedSci MedSci原创

女性,61岁,因左手大拇指甲床出现畸形并伴有无痛性溃疡史3年来院就诊。

女性,61岁,因左手大拇指甲床出现畸形并伴有无痛性溃疡史3年来院就诊。据该女患者主诉,以往她的左手大拇指没有出现过创伤史或长过疣。当年就诊时会诊医生诊断其患的是甲沟炎,并予抗生素进行治疗。但治疗效果并不理想。通过体格检查发现,其左手大拇指甲床呈现出不规则溃疡病变以及色素沉着,甲床的远端出现断裂消失。切开活检,活检标本的组织病理学检查显示中度分化的鳞状细胞癌。真菌涂片检验结果显示阴性。胸片和全身锝-99骨扫描未见有癌细胞转移的迹象。最后,该女患者接受会诊医生的建议,经手术彻底切除病灶。一般情况下,甲床的鳞状细胞癌是非常罕见的,而这种疾病往往可能是由如银屑病、寻常疣、甲沟炎和甲癣等疾病发展而来。因此,对于本案例的诊断在临床上很容易被漏诊从而导致治疗延误。原始出处:Feily A.Squamous-Cell Carcinoma of the Nail Bed. N Engl J Med. 2015 Dec 10;373(24):2357.

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1978429, encodeId=701519e8429d1, content=<a href='/topic/show?id=3b90e79787f' target=_blank style='color:#2F92EE;'>#细胞癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77978, encryptionId=3b90e79787f, topicName=细胞癌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, createdName=qingting, createdTime=Wed Oct 26 21:42:00 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1678392, encodeId=f04c16e839216, content=<a href='/topic/show?id=a6f85642ebd' target=_blank style='color:#2F92EE;'>#指甲#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56427, encryptionId=a6f85642ebd, topicName=指甲)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3ee927698160, createdName=ycmayy, createdTime=Wed Jun 22 10:42:00 CST 2016, time=2016-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=49703, encodeId=9df349e034e, content=少见, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Dec 27 22:31:00 CST 2015, time=2015-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=48567, encodeId=84e84856efa, content=罕见, beContent=null, objectType=article, channel=null, level=null, likeNumber=176, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sat Dec 26 17:35:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=46448, encodeId=2326464487c, content=很少见, beContent=null, objectType=article, channel=null, level=null, likeNumber=168, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4bfa83595, createdName=jetleo, createdTime=Wed Dec 16 22:38:00 CST 2015, time=2015-12-16, status=1, ipAttribution=)]
    2016-06-22 ycmayy
  3. [GetPortalCommentsPageByObjectIdResponse(id=1978429, encodeId=701519e8429d1, content=<a href='/topic/show?id=3b90e79787f' target=_blank style='color:#2F92EE;'>#细胞癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77978, encryptionId=3b90e79787f, topicName=细胞癌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, createdName=qingting, createdTime=Wed Oct 26 21:42:00 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1678392, encodeId=f04c16e839216, content=<a href='/topic/show?id=a6f85642ebd' target=_blank style='color:#2F92EE;'>#指甲#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56427, encryptionId=a6f85642ebd, topicName=指甲)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3ee927698160, createdName=ycmayy, createdTime=Wed Jun 22 10:42:00 CST 2016, time=2016-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=49703, encodeId=9df349e034e, content=少见, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Dec 27 22:31:00 CST 2015, time=2015-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=48567, encodeId=84e84856efa, content=罕见, beContent=null, objectType=article, channel=null, level=null, likeNumber=176, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sat Dec 26 17:35:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=46448, encodeId=2326464487c, content=很少见, beContent=null, objectType=article, channel=null, level=null, likeNumber=168, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4bfa83595, createdName=jetleo, createdTime=Wed Dec 16 22:38:00 CST 2015, time=2015-12-16, status=1, ipAttribution=)]
    2015-12-27 忠诚向上

    少见

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1978429, encodeId=701519e8429d1, content=<a href='/topic/show?id=3b90e79787f' target=_blank style='color:#2F92EE;'>#细胞癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77978, encryptionId=3b90e79787f, topicName=细胞癌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, createdName=qingting, createdTime=Wed Oct 26 21:42:00 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1678392, encodeId=f04c16e839216, content=<a href='/topic/show?id=a6f85642ebd' target=_blank style='color:#2F92EE;'>#指甲#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56427, encryptionId=a6f85642ebd, topicName=指甲)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3ee927698160, createdName=ycmayy, createdTime=Wed Jun 22 10:42:00 CST 2016, time=2016-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=49703, encodeId=9df349e034e, content=少见, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Dec 27 22:31:00 CST 2015, time=2015-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=48567, encodeId=84e84856efa, content=罕见, beContent=null, objectType=article, channel=null, level=null, likeNumber=176, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sat Dec 26 17:35:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=46448, encodeId=2326464487c, content=很少见, beContent=null, objectType=article, channel=null, level=null, likeNumber=168, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4bfa83595, createdName=jetleo, createdTime=Wed Dec 16 22:38:00 CST 2015, time=2015-12-16, status=1, ipAttribution=)]
    2015-12-26 hixiaoluo

    罕见

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1978429, encodeId=701519e8429d1, content=<a href='/topic/show?id=3b90e79787f' target=_blank style='color:#2F92EE;'>#细胞癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77978, encryptionId=3b90e79787f, topicName=细胞癌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e457184, createdName=qingting, createdTime=Wed Oct 26 21:42:00 CST 2016, time=2016-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1678392, encodeId=f04c16e839216, content=<a href='/topic/show?id=a6f85642ebd' target=_blank style='color:#2F92EE;'>#指甲#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56427, encryptionId=a6f85642ebd, topicName=指甲)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3ee927698160, createdName=ycmayy, createdTime=Wed Jun 22 10:42:00 CST 2016, time=2016-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=49703, encodeId=9df349e034e, content=少见, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Dec 27 22:31:00 CST 2015, time=2015-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=48567, encodeId=84e84856efa, content=罕见, beContent=null, objectType=article, channel=null, level=null, likeNumber=176, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sat Dec 26 17:35:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=46448, encodeId=2326464487c, content=很少见, beContent=null, objectType=article, channel=null, level=null, likeNumber=168, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4bfa83595, createdName=jetleo, createdTime=Wed Dec 16 22:38:00 CST 2015, time=2015-12-16, status=1, ipAttribution=)]
    2015-12-16 jetleo

    很少见

    0

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BMJ:甲床鳞状细胞癌案例报道

75岁老年男性,疑似右手食指甲沟炎4个月,使用抗生素和抗真菌治疗无效。X线平片:远端指骨的破坏。提示骨髓炎。外科手术发现边界清晰的指甲下肿块,活检证实为:甲床中度分化鳞状细胞癌(不伴感染)。尽管是什么原因导致的甲床鳞状细胞癌仍不清楚,但是是甲床常见的原发性肿瘤。该疾病很少出现转移,也没有发现过淋巴结病变。为清除肿瘤病灶,该患者经中间指骨行了截肢。要点:1.指甲下的鳞状细胞癌与很多良性病变表现类似,

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