毛囊来源肿瘤

 考虑毛发上皮瘤

新手学习，各位老师多多指教。

It seems that we have seen more basal cell carcinoma of the vulva here than my whole pathology career. I want to make a few points about making diagnosis of " Vulva Basal Cell Carcinoma". That is, you need have a deep breath before you make such a very unusual diagnosis. Vulva BCC is vanishingly rare, counts about 2% of all vulva malignancy. Vast majority (>95%)of vulva cancer is squamous cell carcinoma. We all know the prognosis between BCC and SCC is dramatically different. Most BCCs are local cancer with minimal potential to metastasize. In contrast, vulva SCC has great potential to metastasize. Therefore, when you make a diagnosis of vulva BCC, you basically tell clinicians and this patient: " You are fine after local resection of your BCC!". That is very risk approach since you most likely deal with a focal basaloid SCC, not a keratinizing BCC! Therefore, when you have a case sharing features between SCC and BCC, if you are not sure which side you should lean on, you should air on the side of SCC, not the BCC!

Now I like to share a painful mistake in our hospital recently. A older female patient went to dermatology clinic due to vulva itching and a about less than 1.0 CM nodule with superficial ulceration. Biopsy was sent to dermatopathologist, not GYN pathologist. Dermatopathologist made a diagnosis of vulvar BCC with focal keratin formation. Local excision of this lesion is done. A year later, the patient came back with inguinal LN metastasis and pelvic LN metastasis. Guess what is diagnosis of biopsy of inguical LN? KERATINIZING SQUAMOUS CELL CARCINOMA!!! When GYN pathologists  re-reviewed the previous biopsy, we all agree it was a vulva SCC with some kind of basaloid feature, NOT a BCC! I hope we all can learn lessons from this painful story! That is:  1) Have a deep breath before you act like a cavelier to render your diagnosis of "Vulva Basal Cell Carcinoma"! 2) If you have any question or hesitation, you need make sure you have totally rule out a vulva squamous cell carcinoma! 3) If you have to rush the case and are not sure which way to go, making a diagnosis of SCC rather than BCC! Statistically you have 95% of chance on the right side.

Again, pathology to me is not just toss couple photos or slides and everybody guess what the diagnosis is! A sound knowledge of clinical and pathological correlation is the foundation to be a great pathologist! Couple weeks ago, Dr. Wenxin Zheng and I along with Dr. Hatch (president of American Society of Gynecologic Oncology) and Dr. Belinson (a world-renown gynecologic oncologist and our previous Chairman of GYN Department at Cleveland Clinic)gave several "Tumor Boards or CLinicopathologic Correlation Conference" in Peking University, Fudan University and Zhongshan University along with Chinese genecologic oncologists. The purpose is to strengthen the close tie between pathologists and clinicians. I have learned a great deal in participating in such discussion and understand lot of issues I did not understand before by communicating with clinicians, especially Chinese clinicians. I encourage all pathologists here to get more and more interaction with clinical colleagues and making diagnosis not only based on morphology, but integrating biology and clinical management into our decision making process.