The Study Of Differential Diagnosis Of The BCC And TB

1ObjectivesBasal cell carcinoma(BCC) has much difference with trichoblastoma in therapyand prognosis．In the past years, due to the lack of definite classifications anddistinctions of basal cell carcinoma and trichoblastoma, misdiagnosis andmismanagement were often encountered and patients underwent inappropriatetreatment.So we must differentiate basal cell carcinoma from trichoblastoma early andaccurately. It is difficult to distinguish them distinctly only by clinical presentationand pathologic features．In recent years, with the development of molecular biology，research in immunohistochemistry and genetics has increased，and providing us somenew identifications of evidence. However, there are differences in the benign andmalignant,biological behavior, treatment and prognosis between BCC and TB, so theclinical work of the differential diagnosis to them is very important. This study wasdesigned to analyze the expression of CD10, Bcl2, CyclinD1, EZH2and NSD2inBCC with TB, and in order to explore the role and value of them in both thediagnosis and differential diagnosis.2MethodsCollecting and reviewing patient’s pathology specimens confirmed40cases ofBCC and40cases of TB from Affiliated Hospital of Dali University Pathology fromJanuary2008to December2013, the specimens had been fixed with a solution of4%formaldehyde, we observed them under the microscope after conventional tissuedehydration, embedded in paraffin, sliced, and HE staining morphology; we appliedimmunohistochemistry (Envision TM two-step) to detect the expression of eachspecimen slices to CD10, Bcl2, CyclinD1, EZH2and NSD2. Through observation ofthe number and the degree of staining positive cells in each sample, we analyzed the relationship between clinicopathological features in BCC and TB and CD10, Bcl2,CyclinD1, EZH2and NSD2; comparing differences and relationship about CD10,Bcl2and CyclinD1in expression levels in both tumors.3Results3.1The basic histopathological features of BCC and TB:(1) BCC: Specimens ulcerspigmentation were visible. The cancer cells were palisading composition aroundcancer nests, which was surrounded by loose stroma, and visible crack-likecontraction between epithelial and mesenchymal nest. What is more, we can seerelatively deep invasion of cancer cells, some even broken the basal layer to thesuperficial muscle.(2) TB: Tumor tissue had rough surface in the gross specimen,and texture was relatively hard and wide substrate range. It was difficult to identifywith BCC with the naked eye, and ulcers were rare. Tumor cells arrange mostlyshaped collar or fence-like arrangement, the organization had the typical leaf and novisible gap between nests of epithelial and mesenchymal and non-invasive.3.2The immunohistochemical results of CD10expression and the relationshipbetween clinical pathological features with them in BCC and TB:There were37casesexpressing CD10(positive rate of92.5%) in40cases of BCC. Results of the tumorcells express CD10wereχ2=45.113, P=0<0.05, and the difference was statisticallysignificant.That is to say tumor cells expressing CD10in BCC and TB are significantdifferences. The stromal cells expressing CD10results: χ2=50.612, P=0<0.05,and the difference was statistically significant, the tumor cells of CD10expressionwere dominant in BCC compared with TB. The CD10expression in patients over theage of50were difference in patients50years of age in TB, people over the age of50showed a higher proportion (χ2=5.177, P=0.023<0.05).3.2The immunohistochemical results of Bcl2expression and the relationship betweenclinical pathological features with them in BCC and TB: Bcl2-positive rate was ashigh as97.5%in BCC, while positive rate was80%in TB. The inter-comparisonbetween weakly positive (+) and positive and strong positive (++~+++) of Bcl2in BCC and TB displayed that Bcl2(++~+++) expression in BCC were dominant compared with TB, while weakly positive expression in TB showed significantincreases in the trend, and the difference was statistically significant (χ2=66.093, P=0<0.05). Bcl2expression was difference (P=0.001) in the head, face and neck(93.5%) and the incidence of limb parts (28.6%) in TB, and there was higherincidence of head and face.3.4The immunohistochemical results of CyclinD1expression and the relationshipbetween clinical pathological features with them in BCC and TB: CyclinD1expression was82.5%in BCC and32.5%in TB, and its expression in BCC wassignificantly higher than in TB; the difference was statistically significant (χ2=20.460, P <0.05), and there were mostly positive and strongly positive in BCC, whilemost weakly positive in TB. CyclinD1expression was difference in the Han nati-onality(91.2%) and in the Bai nationality(40%),and it was statistically significant (P=0.019<0.05).3.5The immunohistochemical results of EZH2and NSD2expression and therelationship between clinical pathological features with them in BCC and TB: EZH2and NSD2expressions were not statistically significant between BCC and TB. It canbe considered that EZH2and NSD2expressions were not useful for differentialdiagnosis of BCC and TB. NSD2expression in female ratio (83.3%) was higher thanmen (43.8%) in BCC, and statistically significant (χ2=6.857, P=0.009).3.6The relationship of expressions of CD10, Bcl2and CyclinD1in BCC and TB:There were differences in the test results of CyclinD1and CD10in TB,CD10-positive rate was higher than CyclinD1, and the difference was statisticallysignificant. Bcl2and CyclinD1test results differed, Bcl2-positive rate was higher thanCyclinD1, and the difference was statistically significant. Only value changed toothers.4Conclusion4.1Basic pathological changes were consistent with the tradition in BCC and TB, butits reference value was smaller in the identification of the two.4.2CD10expression has a significant difference in tumor cells and stromal cells of BCC and TB. in tumor cells of CD10expression were dominant in BCC comparedwith TB, and stromal cells expressing CD10were dominant in TB.4.3Positive and strong positive expression of Bcl2in BCC was dominant than TB,and TB weakly positive expression showed significantly increased, and the trend maybe initially speculated that if a large number of strong positive tumors expressingBcl2, it supported the diagnosis of BCC, supported TB on the contrary.4.4CyclinD1expression in BCC was significantly higher than TB. There was morepositive and strongly positive in BCC, and most weakly positive in TB. Presumably ithad the same differential diagnosis with Bcl2in both BCC and TB.4.5Analysis the relationship between CD10, Bcl2, CyclinD1, EZH2and NSD2andclinical and pathological features in BCC and TB displays that CyclinD1expressionin the Han nationality was significantly higher than in the Bai nationality in BCC;NSD2expressed in women was higher than men. CD10expression in patients overthe age of50was higher than below50in TB, Bcl2expression in the limbs, head,face and neck was higher than the diseased parts. Relations of them are correlated, thespecific mechanism needs further study.4.6CD10positive rate was general higher than CyclinD1in TB,and the positive rateof Bcl2was higher than CyclinD1, and suggested that CD10and Bcl2had relativelyhigh positive expression rates in TB, but no correlation among the factors.