| Seborrheic keratosis is a kind of benign tumor within epidermal caused by slow maturation of keratinocytes, which occurs mainly in the elderly. The dermoscopic is a new developed noninvasive observationin digital image technology in the surface and the lower epidermis of human skin, when the morphological characteristics can not be recognized by naked eye,with great value for the clinical diagnosis of skin diseases.Pathological is the gold standard diagnosis of seborrheic keratosis, whether the dermoscopic morph-ology and pathological changes of seborrheic keratosis has correspondence, it has not been clarified yet.Seborrheic keratosis is kind of benign skin tumors, the occurrence of tumor is biological events of multifactor, multi-gene complex multistage, including genes associated with apoptosis which plays an essential effect in the process of tumorigenesis.Genes of Survivin and Livin are members of the protein inhibits apoptosis genes family factor, expressed in tumors but not in normal tissues. In our study, 100 cases diagnosed as seborrheic keratosis were observed under microscopy and the dermoscopic endoscopic findings were compared with pathological changes to analysis the relationships between dermoscopic of different manifestations of pathological types and Livin and survivin protein to evaluate the value of the dermoscopic in the diagnosis of seborrheic keratoses.Objective:To investigate the relationships between dermoscopic of different manifestations of pathological types and the protein Livin and survivin.Methods:100 patients diagnosed as seborrheic keratosis from our hospital clinic patients from June 2013 to October 2014 were selected. Patients diagnosed by using the dermoscopic and histopathology techniques were divide into groups according to endoscopic and pathological features to analyze the correspondence between dermoscopic manifestations and pathological changes. The expression level of Survivin and Livin gene with different dermoscopic performance were observed using immunohistoche-mistry for further exploration the relevance of Survivin and Livin gene and the dermoscopic performance in seborrheic keratoses.Results: 1 85 cases diagnosed clinically as seborrheic keratosis by dermoscopic frm 100 cases of patients were divided into the following four basic types: 1.1 The type of plaque: a total of 32 cases of browns plaque were covered with greasy scales on the surface and the plaque long axis and dermatoglyph performed consistent; 1.2 The type of Velvet: a total of 16 cases,of superficial plaque were consist of black cutin grain smicroscopically whose surface were dry and loose; 1.3 The type of flat papules: a total of 19 cases of papules were brown-black, slightly uplift,clear border,and the shape were similar to the flat warts; 1.4 The type of Verrucous hyperplasia: a total of 18 cases, based on brown patch, forming the common wart hyperplasia on the edge of the lesion side, smooth surface without burr, which were 3 cm in diameter. 2 Diagnosis results of histopathology86 cases diagnosed clinically as seborrheic keratosis according to the pathological from 100 cases of patients were divided into the following five basic types. 2.1 The type of keratinize: a total of 31 cases with epidermal hyperkeratosis and significant papilloma hyperplasia, while the stratum spinosum hypertrop-hy were not obvious, were mostly made up with squamous epidermis cells with only a small amount of basaloid cells and more angle of pseudocyst. 2.2 The type of acanthosis: a total of 25 cases were with obvious acanthosis, hyperkeratosis,lighter papilloma hyperplasia,thick skin formeing coarse mesh or a beam.there were more basal cells rather than squamous cell,Angle of pseudo cyst,true keratin cysts and melanin. 2.3 The type of nests: a total of 13 cases presented cell nests in the epidermis, part of the cell nests appeared small hyperchromatic, like skin epithelial tumors, while some cell nests were consists of larger basaloid cells with apparent intercellular bridges. 2.4 The type of adenoid: a total of 9 cases,were majority consists of the thin beam shaped epidermis cells, the beam stretched from the epidermis to the dermis and interweaved each other, the bundle were composed of two layers of glands basaloid cells, which were lack of keratin cysts, but more melanin 2.5 The sype of stimulus: a total of 6 cases were made up of more squamous flat ell forming squamous eddy, with more eosinophilic degeneration and minority spines release phenomenon. 3 The comparison beween diagnosis results of dermoscopic and histopath ology.Histopathological diagnosis is the gold standard in the diagnosis of seborrheic keratosis. Compared with the dermoscopic diagnosis, sensitivity, coincidence rate, total coincidence rate,misdiagnosis rate,missed diagnosis rate, Youden index and Kappa value of the dermoscopic in diagnosis of skin were respectively 97.67%, 92.86%, 97%, 7.14%, 2.33%,0.905 and 0.879. From statistical analying between the two diagnosis methods, there was no statistical significance of the differences(P>0.05), illustrating the high consist-ency between the dermoscopic and pathological diagnosis. 4 The relationship of dermoscopic and pathological classificationIn this study,a total of 84 cases were diagnosed as seborrheic keratosis according to both dermoscopic and pathological diagnosis and the distribution of the result of dermoscopic and pathological classification were as follows.Four groups of the dermoscopic performance were not parallel with the common pathological type.the difference was statistically significant(P <0.05),for the four pairwise comparison, any difference between the two groups also had significant(P=0.0083<0.05).The type of plaque in dermoscopic classification corresponded with the type of keratinize and followed by stratum spinosum hypertrophic in path-ological classification; The type of velvet corresponded with the type of velvet in pathological classification;The pathological changes of the flat papules type were the stratum spinosum hypertrophy; The type of verrucous proliferation corresponded with the type of adenoid or stimulation in pathological classification. 5 The expression level of Survivin and LivinThe expression level of Survivin proteinand Livin protein were different in four typesof seborrheic keratosis skin and in the normal, the difference is statistically significant(P<0.05).These two kinds of protein expressed higher in seborrheic diversification than in the normal skin(P<0.05), but between the four types of dermoscopic has no statistical significance difference(P>0.05). Positive rate of Livin protein and Survivin protein in the Seborrheic keratosis were similar(P>0.05).Conclusions:1 Compared with the pathological diagnosis, the dermoscopic has higher diagnostic consistency.2 Different seborrheic keratosis corresponded with different pathological types.The type of plaque in dermoscopic classification corresponded with the type of keratinize and followed by stratum spinosum hypertrophic in pathological classification;The type of velvet corresponded with the type of velvet in pathological classification;The pathological changes of the flat papules typewere the stratum spinosum hypertrophy; The type of verrucous proliferation corresponded with the type of adenoid or stimulation in pathological classification.3 Survivin and livin expressed higher in seborrheic keratosisof, declaring that development of seborrheic keratosis was closely related to apoptosis inhibition. Between the four types of dermoscopic has no statistical significance difference, suggested that survivin and livin participate in the pathogenesis of all types of dermoscopic. |
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