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Master's Dissertation
DOI
https://doi.org/10.11606/D.5.2020.tde-18042021-193859
Document
Author
Full name
Marcela Veronica Ricaurte Jimenez
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2020
Supervisor
Committee
Nico, Marcello Menta Simonsen (President)
Miyamoto, Denise
Prigenzi, Karla Calaça Kabbach
Valente, Neusa Yuriko Sakai
Title in Portuguese
Microscopia confocal a laser na avaliação in vivo de tumores cutâneos de anexo
Keywords in Portuguese
Diagnóstico diferencial.
Microscopia confocal
Neoplasias cutâneas
Neoplasias das glândulas sebáceas, Método diagnóstico não invasivo
Neoplasias de anexos e de apêndices cutâneos
Siringoma
Tricoepitelioma
Abstract in Portuguese
INTRODUÇÃO: Os tumores cutâneos de anexo são definidos como um grupo diverso de neoplasias benignas e malignas, que apresentam diferenciação morfológica para um dos diferentes anexos cutâneos, seja unidade pilossebácea, écrina ou apócrina. Embora a maioria dos tumores cutâneos de anexo seja benigna e sua excisão cirúrgica, curativa, alguns podem fazer parte de síndromes associadas com neoplasias viscerais. O aspecto clínico das neoplasias anexiais é muitas vezes incaracterístico, com semelhanças clínicas, entre elas, cujo diagnóstico diferencial mais importante é o carcinoma basocelular, uma neoplasia maligna. O diagnóstico é feito por análise histopatológica; reações imunoistoquímicas são utilizadas em casos de dúvida quanto à diferenciação. A microscopia confocal de reflectância é um método de imagem não invasivo que revela a morfologia celular e nuclear da epiderme, colágeno e vasos sanguíneos circulantes na derme e outras estruturas como a unidade pilossebácea, na pele humana, in vivo. O objetivo deste trabalho foi analisar as características dos tumores cutâneos anexiais na microscopia confocal e compará-las com suas características histológicas, para demonstrar a utilidade desse método não invasivo no diagnóstico dessas lesões. MÉTODOS: estudo prospectivo com casos clínicos suspeitos de tumores cutâneos de anexo; no total, 13 casos foram incluídos, sendo 4 tricoepiteliomas, 1 sebaceoma, 7 siringomas e 1 fibrofoliculoma, tricodiscoma. Foi realizada a avaliação clínica, dermatoscópica, exame de microscopia confocal de reflectância e biópsia para análise histopatológica. Posteriormente foi realizada a comparação entre o exame de microscopia confocal e o exame histopatológico. RESULTADOS: O exame da microscopia confocal no tricoepitelioma evidenciou blocos celulares sólidos e cordões de células que, na histopatologia, correspondem a ninhos de células basaloides sólidas e ao padrão cribiforme, respectivamente, além de fenda interestromal e cistos córneos como áreas redondas brilhantes dentro dos blocos. No sebaceoma foram encontradas células grandes de formato cuboidal com citoplasma amplo brilhante e núcleo escuro, dispostas em blocos, porém células basaloides não puderam ser evidenciadas; nas descrições prévias de sebaceoma, adenoma sebáceo, foram evidentes, além dos sebócitos, células basaloides, na periferia. Os siringomas exibiram estruturas epiteliais com ramificações em formato de girino ou vírgula e, em seu interior, espaços císticos preenchidos por substância amorfa. O uso da MCR se mostrou útil para diferenciar, entre vários tumores anexiais ao vivo, no diagnóstico inicial, mesmo sem avaliação de melanoma amelanótico, neste trabalho, existem descrições prévias que diferenciam lesões róseas malignas e benignas com bons resultados. CONCLUSÃO: Foi possível avaliar com o uso da microscopia confocal que a pesar de ser um exame com limitação de profundidade os diferentes tumores de anexo, pois mesmo com as características da microscopia confocal de superfície, foi possível fazer uma diferenciação entre eles.
Title in English
Laser confocal microscopy in the in vivo evaluation of adnexal tumors
Keywords in English
adnexal and skin appendage
confocal
Diagnosis
differential.
Microscopy
Neoplasms
Non-invasive diagnostic method
Sebaceous gland neoplasms
Skin neoplasms
Syringoma
Trichoepithelioma
Abstract in English
INTRODUCTION: Cutaneous adnexal tumors are defined as a diverse group of benign and malignant neoplasms that present morphological differentiation for one of the different cutaneous attachments, such as pilosebaceous, eccrine or apocrine units. Most cutaneous adnexal tumors are benign and surgical excision is curative, but the presence of some of these tumors may be part of syndromes associated with visceral neoplasms. The clínical aspect of the adnexal neoplasms is often uncharacteristic, with clinical similarity between them, being the most important differential diagnosis the basal cell carcinoma, being this neoplasm malignant. The diagnosis is made by histopathological analysis; immunohistochemical reactions are used in case of doubt as to the differentiation. Confocal reflectance microscopy is a noninvasive imaging method that reveals the cellular and nuclear morphology of the epidermis, collagen, and circulating blood vessels in the dermis and other structures such as the pilosebaceous unit on human skin in vivo. The objective of this study was to analyze the characteristics of adnexal cutaneous tumors in confocal microscopy and to compare them with the histological characteristics of the same to demonstrate the utility of this noninvasive method in the diagnosis of these lesions. METHODS: prospective study with suspected cases of cutaneous adnexal tumors in a total of 13 cases were included: 4 trichoepitheliomas, 1 sebaceoma, 7 syringomas and 1 fibrofoliculoma / tricodiscoma. Clinical evaluation, dermoscopy, reflectance confocal microscopy examination and biopsy were performed for histopathological analysis. Subsequently, the comparison between the confocal microscopy examination and the histopathological examination was performed. RESULTS: The examination of the confocal microscopy in the trichoepithelioma evidenced solid cellular blocks and cords of cells that in the histopathology correspond to nests of solid basaloid cells and to the cribiform pattern respectively, in addition to the interstimal cleft and horny cysts as bright round areas within the blocks. In sebaceous cells large cube-shaped cells with a broad, bright cytoplasm and dark nucleus arranged in blocks were found, but basaloid cells could not be detected. In the previous descriptions of sebaceous / sebaceous adenoma, sebaceous cells were evident in the periphery. Syringomas exhibited epithelial structures with ramifications in the form of a tadpole or comma and within them cystic spaces filled with amorphous substance. The use of MCR has been shown to be useful for differentiating between several adnexal tumors in vivo at the initial diagnosis, even if no evaluation has been made in this work of amelanotic melanoma, there are already previous descriptions to differentiate benign and malignant lesions with good results. CONCLUSIONS: It was possible to evaluate the use of confocal microscopy in spite of being an examination that has the limitation of the depth of the different adnexal tumors because even with the characteristics of surface confocal microscopy it was possible to differentiate between them.
 
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Publishing Date
2021-06-16
 
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