小汗腺汗孔癌局部淋巴结转移

报告1例肝细胞癌术后小汗腺汗孔癌伴局部淋巴结转移。患者男,60岁。右侧腹股沟斑块伴瘙痒3年。既往史:肝癌术后3年。皮损组织病理检查:真皮内见大量上皮样细胞组成的瘤团,肿瘤细胞核大、深染,核仁突出,核分裂象增多,瘤团内可见管腔样结构。淋巴结组织病理检查:淋巴结结构内可见上皮样细胞组成的瘤团。免疫组化:上皮细胞膜抗原(EMA)(+)。诊断:小汗腺汗孔癌局部淋巴结转移,肝癌术后。     

皮脂腺瘤31例临床病理分析

目的：对皮脂腺瘤进行临床病理分析。方法回顾性分析31例皮脂腺瘤患者的临床病理资料,结合免疫组化,总结其临床病理学特征。结果31例皮脂腺瘤中男9例,女22例,年龄（53.90±15.40）岁,病程（9.41±13.75）年,皮损位于面部者最常见,形态为丘疹,颜色分别呈红色、黄红色、正常肤色、淡褐色,大多无明显自觉症状。组织病理检查显示,肿瘤位于真皮内,所有肿瘤组织结构对称,其中9例与表皮相连。肿瘤细胞为基底样细胞及少许成熟皮脂腺细胞和部分过渡细胞,26例肿瘤组织中偶见成熟皮脂腺细胞（<1%）,2例成熟皮脂腺细胞<20%,3例成熟皮脂腺细胞占20%~40%。5例部分区域偶见核分裂像。1例合并小汗腺汗孔瘤。31例均可见数量不等的导管。免疫组化结果显示,上皮膜抗原在皮脂腺瘤导管及成熟皮脂腺细胞全部呈阳性表达,上皮抗原在所有皮脂腺瘤中均不表达,20例皮脂腺瘤的导管癌胚抗原阳性,24例雄激素受体阳性,28例D2?40阳性。结论皮脂腺瘤的诊断主要依靠组织病理检查。免疫组化检查抗上皮膜抗原抗体、抗雄激素受体抗体和D2?40的组合有利于与其他肿瘤鉴别。     

皮脂腺痣并发基底细胞癌及管状乳头状大汗腺腺瘤

报告1例皮脂腺痣并发基底细胞癌及管状乳头状大汗腺腺瘤。患者男,43岁。因右侧头部斑块43年就诊。皮肤科检查:右侧头部见淡黄色丘疹、结节及疣状斑块,质软,边界清楚,局部见数个大小不等黑色结节。皮损组织病理检查示(1)切片右侧:表皮角化过度伴角化不全,真皮浅、中层可见大小不等的肿瘤细胞团块,部分和表皮相连,肿瘤细胞团块由基底样细胞组成,肿瘤团块周边细胞呈栅栏状排列并可见收缩间隙;(2)切片左侧:表皮角化过度、棘层肥厚,乳头瘤样增生,真皮浅、中层可见增生的皮脂腺及以淋巴细胞为主的炎性细胞浸润,真皮深层见大汗腺分布,形成较多管腔样结构,管腔内见大汗腺呈乳头状突入管腔。     

上皮样肉瘤

报告1例上皮样肉瘤.患者男,19岁.右侧臀部出现结节并渐增多伴破溃4个月来诊.皮损组织病理检查显示真皮及皮下组织内有一肿瘤浸润,瘤细胞由上皮样细胞和梭形细胞构成,部分细胞有异形性,瘤团内见小的坏死灶.免疫组化染色显示肿瘤细胞表达角蛋白(CK)和波形蛋白(VIM),而不表达CD34、平滑肌肌动蛋白(SMA)、上皮膜抗原(EMA)、S-100蛋白及CD68.患者的临床表现、组织病理改变及免疫组化染色均符合上皮样肉瘤的特点.     

皮脂腺痣并发色素性毛母细胞瘤

报告2例皮脂腺痣并发色素性毛母细胞瘤。患者分别为40岁和38岁中年男性,临床均表现为出生时即有头、面部蜡样斑块,青春期后在其基础上出现色素性肿块。皮损组织病理检查:表皮大致正常,真皮下可见边界清楚无包膜的结节,肿瘤细胞呈基底细胞样,肿瘤内及周围见大量黑素沉着。2例均诊断为皮脂腺痣并发色素性毛母细胞瘤。     

臀部疣状皮肤结核误诊1例

患儿女,10岁,右臀部环状斑块8余年,曾多次误诊为股癣。皮损组织病理示:表皮角化不全,毛囊角栓,表皮假上皮瘤样增生;真皮浅中层弥漫炎细胞浸润,以淋巴细胞为主;真皮内可见上皮样细胞结节,浸润的细胞有淋巴细胞、多核巨细胞及组织细胞等。抗酸染色(-),PPD试验(3+)。诊断:疣状皮肤结核。     

上皮样肉瘤

报告1例跖部上皮样肉瘤.患者男,40岁.右足跖部结节2年,溃疡4～5个月.皮肤科检查:右足跖中央一5 cm×2 cm、深约1 cm的溃疡,周边少许肉芽样组织生长.皮损组织病理检查:真皮中下部可见栅状肉芽肿样瘤细胞团块,中央有坏死表现,周边主要由上皮样细胞和梭形细胞组成,核分裂象增多.免疫组化染色显示肿瘤细胞表达细胞角蛋白(CK)、上皮膜抗原(EMA)、波形蛋白(vimentin)和CD34,而不表达CD31和S-100蛋白.患者的临床表现、组织病理改变及免疫组化染色均符合上皮样肉瘤的特点.     

皮脂腺痣合并毛母细胞瘤1例

 报告1例皮脂腺痣合并毛母细胞瘤。患者男,39岁。左面部皮疹30余年,无自觉症状。皮肤专科情况：左面部见一个4 cm× 2 cm大小的皮色斑块,表面粗糙。斑块基础上可见两个约黄豆大小、表面光滑的蓝灰色半球形肿物和一个黄豆大小的乳头状淡红色肿物,质中。浅表淋巴结未触及肿大。皮肤镜下可见蓝灰色均质结构、分枝状血管、黄白色叶状结构。皮损组织病理示：真皮浅层内可见大量皮脂腺、由基底样细胞构成的上皮性肿瘤,伴色素沉着,肿瘤间质纤维组织增生,基底样细胞具有毛囊特征。免疫组化示AR(-), Ki-67（15%+）, BCL-2（+）,CD10(灶性+),CD34(-),CK20（散在+）,Ber-EP4（+）。结合临床表现及病理检查,诊断为皮脂腺痣合并毛母细胞瘤。手术完整切除皮损,随访半年无复发。     

朗格汉斯细胞肉瘤

报告1例朗格汉斯细胞肉瘤。患者男,78岁。躯干、四肢红色丘疹、斑块7个月。皮疹渐增大,增多,部分融合,伴明显瘙痒。皮损组织病理检查示:表皮内及真皮浅层可见较多上皮样细胞增生,胞质丰富呈嗜酸性,细胞核大、深染,核仁明显,有明显的异形性和异常核分裂象。免疫组化结果显示肿瘤细胞S-100蛋白、CD1a和CD207阳性,CD68阴性。结合临床、组织病理及免疫组化结果诊断为朗格汉斯细胞肉瘤。     

头部肌上皮瘤

报告1例头部肌上皮瘤.患者男,42岁.发现头皮肿物2年余,无自觉症状.皮肤科检查:头顶部可见一直径为1cm的半球形红色肿物,边界清楚,表面光滑,无破溃,伴有毛细血管扩张,质地较硬,无压痛.完全切除肿瘤后组织病理检查示:表皮大致正常,真皮内可见边界清楚的结节.结节内肿瘤细胞呈上皮样或浆细胞样,细胞间基质呈明显玻璃样变性.变性 的纤维隔将细胞团分割成条索状、小梁状或团块状.免疫组化学染色:肿瘤细胞CK强阳性、S-100蛋白灶性阳性、P63弥漫性强阳性.结合临床、皮损组织病理检查及免疫组化染色结果确诊为皮肤肌上皮瘤.患者术后1年无复发,目前仍在随访中.     

无色素性黑素瘤误诊为表皮囊肿1例

患者男,39岁。头部红色结节、斑块2年。2年前患者头部出现一黄豆大红色结节,当地医院以"表皮囊肿"相继予激光和手术治疗,皮损均复发。皮损组织病理示:表皮与真皮交界处和真皮内瘤细胞呈巢状分布,肿瘤细胞大小不等,核深染,具显著异型性,肿瘤细胞内无明显黑素颗粒。免疫组化检查:瘤细胞表达S-100及Melan-A。CT检查示肺转移癌。诊断:无色素性黑素瘤。     

黏蛋白痣一例

患者,男,28岁。右侧腰部出现多发褐色丘疹、斑块10年。皮肤科查体：右侧腰腹部散在粟粒至蚕豆大褐色丘疹、斑块,部分融合成片。皮肤组织病理示：表皮角化过度伴角化不全、棘层肥厚,呈疣状增生,表皮突延长,有散在或小片状的淋巴细胞及组织细胞浸润。阿新兰染色阳性。诊断：黏蛋白痣。患者拒绝治疗。     

Nasal natural killer/T cell lymphoma with cutaneous involvement: case report and Chinese literature review reported in China mainland

Nasal natural killer (NK)/T cell lymphoma is an Epstein-Barr virus (EBV) associated lymphoma that arises in the nasal area and aggressively invades surrounding tissues. Our patient was a 48-year-old male who had had nasal obstruction and nasal discharge for 2 years and infiltrating plaques and necrosis on his nasal dorsum for three months. He developed fever and fatigue two weeks before admission. Biopsy from both skin and nasal mucosa revealed atypical medium-sized tumor cells infiltrating into the dermis. Immunohistochemical studies revealed that the tumor cells were UCHL-1, cytoplasmic CD3, CD56, TIA-1, and granzyme B positive, and CD8 and CD20 negative. In situ hybridization for EBV-DNA was positive. Clonal TCRb and TCRg gene rearrangement were negative. The patient was treated with cyclophosphamide, vincristine, and prednisone (COP) and with local radiotherapy, but he died 20 days later. We reviewed the cases of nasal NK/T cell lymphoma reported in mainland China in the Chinese literature during the last 5 years.     

皮肤毛发平滑肌瘤一例

53岁女性患者,左上肢伸侧大量红色丘疹、结节18年。皮损组织病理示:表皮轻度增厚,表皮突不规则向下延伸,基底层黑素增加,真皮浅中层可见境界不清楚的肿瘤细胞浸润,肿瘤细胞呈梭形、胞质嗜酸性,核呈细长梭形、两端钝圆、位于细胞中央,未见异形性及核分裂像;Masson三色染色:肿瘤细胞被染成红色,其间夹杂少量被染成蓝色的胶原纤维;α-SMA染色阳性。诊断:皮肤毛发平滑肌瘤。患者无明显自觉症状,故未行治疗。     

硬皮病样皮肤转移性恶性纤维组织细胞瘤1例

报告1例硬皮病样皮肤转移性恶性纤维组织细胞瘤。患者男,60岁。面颊及颈部皮肤硬韧1个半月。病理检查示:真皮浅中层胶原纤维间见散在或密集的类似成纤维细胞样细胞、组织细胞样细胞浸润,细胞核大而深染,呈长梭形及圆形,小血管腔内也见核大深染的细胞及多核巨细胞。免疫组化示:CD68(+),CD34,CK,SMA均阴性。诊断:皮肤转移性恶性纤维组织细胞瘤。     

原发皮肤CD30阳性间变大细胞淋巴瘤七例临床病理分析

目的 探讨原发皮肤CD30阳性间变大细胞淋巴瘤（PC-ALCL）的临床与组织病理学特征。 方法 回顾性分析7例PC-ALCL患者的临床及病理资料情况。 结果 7例患者中,男6例,女1例,平均发病年龄52岁。皮损为红色结节、肿块和（或）斑块,3例多发,4例单发,6例伴溃疡形成。所有患者均未见系统受累。组织病理改变：肿瘤细胞在真皮内弥漫性分布,细胞体积大,胞质丰富,胞核呈异形改变,可见核分裂象。肿瘤细胞CD30和细胞毒蛋白阳性,CD20、CD56、间变性淋巴瘤激酶（ALK）和EB病毒编码小RNA原位杂交均阴性。结论 PC-ALCL是一种少见的原发于皮肤的低度恶性T细胞淋巴瘤,结合临床表现、皮损组织病理及免疫组化检查可确诊,罕见系统受累及转移。     

皮肤结核2例

报告2例皮肤结核,例1全身皮肤散在红斑,结节7年,例2左肩背部有暗红色斑块18年,2例患者皮损组织病理检查示真皮内有上皮样细胞团块,团块内及团块周围有淋巴细胞浸润,皮损组织真菌培养均阴性。皮损组织液抗酸染色涂片见点状或短棒状杆菌,组织液培养8-10周见阳性菌落生长。对菌落行PCR检测,结果检测出结核杆菌。     

Pseudocarcinomatous hyperplasia mimicking squamous cell carcinoma in a case of CD56‐positive cytotoxic T‐cell lymphoma

We present the case of an 84‐year‐old patient with a cutaneous CD56 positive cytotoxic T‐cell lymphoma associated with substantial pseudocarcinomatous hyperplasia mimicking squamous cell carcinoma (SCC). The patient presented with a 7‐month history of several progressive, ulcerated plaques on his right forearm. An initial biopsy showed changes consistent with a diagnosis of SCC for which the patient underwent surgical treatment. Several months later, the patient developed recurrent ulcerated plaques on the right forearm of which several biopsies were performed. The biopsies repeatedly showed marked pseudocarcinomatous hyperplasia resembling SCC. Deeper punch biopsies, however, showed a dense superficial and deep infiltrate of markedly atypical lymphocytes. Immunohistochemical analysis revealed strong positive staining for CD3, CD8, CD56 with negative stains for CD30 and Epstein‐Barr virus‐encoded small non‐polyadenylated RNAs (EBER). Staining for beta F1 and gamma‐delta T‐cell receptor (γδ TCR) were both negative. This constellation was most consistent with a diagnosis of cutaneous peripheral T‐cell lymphoma, unspecified in association with marked pseudocarcinomatous hyperplasia. Our case adds cutaneous peripheral T‐cell lymphoma, unspecified to the list of conditions associated with pseudocarcinomatous hyperplasia (PCH) and illustrates once again the potential pitfalls of distinguishing marked pseudocarcinomatous hyperplasia from SCC.     

Kaposi Sarcoma in a Patient with Chronic Renal Failure Undergoing Dialysis

Kaposi sarcoma (KS) is a multicentric proliferative vascular tumor involving the skin and other organs. Human herpesvirus 8 (HHV-8) has been detected in KS lesions and is considered the putative causative agent of KS. The relationship between chronic renal failure, HHV-8, and KS is not clear. KS appears to develop in association with renal transplantation, but is unlikely with dialysis, and there have been few reports on this. Here, we report the case of a 51-year-old man, who underwent peritoneal dialysis to treat chronic renal failure, and presented with multiple brownish plaques on his soles. On histopathological examination, abnormally proliferated vessels, vascular slits, and spindle-shaped cells were seen in the dermis. Immunohistochemical staining for HHV-8 was positive. This case is another example in which factors other than immunosuppression contributed to the development of KS, due to activation of HHV-8.     

易误诊的二期梅毒一例

患者,男,34岁。左鼻孔、阴囊起无痛性丘疹、结节2个月。皮肤科检查：左鼻孔见一枚黄豆大丘疹,阴囊根部可见一蚕豆大结节。临床诊断为肿瘤,予手术切除。术前血液常规检查示：TPPA≥1∶2560;TRUST:1∶4;TPAB-ELISA:阳性。阴囊结节活检病理示表皮突增生延长,表皮内可见角化物,真皮浅层可见包含大量浆细胞的炎细胞浸润巢,诊断为二期梅毒。