毛母质瘤40例临床病理分析

目的：探讨毛母质瘤的临床和病理特点。方法：对40例毛母质瘤进行了临床资料和组织病理回顾性分析。结果：男女发病比例为1：1，平均发病年龄21．2岁，平均病程2．3年，10岁以内发病者20％，20岁以内者加％，30～40岁35％，除1例多发外，均为单发的质地较硬的皮下结节，有压痛者7例（17．5％），病理上均可见到影细胞。发现3例特殊类型，1例表现为穿通型，其中2例为与表皮囊肿相关的毛母质瘤。临床正确诊断率15％。结论：毛母质瘤少见，临床表现多样，影细胞是确诊的重要依据和必要条件。病理上可以出现特殊类型。     

播散性红色毛癣菌肉芽肿一例

目的报道1例播散性红色毛癣菌肉芽肿。方法对患者的临床资料、真菌学检查、组织病理及疗效进行分析。结果患者为46岁女性,手足、躯干红斑、脱屑30年,头皮、躯干、上肢结节、溃破2年。检查见头皮、颈、躯干和上肢有紫红色浸润性斑块、结节,部分皮损表面破溃、渗液、结痂。皮损内穿刺液及甲直接镜检菌丝阳性,培养为红色毛癣菌生长。皮损病理检查:真皮内可见上皮细胞样肉芽肿,其中央大片坏死,周围见结节样上皮样细胞团块,伴少许多核巨细胞、淋巴细胞及嗜酸粒细胞浸润。PAS染色真皮内见真菌菌丝。诊断为播散性红色毛癣菌肉芽肿。伊曲康唑治疗3个月后皮损消退,遗留萎缩性瘢痕。用药期间未见不良反应。结论播散性红色毛癣菌肉芽肿临床少见,伊曲康唑疗效满意。     

国内首见球毛过壳菌所致暗色丝也霉病

报告一例由球毛壳菌所致的皮肤和甲暗色丝孢霉病。患者男性，１３岁，江苏农民。主诉面部，四肢，掌跖，臂部出现暗红色结节，斑块伴溃疡和结励壳样厚痂５年。     

皮肤混合瘤17例临床及组织病理分析

目的探讨皮肤混合瘤临床、组织病理特点及鉴别诊断。方法回顾性归纳分析华中科技大学同济医学院附属协和医院皮肤科1999—2017年17例皮肤混合瘤患者的临床病理资料。结果 17例患者中14例向顶泌汗腺分化,其中10例有明显的管泡状结构,9例有导管结构,4例见角质囊肿及毛乳头结构;17例患者均见黏液样、纤维化间质,间质中均见浆细胞样细胞、多角形细胞、梭形细胞,1例出现软骨样间质;初诊误诊15例,误诊率为88.24%。结论皮肤混合瘤虽然组织病理学上具有特征性,但临床误诊率极高,应引起临床医生的重视。     

125例不同部位色素痣样皮损临床病理特征及误诊原因分析

目的 比较不同部位的125例色素痣样皮损的临床诊断与病理诊断的符合率,分析临床误诊的原因,提高皮肤科医生对色素痣的认识。方法 回顾性分析某医院门诊2019年1月至12月临床诊断为色素痣且均行手术切除及病理检查的125例患者的临床及病理资料。分析不同年龄和性别中各种色素痣样皮损的分布情况。结果 125例患者中,病理诊断为色素痣75例、脂溢性角化29例、蓝痣2例、皮肤纤维瘤4例、疣状痣4例、基底细胞癌1例,其他如角化棘皮瘤、血管瘤、日光性角化、毛母质瘤等共10例;其中的75例色素痣患者包括交界痣7例(9.3%)、皮内痣49例(65.3%)、混合痣19例(25.4%)。结论色素痣样皮损的病理类型较多,虽然是常见多发病,但临床诊断符合率较低,正确诊断必须结合病理检查;并且发现特定病理类型的色素痣与发病部位有相关性。     

毛母质瘤25例临床分析

毛母质瘤又称毛发基质瘤或钙化上皮瘤，是一种少见的良性肿瘤，以毛发基质上皮或毛母质细胞分化为特点[1]，临床表现形式多样。常因临床医生对其认识不足，导致误诊率高[2]。本文对2008-2013年间我院经病理确诊为毛母质瘤的25例病例进行分析，以增强对毛母质瘤的临床及病理特征的认识，进一步提高临床诊断水平。     

老年性雀斑样痣25例临床病理分析

为探讨老年雀斑样痣临床与病理关系，对我科病理室１９８９年７月～１９９７年７月间所诊断的２５例资料较完整的病例进行了临床病理分析，结果如下。临床资料男１６例，女９例，年龄６０～７５岁，病程１月～３０年。病检部位：头面、颈部１５例，背部３例，腰腹部２例。...     

水疱型毛母质瘤3例分析

本文详述3例水疱型毛母质瘤临床、病理特点及治疗方法,分析了水疱型毛母质瘤临床及病理特点。3例患者手术切除后经过随访治疗效果满意。水疱型毛母质瘤有其独特的临床及病理特点,手术切除是最佳治疗手段。     

毛霉病七例临床与病理分析

目的 探讨毛霉病的临床表现、预后和病理表现之间可能存在的关系。方法 回顾性分析1989-2006年我院诊治的7例经真菌培养证实为毛霉病患者的临床资料和病理切片。结果 7例中鼻脑毛霉病1例、皮肤毛霉病6例，其中2例为毛霉性坏死性筋膜炎。鼻脑毛霉病和毛霉性坏死性筋膜炎患者病情进展快，均以死亡告终；其皮损组织病理表现呈混合性炎症细胞浸润，坏死明显，可见大量菌丝和侵血管现象。4例以浸润性红斑为主要表现的皮肤毛霉病患者病情进展慢，有2例已治愈；其皮损组织病理呈肉芽肿性炎症，菌丝较少，未见明显的侵血管现象。7例均未见明确的菌丝侵神经现象。结论 毛霉病皮损组织病理表现呈混合性炎症细胞浸润，菌丝多，出现明显侵血管现象者预后较差。     

Majocchi肉芽肿1例临床分析及其病原菌分子鉴定

分析我科收治的1例Majocchi肉芽肿的临床、病理特点、真菌学及分子生物学鉴定结果，并对文献进行复习。该患者以右侧面颊部红色斑块状损害10余年为主要症状，病理检查示上皮样细胞肉芽肿，PAS染色见分枝分隔菌丝。活检组织培养出丝状真菌，37℃生长良好。分子生物学ITS1、ITS2和D1/D2区测序结果示：病原菌与红色毛癣菌标准株ATCC28188的相似性为100%。本病例为耐热型红色毛癣菌引起的Majocchi肉芽肿。     

Incidental acantholysis

The incidental finding of microscopic foci of acantholytic dyskeratosis, reproducing the histological pattern of Darier's disease, has been the subject of a number of papers in the last few years. In contrast, the incidental finding of other types of acantholysis has not been mentioned in the literature. In the last 5 years, we have noticed such a microscopic finding in 14 biopsy specimens (0.15% of our cutaneous specimens). They were from 13 patients (7 men and 6 women); their ages ranged from 37 to 79 years (mean, 63). Three lesions were located on the head, 7 on the trunk, and 4 on the limbs. The histological diagnoses were basal cell carcinoma (6 cases), keratoacanthoma (2 cases), psoriasis (2 cases), elastolytic granuloma, acral arteriovenous angioma, tinea corporis, and leukocytoclastic vasculitis (1 case each). The histological patterns of the acantholytic foci simulated pemphigus vulgaris (9 cases), superficial pemphigus (1 case), Hailey-Hailey disease (3 cases), and unclassifiable acantholysis (1 case). None of the patients had familial or personal history of acantholytic disorders. We propose a classification of the primary acantholytic disorders based on both their acantholytic pattern and their clinical extent.     

Skin cancer and psoralen plus UVA: a retrospective study of 106 patients exposed to a great number of PUVA treatments

INTRODUCTION: The benefits of PUVAtherapy in many dermatological affections are well known. Its carcinogenic role in the long term has been assessed varyingly in American and European series. OBJECTIVE: The aim of this study was to assess the role of PUVA in the onset of cancers of the skin. METHODS: Retrospective study of patients presenting with psoriasis and followed-up in the phototherapy unit of the Michallon Hospital in Grenoble since 1976 and having received more than 150 sessions of PUVA. The parameters studied were: age, gender, phototype, age at the time of the first irradiation, type of phototherapy administered, total number of sessions, concomitant treatments, administration of retinoids and the appearance of skin cancers with the interval before their onset after the first session, their localization and their histological type. RESULTS: One hundred six patients were retained among the 152 who replied to the inclusion criteria. Having died or been lost to follow-up, forty-six patients were excluded. Fourteen patients had presented at least one cutaneous tumor with a total number of 35. Excluding the keratoacanthomas, 13 patients had a non-melanic cutaneous cancer with a total number of 32 tumors. Ten out of the 14 were phototype III, 3 were phototype II and one was phototype IV. Nine out of 14 had received PUVAtherapy alone and 5 PUVAtherapy and broad spectrum UVB. The number of sessions of PUVA received in all the cases was more than 200 (220 to 780), corresponding to a total dose of UVA comprised between 1460 and 3882 Joules. The delay before onset of the tumors varied from 6 to 27 years after the first PUVAtherapy. The mean age at the time of the first irradiation was of 50.2 years (14-75 years). The mean duration of phototherapy was of 10 years (2.23 years).     

Bowen's Disease: Statistical Study of a 10 Year Period

According to histological records, a total of 74 patients were diagnosed with Bowen's disease (B.d.) between 1 January 1984 and 31 December 1993 at the Department of Dermatology of Kitasato University. There was slight female predominance (36 ♂, 38 ♀), and 73% of the patients were older than 60 years; the mean age was 66.8 years. Fifteen patients had multiple (two-five) lesions. In 13 patients, other benign skin lesions were also found. Arsenic exposure as etiologic factor could have been present in 2 cases. Only 3 patients had other associated malignant tumors, which does not confirm the paraneoplastic nature of B.d. One-fifth of the lesions were on sun-exposed areas (head, neck and hands). Although we excluded invasive carcinomas from our statistical study, we mention the 8 invasive carcinomas developing from B.d. in that period. Histopathological classification of B.d. is uncommon. Classifying our cases by Darier's histopathological classification, 63.3% of them belonged to the lenticular type. The malignant potential of different histopathological types of B.d. needs further investigation.     

Interstitial granulomatous dermatitis: a distinct entity with characteristic histological and clinical pattern

Background Interstitial granulomatous dermatitis (IGD) is a rare disease for which a clinical–pathological correlation is essential to establish diagnosis. Objectives To describe the histological and clinical features of patients with IGD seen in our department from 2004 to 2010, and to undertake a literature review and critical analysis of additional cases. Methods Twelve adult patients (nine women and three men; mean age 58·5 years; range 32–73 years) with IGD were enrolled. Lesions consisted of asymptomatic erythematous papules and plaques, symmetrically distributed on the trunk and the proximal limbs. Two patients had skin‐coloured papules. Six patients had articular involvement (arthralgias, spondyloarthritis, rheumatoid arthritis) and three patients had cancer. Results All cases showed a predominant CD68‐positive macrophage infiltrate distributed between collagen bundles of the mid‐ and deep dermis. Macrophages were also surrounding degenerated collagen fibres. A few neutrophils and/or eosinophils were also present. No vasculitis or significant mucin deposition was observed. Of the 62 cases of IGD reported since 1993, 53 fulfilled stringent diagnostic criteria. Erythematous papules and plaques on the trunk and proximal limbs were the dominant manifestation. Approximately 10% of patients had cord‐like lesions. More than 50% of patients with IGD had arthralgia or arthritis, and less commonly other rheumatic disorders. Disease duration is months to years, but long‐term prognosis seems favourable. Conclusions IGD is a distinct entity with a typical histological and clinical pattern. The importance and the nature of the association with extracutaneous diseases remains to be clarified. Patients should be screened for rheumatic and autoimmune diseases.     

四川省自贡市结节状疥疮的观察

本文报告四川省自贡市49例结节状疥疮的临末和组织学检查结果.1982年1~3月在皮肤科门诊3576个病人中,结节状疥疮占1.37%.病例仅发生于男性,年龄从13~61岁.多数结节数自2~15个,并不成簇,主要位于阴囊和阴茎.半数以上的病例,结节状疥疮在疥疮发生一周以上时形成. 49例患者的结节作了活检,在苏木素和伊红染色的连续切片中.有6例呈现疥蜿、卵或排泄物,其组织学变化均相同,即多形的、广泛的皮肤浸润.     

融合性网状乳头瘤病32例临床分析

目的探讨融合性网状乳头瘤病(confluent and reticulated papillomatosis,CRP)的临床、组织病理表现及治疗反应特点。方法回顾性分析西安交通大学第二附属医院2010年1月-2019年4月间诊治的32例CRP患者的临床特点、组织病理表现及治疗效果。结果 32例患者平均发病年龄22岁(13~62岁),其中男14例,女18例(56.25%),平均病程2.84年(20 d^20^+年)。皮损主要分布于躯干部位(乳间、上腹部、肩胛区及颈部),表现为多量密集的淡褐色扁平丘疹,皮损中间融合,周围呈网状。组织病理主要表现为角化过度,棘层肥厚,乳头瘤样增生。治疗效果:25例患者治疗方式不详(其中1例现已痊愈);2例患者给予口服异维A酸胶囊,外用阿达帕林凝胶联合抗真菌治疗,病情反复;剩余5例患者均给予口服米诺环素治疗,现已痊愈,随访无复发。结论 CRP多发生于青春期或青春后期,多见于女性。皮损主要位于躯干上部,也可累及其他少见部位,组织病理有时不典型。米诺环素治疗该病效果较好。     

Human herpesvirus 6 and 7 DNA in peripheral blood leucocytes and plasma in patients with pityriasis rosea by polymerase chain reaction: a prospective case control study.

An association between pityriasis rosea and human herpesvirus 7 (HHV-7) has been reported but remains controversial. The purpose of the present study was to investigate the association between HHV-6 and HHV-7 with pityriasis rosea. Fifteen patients aged 6-54 years with a diagnosis of pityriasis rosea and 15 age-matched controls were recruited. None of the patients had HHV-6 or HHV-7 DNA detected by polymerase chain reaction in the acute or convalescent plasma specimen. In the acute peripheral blood leucocytes specimen, 3 patients and one control had RHV-6 DNA detected (p=0.299; NS), while 7 patients and 5 controls had HHV-7 DNA (p=0.355; NS). Antibody to HHV-6 was detected in the acute specimen of 13 patients and 13 controls, while antibody to HHV-7 was found in all 15 of patients and controls. We thus found no evidence of recent HHV-6 or HHV-7 infection in patients with a diagnosis of pityriasis rosea.     

Prurigo nodularis: systematic analysis of 58 histological criteria in 136 patients

Background: To date, there has been no systematic investigation of the detailed histological features of prurigo nodularis (PN) in a large cohort of patients. Methods: This retrospective study includes skin biopsies of 136 patients (63 males, 73 females; mean age: 58.38 years) with PN. Results: Highly characteristic for PN is the presence of thick compact orthohyperkeratosis; the hairy palm sign (folliculosebaceous units in nonvolar skin in conjunction with a thick and compact cornified layer, like that of volar skin); irregular epidermal hyperplasia or pseudoepitheliomatous hyperplasia; focal parakeratosis; hypergranulosis; fibrosis of the papillary dermis with vertically arranged collagen fibers; increased number of fibroblasts and capillaries; a superficial, perivascular and/or interstitial inflammatory infiltrate of lymphocytes, macrophages and, to a lesser extent, eosinophils and neutrophils. For comparison, histological findings in 45 patients (18 males, 27 females; mean, 55.64 years) with lichen simplex (LS) were studied. PN and LS, both of them scratch‐induced, had 50 of 58 (86.2%) histological features in common. Conclusions: PN revealed a characteristic histological pattern. Absence of pseudoepitheliomatous hyperplasia or nerve fiber thickening, however, does not rule out the histological diagnosis of PN. A correlation of clinical and histological findings is necessary to reliably distinguish between PN and LS. Weigelt N, Metze D, Ständer S. Prurigo nodularis: systematic analysis of 58 histological criteria in 136 patients.     

A prospective study of cutaneous intolerance to topical mechlorethamine therapy in patients with cutaneous T-cell lymphomas. French Study Group of Cutaneous Lymphomas

OBJECTIVE: To study the exact frequency and the histological features of cutaneous intolerance to mechlorethamine (CIM) hydrochloride therapy in patients with cutaneous T-cell lymphomas, including Langerhans cell histiocytosis. DESIGN: A multicenter prospective study was conducted from January 1, 1994, to May 31, 1996, in 12 different hospitals in France. PATIENTS: Of the 52 patients with cutaneous T-cell lymphomas or Langerhans cell histiocytosis, 35 were men and 17 were women, aged 18 to 87 years. Of the 52 patients, 35 had mycosis fungoides, 8 had nonepidermotropic cutaneous lymphoma, 7 had lymphomatoid papulosis, 1 had Sézary syndrome, and 1 had Langerhans cell histiocytosis. METHODS: Patients were treated with topical applications of a 0.02% aqueous solution of mechlorethamine. The diagnosis of CIM was determined by the presence of erythema and pruritus. Patients who developed CIM underwent closed patch testing with three 10-fold dilutions of 0.02% mechlorethamine solution. A positive patch test result was the presence of erythema and pruritus, a weak result was the presence of simple erythema without pruritus, and a negative result was the absence of erythema and pruritus. Skin biopsy specimens from patients with positive patch test results were obtained in patients who developed CIM. The biopsy specimens were reviewed, and the results determined by 2 pathologists (E.T. and J.W.). The histopathological findings were classified in 3 categories: (1) spongiotic dermatitis, (2) irritant dermatitis, and (3) insignificant or normal. In September 1998, the referring physicians were contacted if mechlorethamine therapy had been continued in patients with CIM. RESULTS: Of the 52 patients, 43 were evaluated for tolerance to mechlorethamine therapy. Of the 43 patients, CIM developed in 23, from 4 days to 9 months after the initiation of mechlorethamine therapy. Of those 23 patients, CIM developed within 3 months in 21 and within 1 month in 13. Closed patch tests were performed in 21 of the 23 patients who developed CIM. The results of the patch test were positive in 12, weak in 4, and negative in 5. Of these 21 patients, 14 skin biopsy specimens were obtained in 14 different patients who had positive or weak patch test results. The specimens showed histological features that were consistent with spongiotic dermatitis in 9 patients, irritant dermatitis in 2, and insignificant or normal in 3. All 9 patients with histological features of spongiotic dermatitis discontinued mechlorethamine therapy. All 5 patients without histological features of spongiotic dermatitis were able to resume mechlorethamine therapy. These results do not correlate with those of previous study results. CONCLUSIONS: Mechlorethamine therapy is a cost-effective and easily administered treatment for cutaneous T-cell lymphomas. Our study shows that allergic dermatitis caused by mechlorethamine therapy is an early and frequent adverse reaction in patients with cutaneous T-cell lymphomas. The most common histological feature of patients with CIM is spongiotic dermatitis.     

Primary cutaneous polypoidal non-stageable melanomas in Queensland

Patients who develop a polypoidal melanoma which does not appear to invade the reticular dermis have a poor prognosis. Thirty three or 2-1% of 1607 patients treated for melanoma, in Queensland (1963–1969) had a polypoidal non-stageable melanoma. Twenty two patients were men. Four patients (12% of the thirty three) developed a second melanoma. Of the, thirty three patients, twenty one [sixteen men, five women) died from melanoma within jour years of the initial treatment. One man was lost to follow-up after fourteen months. Another man died eleven years after treatment. The ten patients [jour men, six women) surviving have been followed for a mean time of 113 months [86—133) and were reported free of melanoma at their last check-up. It is preferable to excise polypoidal skin lesions which look like atypical telangiectatic granulomas (pyogenic granulomas) or other unusual-looking benign pedunculated skin tumours rather than to treat by curettage so that adequate material is available for histological examination.