308nm准分子激光对斑块型银屑病患者皮损中IL-17、CD4表达的影响

目的采用308 nm准分子激光治疗斑块型银屑病,治疗前后用免疫组化法检测组织中IL-17、CD4的表达,为阐明308 nm准分子激光治疗斑块型银屑病的机制提供理论依据。方法取20例斑块型银屑病患者皮损和10例正常人对照者皮肤,308 nm准分子激光照射治疗前后用免疫组化法检测组织中IL-17、CD4表达。结果银屑病患者皮损中可见IL-17、CD4+T细胞浸润,主要集中在真皮浅层血管周围;而正常皮肤组织仅有微量CD4+T、IL-17细胞表达。采用308 nm准分子激光照射治疗后患者皮损IL-17、CD4阳性水平均显著下降(P0.001)。结论银屑病患者皮损内IL-17、CD4细胞数目增多,表示其可能与银屑病的发生有一定的相关性。显著降低皮损中IL-17、CD4阳性水平可能是308 nm准分子激光治疗作用机制之一。     

皮肤异色病样淀粉样变病2例

例1于17岁发病,皮损首发于四肢,家族有类似患者;例2于8岁发病,皮损首发于两前臂。2例患者临床表现均为皮肤弥漫性色素沉着伴点状色素减退斑。皮损组织病理示:真皮乳头可见类淀粉样物质沉积。     

慢性苔藓样角化病5例临床病理分析

报告5例慢性苔藓样角化病。男4例，女1例，年龄13～50岁。3例皮损为带状或网状分布的紫红色丘疹，2例皮损呈疣状。皮损多无自觉症状，但有1例患者皮损伴有剧烈的瘙痒。组织病理改变主要为表皮角化过度伴局灶性角化不全，局部颗粒层增厚，棘层不规则肥厚，表现为棘层肥厚和萎缩相间，基底细胞液化变性。真皮浅层炎性细胞呈带状浸润，主要为淋巴细胞和组织细胞，并可见少量嗜酸性粒细胞和浆细胞。4例患者的毛囊和真皮血管周围也有炎性细胞浸润。本病需与扁平苔藓和扁平苔藓样角化病等鉴别。     

无色素痣的临床、组织学和超微结构观察

目的 探讨无色素痣的临床和组织学特征。方法 分析85例无色素痣患者的发病年龄、类型和皮损特点,并对部分患者行皮肤色素测定和反射式共聚焦显微镜（RCM）观察。对其中17例患者的皮损区和正常区皮肤组织进行组织病理检查,透射电镜观察皮损区超微结构。免疫组化法检测皮损区和正常皮肤处酪氨酸酶（TYR）、HMB45、酪氨酸酶相关蛋白1（TRP-1）、TRP-2和CD117表达。结果 85例无色素痣患者中,23例（27.1%）出生时发现皮损,21例（24.7%）出现于3岁以后,最大发病年龄为29岁。皮损分布于躯干部25例（29.4%）,颈部13例（15.3%）;72例（84.7%）皮损边缘不规则,54例（63.5 %）仅有1处皮损。19例无色素痣患者患处的黑素指数（186.56 ± 52.86）和相对黑素指数（80 ± 11）低于正常人皮肤（分别为223.88 ± 63.19和100）,高于12例白癜风患者皮损处（分别为128.57 ± 64.31和60 ± 20）,差异均具有统计学意义（P < 0.01）。反射式共聚焦显微镜示,无色素痣皮损中含黑素细胞数量减少,亮度减低,黑素分布均匀,皮损区与正常皮肤分界区常不清晰。皮损区Fontana-Masson染色示皮损区黑素强度为1810.12 ± 327.96,较正常区（2064.24 ± 260.41）明显减弱。电镜下发现黑素细胞数量减少,黑素小体减少,黑素细胞胞质和树突以及角质形成细胞中可见Ⅱ、Ⅲ期未成熟的黑素小体,角质形成细胞中可见聚集成团的黑素小体。17例患者正常区TYR表达水平为1827.35 ± 307.09,TRP-1为6102.54 ± 1642.64,而皮损区TYR（1477.35 ± 224.05）和TRP-1（5322.33 ± 1565.26）表达下降,正常区与皮损区比较,P均 < 0.01;HMB45、TRP-2、CD117表达两处比较差异均无统计学意义。 结论 无色素痣是一种早期发病、非家族聚集性、稳定的不规则色素减退性疾病,其皮损中黑素细胞和黑素小体数量均减少,可见未成熟黑素小体。相对黑素指数和反射式共聚焦显微镜检查可作为诊断无色素痣的无创性检测方法。     

皮肤混合瘤74例临床及病理分析

目的 探讨皮肤混合瘤(mixed tumor of the skin, MTS)的临床表现、病理特点及治疗、预后。方法 回顾性分析西安交通大学第二附属医院2011年11月—2022年7月经组织病理确诊的74例MTS患者的病史、临床特点、病理特征、治疗效果等资料。结果 74例患者中男45例，女29例，平均发病年龄(44.23±13.74)岁，病程中位数为2(1.0,3.75)年。皮损多位于面部(69例，93.24%),其中以鼻部(14例，18.92%)、口鼻间(17例，22.97%)、面颊部(20例，27.03%)多见，也可见于耳部(3例)、头皮(1例)、背部(1例)。皮损表现为大小0.5～3.0 cm孤立、境界清楚、质韧或中等硬度、肤色或红色的结节丘疹，71例(95.95%)皮损表面光滑，3例皮损表面可见顶针状凹陷。17例(22.97%)病例皮损表面可见毛细血管扩张。组织病理：62例混合瘤位于真皮，1例位于皮下脂肪层，11例未见表皮，瘤体位置不明确。54例境界清楚，其中53例有假包膜，20例境界不清。肿瘤由比例不定的上皮及间质成分组成。根据上皮组织成分，63例向顶泌汗腺分化，11例向外...     

生殖器汗管瘤3例

 报告3例生殖器汗管瘤患者，其中男1例，发生在阴茎,无明显自觉症状；女2例，发生在大阴唇，皮损均表现为细小丘疹，孤立互不融合，质中，1例伴微痒，另1例伴剧痒。皮损组织病理：表皮轻度增生，真皮内可见嗜碱性小立方细胞形成的肿瘤团块，呈条索状团块及管腔样结构，部分管腔内可见嗜伊红的无定形物质。诊断为汗管瘤。3例患者均予  CO₂激光治疗，目前均在随访中，暂无复发。     

痣样基底细胞癌综合征1例及文献复习

报告1例痣样基底细胞癌综合征。患者男,68岁。头部、面部、躯干及双下肢多发米粒至鸽蛋大黑褐色丘疹、结节及斑块7年。皮肤科检查:皮损主要分布于头皮,界限清楚,部分表面破溃;双手掌可见点状凹陷。皮损组织病理检查:表皮部分缺失,棘层轻度增生,真皮可见基底细胞组成的肿瘤细胞团块,肿瘤团块与正常组织间可见裂隙,考虑基底细胞癌。诊断:基底细胞癌综合征。因患者拒绝口服药物,予手术切除头皮破溃结节,随访1年无新发皮损。     

一家三口同患羊痘

报告一家三口同患羊痘。例1.患者男,41岁。有病羊接触史,左手背及右前臂脓疱、结节伴痛痒2周。皮肤科检查：左手背一直径约1 cm乳头瘤样结节;右前臂可见数个直径1～1.5 cm扁平脓疱。皮肤镜检查：镜下可见皮损中央溃疡结痂区及周围黄白色环状区域,可见点状血管。皮损组织病理检查：表皮细胞内及细胞间水肿、空泡形成及气球状变性;真皮血管内皮细胞和表皮细胞胞质可见嗜酸性包涵体。例2和例3患者分别为例1父亲及母亲,皮肤科检查与例1类似。例2发病前有病羊接触史,例3否认发病前有病羊接触史。3例患者结合典型临床表现及皮肤镜、组织病理检查结果,均诊断为羊痘。     

丛状神经鞘瘤10例临床及组织病理分析

目的：探讨丛状神经鞘瘤（PS）临床及组织病理学特点。方法：回顾性分析10例PS患者临床表现及组织病理学特点，并进行文献复习。结果：10例患者中女7例,男3例；发病年龄1～58岁。皮损单发者9例，多发者1例。皮损位于躯干者7例，上肢者2例，躯干及四肢均累及者1例。所有患者皮损表现为单发光滑的丘疹（2例）、多个光滑丘疹融合成的斑块（2例）、外生性结节（2例）、褐色丘疹（3例）及褐色斑块（1例）。1例并发神经纤维瘤病Ⅰ型（NF1）,1例并发神经纤维瘤病Ⅱ型（NF2）。所有患者皮损组织病理均示真皮或皮下可见丛状分布的具有包膜的肿瘤团块，肿瘤团块内细胞形态以Antoni A型为主，可见特征性的Verocay小体，可见个别核分裂象或轻度异形性，肿瘤团块内或间质中可有黏液。免疫组化示肿瘤团块内S-100蛋白弥漫性阳性，神经丝蛋白（NF）阴性。结论：PS是神经鞘瘤中罕见的类型，好发于躯干及双上肢，其临床表现缺乏特征性，诊断主要依靠皮损组织病理及免疫组化检查。     

有红斑表现的多中心网状组织细胞增生症

报告1例有红斑表现的多中心网状组织细胞增生症。患者男，67岁。因头面部，躯干四肢多发性红斑，结节1年就诊。皮损组织病理示真皮内可见结节状分布的组织细胞。组织细胞胞质丰富，细颗粒状（毛玻璃样），可见多核巨细胞。CD1a和S-100蛋白均为（-）；CD68（+）提示非朗格罕细胞来源。诊断为多中心网状组织细胞增生症。     

皮脂腺癌八例临床及病理分析

回顾性分析我院2017年5月至2022年4月诊断的8例皮脂腺癌临床病理资料，其中男3例，女5例，发病年龄平均72岁，临床表现为单个无痛性肿块，病程2个月~3年。6例位于眼睑，1例在面部，1例在耳后，8例患者中2例复发，均在眼睑部位。镜下见肿瘤细胞巢排列成不规则的小叶或结节状。胞质较少的嗜碱性基底样细胞，略呈栅栏状排列，主要位于周边，中央为胞质空亮的皮脂腺细胞。免疫组化CK、EMA、p63、AR阳性，Ki-67阳性率约20%~90%。     

幼年黄色肉芽肿85例临床分析

回顾性分析85例经病理确诊的幼年黄色肉芽肿患者的临床资料。 85例患者中男54例,女31例,中位发病年龄为395天。60例患者（71％）为单发皮损,25例（29％）为多发皮损。皮损主要颜色为黄色（44例,52％）和红色（29例,34％）。85例患者共有108处皮损,其中位于头面部的皮损占31.5%（34/108）、躯干占34.2%（37/108）和四肢占28.7%（31/108）。黄色和红色皮损中更容易见到Touton巨细胞、以泡沫细胞为主的浸润和嗜酸粒细胞。85例患者均未发现系统受累。     

Clinicopathological and genotypic aspects of anticonvulsant-induced pseudolymphoma syndrome

BACKGROUND: Pseudolymphoma syndrome (PLS) is relatively rare but can lead to death if there are extensive skin lesions, severe hepatitis, agranulocytosis and neutropenia. PLS may also give rise to harmful effects if misdiagnosed as malignant lymphoma and patients with PLS are treated unnecessarily with chemotherapy, because it may mimic histologically other lymphomas, including mycosis fungoides (MF). OBJECTIVES: To examine the clinicopathological and genotypic features of anticonvulsant-induced PLS. Patients and methods We retrospectively reviewed clinical, laboratory and histological findings for eight cases of anticonvulsant-induced PLS, and performed T-cell receptor gene rearrangement using polymerase chain reaction with paraffin-embedded specimens from each case. RESULTS: The causative agents were carbamazepine (four cases), phenytoin (two cases), phenobarbital (one case) and valproic acid (one case). A cross-reaction between phenobarbital and phenytoin was observed in one case. The duration from the start of anticonvulsant therapy to skin eruption was 3-24 weeks (mean 7 weeks). The skin lesions were generalized maculopapular eruptions in all cases, including one case accompanied by vesiculopustular lesions. The frequencies of the associated features were as follows: facial oedema (88%), fever (75%), lymphadenopathy (63%), and hepatomegaly (25%). Laboratory findings revealed leukocytosis, atypical lymphocytes, eosinophilia, monocytosis, neutrophilia, lymphocytosis and abnormal liver function. Histopathologically, there was similarity between PLS and MF in that epidermotrophism of atypical lymphocytes (100%) and Pautrier's microabscess-like structures (38%) were observed. However, PLS has some differences from MF that include moderate to marked spongiosis (75%), necrotic keratinocytes (63%), and infiltration of eosinophils (25%) in the epidermis and, in the dermis, papillary dermal oedema (100%), extravasated erythrocytes (100%), lymphocytes within the dermis larger than those within the epidermis (63%), and infiltration of various inflammatory cells including neutrophils (50%). Genotypic analysis demonstrated a rearrangement of the T-cell receptor-gamma gene in one of eight cases studied. There were no deaths and all cases were improved at 2-9 weeks (mean 6 weeks), after the cessation of causative agents, systemic and topical corticosteroid therapy, and symptomatic therapy. There were no significant differences in clinical, laboratory and histological findings between the causative agents. CONCLUSIONS: PLS may show histopathological findings similar to MF and take a prolonged course even after the cessation of causative agents. Thus, a clear understanding and diagnosis of this disease is considered to have an important effect on treatment and prognosis.     

皮肤转移癌62例临床及组织病理分析

回顾性分析我院皮肤科2010年1月至2021年1月期间62例皮肤转移癌患者的临床及组织病理特征。结果示62例患者中,男34例(54.8%),女28例(45.2%),发病平均年龄为(59.2±12.5)岁(41~89岁)。患者就诊时间中位数为2个月。45例患者仅有一个转移灶,17例有两个或以上转移灶。好发部位依次为胸部(18例),头部(14例),四肢(12例)。皮损表现多为结节、包块(49例),其次红斑(9例)、丘疹(4例)。原发肿瘤中最多的为转移性腺癌56例(90.3%),其次为转移性鳞癌4例(6.5%),另2例为小细胞癌。男性以肺癌最常见,女性以乳腺癌最多见。62例病例中19例误诊为其他疾病,首诊误诊率为30.6%。皮肤转移癌临床上容易误诊,应提高对皮肤转移癌的警惕性。     

上皮样血管瘤16例临床与病理分析

 目的:探讨上皮样血管瘤（EH）的临床及组织病理学特征。 方法:回顾性分析16例已确诊患者的临床及病理资料,并对相关文献进行综述。 结果:16例患者中女8例,男8例;平均年龄（45.44±12.52）岁;病程3个月~20年;皮损主要表现为红色至暗红色丘疹、结节,可伴瘙痒和糜烂,好发于头皮、耳部,其中发生在头部10例、耳部5例、外阴1例;皮损单发者5例,多发者11例。皮损组织病理学检查均具有典型的血管增生,管壁增厚,内皮细胞呈上皮样突向管腔,管周大量淋巴细胞及嗜酸性粒细胞浸润。结论：上皮样血管瘤少见,诊断需要临床与病理密切结合。加强对该病的认识,可避免误诊误治。     

Hemangioma with dabskoid features: a rare histopathologic variant of acquired hemangioma

Dabska tumor, also known as papillary intralymphatic angioendothelioma (PILA), is a locally aggressive hemangiendothelioma characterized by intravascular papillary proliferations of atypical endothelial cells. Besides PILA, papillary tufts lined by hobnail endothelial cells have been rarely described in vascular proliferations. We report two cases of acquired hemangiomas, which focally showed this finding. We present a 15‐year‐old male and a 7‐year‐old girl with erythematous nodules. Both lesions were composed of capillary lobules intermingled with large sinusoidal spaces lined with a single layer of flat endothelial cells, which focally developed intravascular papillary proliferations lined by plump hyperchromatic endothelial cells and a central connective tissue core. Both types of cells were positive with CD31 and ERG and negative for Lyve‐1, Prox‐1 and podoplanin. Wilm's tumor 1 marker was strongly positive in the capillary hemangioma areas while negative in the intravascular tufts. Both lesions recurred after the first excision but we did not observe further recurrence or evidence of metastasis in the follow‐up. In summary, our cases expand the histopathologic findings that may be seen in conventional acquired capillary hemangiomas. The focal presence of dabskoid tufts within an otherwise conventional capillary hemangioma should be not misinterpreted as evidence of malignancy.     

36例乳房外Paget病临床特点分析

 目的:对乳房外Paget病进行回顾性研究，为临床诊治提供帮助。方法：对2013年1月至2018年12月我院确诊的36例乳房外Paget病患者的临床资料进行回顾性分析。结果：36例患者男女比例为3 ∶1；平均发病年龄(65.72±10.41)岁；病程6个月至10年，中位病程4年；皮损多为单发，阴囊常见；主要表现为红斑、糜烂；既往误诊率60.61%；免疫组化以CK7、CEA、EMA阳性表达为主；不伴有转移者30例，伴有转移者6例；30例行局部扩大切除术+术中冰冻治疗，其中27例扩切范围明确，扩大切除范围以1.0 cm、2.0 cm为主，扩切2.0 cm的一次切净率为90.91%。术后有2例复发。结论：该病男性好发，老年多见，皮损多为单发，误诊率高，免疫组化有提示原发或继发意义，病情进展缓慢但仍可发生转移，治疗以局部扩大切除术+术中冰冻为主，建议扩切范围在2.0 cm及以上。该病术后仍有较高复发率。     

Expression of intercellular adhesion molecule-1 (ICAM-1) and OKM5 in UVA- and UVB-induced lesions in patients with lupus erythematosus and polymorphous light eruption

Pathological skin reactions were induced with both UVA and UVB in 12 patients with lupus erythematosus (LE) and with UVA in 7 with polymorphous light eruption (PMLE) but in none of the controls. Biopsy specimens taken from UV-induced lesions showed that in dermal infiltrates of LE cases CD4-positive cells predominated, whereas in the majority of PMLE cases CD8-positive cells predominated. Keratinocytes expressed intercellular adhesion molecule-1 (ICAM-1) in 7 of the 12 UVA- and in eight of the ten UVB-induced LE lesions, and in three of the UVA-induced lesions of PMLE patients. Three different staining patterns were found. In subacute cutaneous LE (SCLE) cases staining throughout the epidermis resembled that seen in genuine SCLE lesions. In discoid LE (DLE) lesions, the staining was most prominent in and near the basal cell layer. In the one systemic LE case and in the PMLE cases, ICAM-1 expression was seen only in association with epidermal spongiosis and T-cell infiltration. Keratinocytes did not express ICAM-1 in the controls or in the non-irradiated skin of the LE patients. In five on the UVA-induced lesions, in eight of the UVB-induced LE lesions and in one of the PMLE cases, keratinocytes expressed CD36. In four of the six LE lesions with fewer CD1a-positive cells, dendritic CD36-positive cells were seen in the epidermis. In conclusion, the pattern of activated keratinocytes and immunocompetent cells in the dermis was similar to that seen in genuine LE and PMLE lesions, but dissimilar to each other and to the controls. Keratinocytes in both UVA- and UVB-induced lesions in LE patients and in UVA-induced lesions of PMLE expressed ICAM-1 with a staining pattern resembling that seen in genuine lesions. This may help to explain the pathomechanism of these skin lesions.     

Nerve-sheath myxoma (perineurial myxoma)

Seventy cases of nerve-sheath myxoma, an uncommon cutaneous neoplasm, are reported. Lesions developed most frequently on the face and upper extremities, and affected women about twice as often as men. Their average size was one centimeter. Histologically, the lesions involved the reticular dermis; many extended into the superficial portions of the subcutis. They were composed of fascicles of cells with interconnected cytoplasmic processes. The neoplastic cells were associated with variable amounts of a matrix that was rich in acid mucopolysaccharides. Mitoses were common, but evidently had no prognostic significance. Only one of 70 lesions was recurrent and no metastases are known to have occurred from any. For eight cases, immunoperoxidase staining for S-100 protein was done and all were positive. One lesion showed ultrastructural features of nerve-sheath cells, specifically perineurial cells.     

51例麻风患者临床及皮肤病理分析

回顾性分析2013年1月至2020年6月我科收治的51例麻风患者临床资料,其中男34例,女17例;35例首诊考虑麻风,16例误诊。皮损主要位于面颈部、躯干、四肢,表现为弥漫性浸润性斑片、斑块,其中伴眉毛脱落(21例)、尺神经粗大(1例)、感觉异常(13例)、畸形(1例),皮疹处瘙痒(2例)。临床分型:结核样型(TT)2例、界线类偏结核样型(BT)2例、中间界线类(BB)2例、界线类偏瘤型(BL)10例、瘤型(LL)34例、未定类麻风(I)1例。I型麻风反应5例(9.8%)、II型麻风反应12例(23.52%)。组织病理示表皮萎缩、变薄33例(64.70%)、有无浸润带30例(58.82%),病变累及真皮全层8例(15.60%);抗酸染色(Wade-Fite染色)阳性率49例(96%)。