基底细胞上皮瘤伴棘状外瓶霉所致的暗色丝孢霉病一例

患者女，67岁，农民。5年前左头顶部长出一无痛性绿豆大小暗红色结节，逐年扩大、隆起，并延及左颞部。近3个月结节、肿块迅速增大，并出现溃疡。肿块经组织病理检查，诊断为基底细胞上皮瘤，肿瘤细胞巢之间和坏死组织内有褐色菌丝、孢子、芽生孢子。真菌培养为深橄榄黑色酵母样菌落，潮湿有光泽，边缘一圈灰色短绒毛状菌丝。方块小培养镜下见褐色分支分隔菌丝，其顶端与侧缘有成直角长出的棘状分生孢子梗，梗尖端有鼻状突起，顶尖及其周围有成堆光滑的椭圆形小分生孢子，梗远端可见清晰的多个环痕，鉴定为棘状外瓶霉，并经DNA序列分析证实。依据临床特征、组织病理学检查、真菌培养鉴定及基因鉴定结果，确诊为棘状外瓶霉致暗色丝孢霉病伴基底细胞上皮瘤。经光动力学治疗10次，中途合用伊曲康唑后临床痊愈。随访1年无复发。

A case of phaeohyphomycosis caused by Exophiala spinifera superimposed on basal cell carcinoma

A 67-year-old female farmer presented with a painless dark-erythematous, green bean-sized nodule on the left side of her head for 5 years. The nodule gradually grew and extended to the left temple. Three months prior to the presentation, the lesion began to enlarge rapidly and ulcerate. Histopathology of the lesion revealed a diagnosis of basal cell carcinoma. Brown hypha, spores, and blastospores were observed between cancer cell nests and in necrotic tissues. Culture of biopsy materials grew moist, glistening, olivaceous-black or dark yeast-like colonies, with gray fluffy hyphae at the margin. Slide culture showed brown branched and septate hypha, with spinate conidiophores arising terminally or laterally at right angles. There were rhino-protuberances at the tip of conidiophores together with clumps of smooth, oval microconidia at the top of or around the conidiophores, and many clear annellations were observed at the distant end of conidiophores. The strain was identified as Exophiala spinifera and confirmed genetically. The patient was diagnosed as phaeohyphomycosis caused by Exophiala spinifera superimposed on basal cell carcinoma based on the clinical manifestations, histopathological and mycological examinations, as well as DNA sequencing results. Clinical cure was achieved after management with oral itraconazole and 10-session photodynamic therapy. No recurrence was noted during 1-year follow-up.