急性痘疮样糠疹合并结节性血管炎1例

患者女,26岁。全身丘疹3月,四肢结节伴疼痛10天。皮损为圆形丘疹,表面有鳞屑覆盖,周围绕以红晕,以四肢明显,部分丘疹中心萎缩凹陷;左前臂、双小腿伸侧散在红色皮下结节,有压痛感。组织病理示:①小腿丘疹:表皮内见基底细胞灶性液化变性,真皮浅层血管周围大量淋巴细胞、组织细胞浸润,可见血管外红细胞。②小腿结节:皮下脂肪组织内见一大血管破坏,周围脂肪小叶弥漫性炎细胞浸润。诊断:急性痘疮样糠疹合并结节性血管炎。     

表现为播散性丘疹型的皮肤型窦组织细胞增生症一例

患者男,54岁,全身红色丘疹、结节及斑块4个月。皮损初发于双下肢,渐波散至全身。查体示全身密集分布的红色丘疹、结节,孤立或呈环形、条带状分布,直径0.3~2.5 cm,质地较硬,略有压痛,有浸润感;皮损大致对称分布,以四肢伸侧、面颊部为著。组织病理示真皮内弥漫性组织细胞浸润,多个具有分枝的肥大的组织细胞及多核巨细胞浸润,灶性浆细胞、淋巴细胞、中性粒细胞浸润,少许嗜酸粒细胞浸润,有细胞伸入现象。免疫组化检查示肥大的组织细胞及多核巨细胞CD68、CD163、S-100蛋白均阳性,CD1a阴性。诊断:皮肤型窦组织细胞增多症。给予复方甘草酸苷口服及卡介菌多糖核酸肌内注射1个月,皮损部分消退。     

原发性皮肤CD30+淋巴细胞增殖性疾病:交界性肿瘤1例

患者女,27岁,右侧臀部丘疹、结节3周余.查体:右侧臀部可见两个孤立类椭圆形红色结节,硬币至鹌鹑蛋大小,表面糜烂,结节周围可见淡红色丘疹呈"卫星灶"样改变,轻压痛.皮损组织病理示:真皮内弥漫淋巴细胞、组织细胞样细胞浸润,局灶中性粒细胞、嗜酸性粒细胞聚集,可见淋巴样细胞破坏毛囊上皮,个别细胞较大.免疫组织化学:大细胞表达...     

组织样麻风瘤1例误诊分析

患者女,48岁。双前臂暗红色丘疹和结节半年,泛发全身伴瘙痒3个月。无麻风病家族史,曾被误诊为结节性痒疹和湿疹,治疗无效。皮损组织病理示:表皮萎缩,表皮突变平或消失;真皮内泡沫样组织细胞呈结节状浸润,少量淋巴细胞浸润。抗酸染色可见大量抗酸杆菌(4+)。诊断:组织样麻风瘤。     

界限类偏瘤型麻风误诊1例

患者男,52岁。左手麻木4年,全身丘疹、斑块、结节、双侧脱眉1年,左手畸形3个月。皮损组织病理:表皮萎缩变薄,表皮下无浸润带,真皮层见结节性或弥漫性组织细胞浸润,血管周围及附属器周围见灶性淋巴细胞,抗酸染色阳性。诊断:界限类偏瘤型麻风。     

皮肤Rosai-Dorfman病7例临床病理特点分析

目的对皮肤Rosai-Dorfman病的临床表现、皮损形态特征及组织病理学特点进行分析。方法回顾分析7例皮肤Rosai-Dorfman病患者的临床表现、皮损形态特征、组织病理学特点及治疗等。结果 7例患者中男2例,女5例;发病年龄30～66岁。7例患者均为多发皮损。按累及解剖部位分为单处4例,多处3例,共计23处皮损。皮损表现为丘疹结节型4处(17.39%),浸润斑块型14处(60.87%),肿瘤样型5处(21.74%)。7例患者中,皮损单纯表现为丘疹结节型1例,浸润斑块型4例,肿瘤样型1例,1例表现为浸润斑块型及肿瘤样型的混合型。7例患者组织病理表现大致相同,为真皮内混合细胞结节样、灶状或弥漫性浸润,浸润细胞以组织细胞为主,也可见较多的淋巴细胞、浆细胞。组织细胞胞质内吞噬有数量不一的淋巴细胞、中性粒细胞等。免疫表型均为组织细胞S-100阳性、CD68阳性、CD1a阴性。结论皮肤Rosai-Dorfman病具有一定的临床和组织病理学特点,皮肤科医生应该提高对该病的认识,以减少误诊和误治。     

儿童泛发性肥大细胞增生症1例

患儿女,11个月。全身反复皮疹伴瘙痒9个月。查体见全身多发淡褐色及淡黄色苔藓样黄豆至蚕豆大小的圆形及半圆形丘疹、结节,界清,表面明显苔藓化及色素沉着,Darier征阳性。皮损组织病理:表皮角化过度,真皮层内可见肥大细胞浸润,细胞呈梭形、卵圆形,胞浆呈淡伊红色。诊断:儿童泛发性肥大细胞增生症。     

多中心网状组织细胞增生症

报告1例多中心网状组织细胞增生症。患者女,53岁。双手及面颈部丘疹5年,乏力伴关节疼痛2年。皮肤科检查:头面部、颈部及胸部可见弥漫性淡红色斑,边界不清,其间散在米粒至黄豆大淡红色丘疹;双上睑内眦处黄色斑疹,右侧内眦可见一花生粒大半球形淡棕红色丘疹,质中等。双手掌、手指、双耳郭及外阴后联合可见散在黄豆大肤色至淡红色丘疹和结节。下唇黏膜可见粟米大淡红色丘疹。皮损组织病理示真皮浅中层体积增大的组织细胞和多核巨细胞,细胞质嗜酸性,呈毛玻璃样,真皮浅层血管周围少量淋巴细胞浸润。诊断:多中心网状组织细胞增生症。     

网状组织细胞瘤1例

患者女,48岁,左侧颞部红色丘疹、结节1年,无自觉症状.系统检查无异常.皮肤科情况:左侧颞部数枚直径0.3～0.8 cm的红色丘疹、结节,表面光滑,界限清楚.皮损组织病理示:表皮轻度萎缩变薄,真皮内全层弥漫细胞浸润,以组织细胞和毛玻璃样多核巨细胞浸润为主,伴散在淋巴细胞.免疫组织化学检查示:CD68、CD163阳性,C...     

未定类细胞组织细胞增生病

报告1例未定类细胞组织细胞增生病.患者女,30岁.全身出现红色丘疹、结节2年.临床表现为无症状、泛发全身的丘疹和结节.分布于四肢、面部及躯干,皮损直径1～3cm,质地坚实,旱黄红色或红棕色.患者无其他系统疾病.皮损组织病理榆查:真皮弥漫性组织细胞增生,免疫组化显示增生细胞具有朗格汉斯细胞的特性:CD1a和S-100蛋白阳性,电镜显示细胞质中无Birbeck颗粒.诊断为未定类细胞组织细胞增生病,给予沙利度胺50mg,每日2次口服,阿维A30mg,每日1次口服,获良好疗效.     

Neonatal Dermal Hematopoiesis Associated with Diffuse Neonatal Hemangiomatosis

Abstract: This report describes a neonate with dermal hematopoiesis associated with diffuse hemangiomatosis. The cutaneous lesions consisted of multiple red papules and bluish subcutaneous nodules scattered over his body. The nodules were bluish due to the presence of hematopoietic tissue within the hemangiomas. Although neonatal dermal hematopoiesis has been described with viral infections or hematologic dyscrasias, the association with diffuse hemangiomatosis has not been previously described.     

An Unusual Case of Cutaneous Pancreatic Fat Necrosis

BACKGROUND: Cutaneous pancreatic fat necrosis is a pathognomonic sign for pancreatic disease and usually presents as subcutaneous nodules in the pretibial region. OBJECTIVE: A case of cutaneous pancreatic fat necrosis is presented in which the clinical presentation of diffuse erythema was unusual. This disease is discussed and its possible etiologies are reviewed. METHODS: A MEDLINE search for cases of cutaneous pancreatic fat necrosis presenting as diffuse erythema without nodules was conducted. RESULTS: Diffuse erythema is an unusual presentation of cutaneous pancreatic fat necrosis. CONCLUSION: This may be the first case of cutaneous pancreatic fat necrosis presenting as diffuse erythema.     

原发于皮肤的老年人EB病毒阳性弥漫大B细胞淋巴瘤一例

患者男,88岁。双下肢多发结节、溃疡6个月。皮肤科检查：双下肢多个暗紫色结节,触之较硬,中央溃疡、结痂。组织病理检查：真皮内及皮下组织淋巴样细胞弥漫浸润,细胞核大、深染,异形性明显,可见核分裂象,部分区域可见小灶状坏死。大淋巴样细胞表达CD20、CD79a、Bcl?2,EB病毒编码RNA原位杂交阳性。诊断：EB病毒阳性弥漫大B细胞淋巴瘤。患者放弃系统化疗,确诊6个月后死亡。     

大疱性类天疱疮并发原发性皮肤弥漫性大B细胞淋巴瘤

报告1例大疱性类天疱疮并发原发性皮肤弥漫性大B细胞淋巴瘤.患者男,80岁.全身水肿性红斑伴水疱、大疱,诊断为大疱性类天疱疮.在发病7个月后,右胫前出现多个暗紫红色结节,逐渐增多、增大,并扩展至右股内侧和背部.皮损组织病理检查示真皮全层及皮下脂肪小叶弥漫致密的淋巴细胞浸润,可见多数淋巴细胞体积增大,形态不规则,核大深染,可见核分裂相.免疫组化染色:CD20( ),bcl-2( ),bcl-6( ).诊断:原发性皮肤弥漫性大B细胞淋巴瘤.在肿瘤出现后1个月,患者大疱性类天疱疮的病情出现反复,通过CHOP方案治疗,病情明显好转.     

Multiple cutaneous reticulohistiocytosis

BACKGROUND: Multicentric reticulohistiocytosis is a non Langerhans cell histiocytosis. This rare disease is characterized by cutaneous papules and nodules and a destructive polyarthritis; multisystem involvement may occur. Multiple and diffuse cutaneous reticulohistiocytosis have been more rarely reported. We present a case which was distinctive by the existence of multiple cutaneous plaques. CASE REPORT: A 65-year-old woman presented cutaneous papules and nodules associated with a destructive arthritis affecting the hands. Histological examination of a cutaneous biopsy associated with immunophenotyping and electronic microscopy permitted us to make the diagnosis of multicentric reticulohistiocytosis. The search for visceral involvement or underlying neoplasia was negative. Rapidly, cutaneous aggravation occurred with multiple and diffuse infiltrated plaques on the back, the face, the ears, the thighs and the forearms. The same histological aspect was found for these lesions. Treatment with corticosteroids and cyclophosphamide was successful. DISCUSSION: This case report is the first one with diffuse cutaneous lesions of multicentric reticulohistiocytosis with aspect of infiltrated plaques. Diffuse cutaneous lesions in multicentric reticulohistiocytosis have been rarely reported with diffuse papules or nodules pattern. A visceral involvement seems to be more frequent for diffuse cutaneous involvement. In all cases, the association of multicentric reticulohistiocytosis with neoplasia in up to 25 p. 100 is of interest. Treatment of multicentric reticulohistiocytosis consists in corticosteroids at the initial phase associated with alkylants agents or methotrexate.     

全身转移性黑素瘤1例

患者女,60岁。头面、躯干、四肢大小不等黑红色结节,无痛痒3年,半年内泛发全身。皮肤科情况:头面、躯干、四肢见大小不等高粱粒至黄豆大小结节,呈皮色、暗红色及黑色。左膝关节上方见一直径约2cm×2cm大小肿块,其上见4～5个大小不等皮色至黑色结节,部分结节表面结痂。皮损组织病理示:真皮内弥漫性肿瘤样细胞浸润,此肿瘤样细胞核大、核仁明显,部分肿瘤样细胞呈巢状排列,肿瘤组织内见坏死。免疫组织化学染色显示肿瘤细胞LCA(-),CK20(-),S100蛋白及HMB45弥漫强阳性,Vimentin弥漫阳性。诊断:黑素瘤。     

Blastic plasmacytoid dendritic cell neoplasm presenting as fever with diffuse cutaneous nodules

A young man, presented with high-grade fever and disseminated asymptomatic skin lesions of 6-weeks duration. Cutaneous examination revealed multiple infiltrated monomorphic skin-colored papules and nodules upto 2×2 cm all over scalp, face, trunk and extremities. Light microscopy of nodules showed diffuse infiltration of dermis and subcutis by a tumor composed of medium to large cells with round to ovoid nuclei with fine chromatin, few with visible nucleoli and scanty to moderate amounts of eosinophilic cytoplasm. Tumor cells were positive for CD4, CD8, CD56 and negative for CD30, terminal deoxynucleotidyl transferase and Alk-1. Excised axillary lymph node showed similar morphologic and immunohistochemical findings. There was bone marrow involvement with infiltrate of large atypical/immature lymphoid cells. Diagnosis of blastic plasmacytoid dendritic cell neoplasm was made. This is a rare neoplasm. presenting commonly in the skin, with or without concurrent extracutaneous disease.     

Bullous Mastocytosis: Diffuse Cutaneous Mastocytosis with Extensive Blisters Mimicking Scalded Skin Syndrome or Erythema Multiforme

Bullous mastocytosis (diffuse cutaneous mastocytosis) is a rare form of mast cell disease that begins during the first month of life and causes extensive blisters that mimic scalded skin syndrome or bullous erythema multiforme. Discrete pigmented macules, papules, and nodules are absent and the characteristic leathery induration of skin may not develop until 6 months of age. Skin biopsy shows a subepidermal blister with mast cells at the base. The most serious complications are gastrointestinal hemorrhage and shock. The symptoms of bullous mastocytosis may be modified by a number of new therapeutic agents.     

Methotrexate-associated lymphoproliferative disorder in a patient with rheumatoid arthritis presenting in the skin

A 91-year-old woman who had been taking methotrexate for approximately 5 years for rheumatoid arthritis developed papules and nodules on her face that enlarged during 6 months. A series of biopsy specimens demonstrated a lymphoplasmacytic infiltrate with increasingly atypical histopathologic features that resembled diffuse large B-cell lymphoma. Epstein-Barr virus was not identified. Withdrawal of methotrexate resulted in complete resolution of all lesions within 8 weeks. This case illustrates the rare occurrence of methotrexate-associated lymphoproliferative disorder with primary presentation in the skin and documents clinical and histopathologic progression from early changes to fully developed lesions.     

Disseminated De Novo Myeloid Sarcoma in a 17‐year‐old Boy

Myeloid sarcoma (MS) is a rare extramedullary tumor of malignant myeloid cells often associated with acute myeloid leukemia. We report a case of a 17‐year‐old boy presenting with diffuse red‐brown skin nodules ultimately diagnosed with the scarcely described disseminated, de novo MS. It is important for dermatologists to keep MS on their differential when assessing patients with disseminated red‐brown nodules.