胃癌皮肤转移1例

<正>患者男,54岁。因颈部、腹股沟皮肤变硬4个月,于2014年1月3日到华西医院皮肤科门诊就诊。患者4个月前无明显诱因发现左颈部手掌大浸润性暗红斑,无明显自觉症状,皮损面积逐渐扩大,累及整个颈项部、下颌及胸前V形区,局部肿胀、变硬,呈橘皮样外观。面部未见类似皮损。2个月前下腹部及双侧腹股沟亦出现上述皮损,并逐渐硬化似皮革样,无活动     

青斑样血管病64例皮损特点分析

【摘要】 目的 分析青斑样血管病网状青斑和紫癜性皮损的特点、分布规律。方法 回顾中国医学科学院皮肤病医院2017年7月至2020年10月诊治的64例青斑样血管病患者的临床资料。结果 64例中男23例,女41例;年龄13 ~ 54岁,发病年龄7 ~ 51岁,48例25岁前发病;病程6个月至10年。49例夏季发病或病情加重,皮损基本表现为坏死性不规则紫癜、紫癜性皮病样红斑、不规则溃疡、网状青斑、毛细血管扩张、不规则的白色萎缩性瘢痕和色素沉着。64例溃疡和坏死性紫癜多为不规则形,发生于足背和踝关节周围。40例有紫癜性皮病样的皮损表现,其中32例表现为色素性紫癜,8例表现为毛细血管扩张性紫癜。4例出现麻木刺痛等神经末梢受损的症状。结论 青斑样血管病的皮损表现多样,对于出现广泛网状青斑、紫癜样皮病样皮损、麻木等症状的患者,需做好鉴别诊断。     

青斑样血管炎一例

患者男,36岁.因左下肢带状分布的红斑、紫癜样皮损伴疼痛3个月就诊.3个月前,在无明显诱因下,先于左内踝处出现红斑、紫癜样丘疹伴疼痛,此后皮损逐渐向上发展,累及左小腿内侧,呈不连续带状分布.     

汗孔角化病并发鳞状细胞癌一例

患者男,46岁.因颈部皮损40年,发生增生、破溃7～8个月,于2009年4月13日到我科门诊就诊.患者5岁时,无明显诱因发现颈后玉米粒大小的皮疹,似烟头烫伤样,无自觉症状,故未治疗.而后皮损逐年增大,24岁时皮损已长至鸡蛋大小,自觉偶有瘙痒感,曾在外院诊治,行局部皮损组织病理检查,诊断为汗孔角化病,给予糖皮质激素类及中药药膏(药名不详)外用,瘙痒可缓解,但皮损未见减小,用药1个月后便自行停药.多年来,皮损缓慢扩大,未予特殊处理.就诊7～8个月前,皮损中央出现一豆粒大小红色肿物,瘙痒明显,搔抓后破溃,并有血性及脓性分泌物,自行外用红霉素软膏,未见明显好转,肿物反复破溃并逐渐增大.既往无其他疾病,否认家族中有同类疾病患者.     

伴肝癌、甲状腺癌的坏疽性脓皮病各1例

例1 男,49岁,农民,2015年7月15日因双小腿起红斑丘疹伴痒2个月,左小腿糜烂溃疡7 d于我科就诊。初发皮损为丘疹、红色斑疹伴瘙痒,逐渐发展为斑块、溃疡（图1A）,病程中一度出现紫癜、血疱,从首发皮损到出现小溃疡历时2个月,至出现直径 > 5 cm巨大溃疡历时7个月,溃疡疼痛,但无需使用止痛药物……     

兄弟同患Bloom综合征

例1,男,9岁,回族.颜面、耳廓反复起红斑8年.出生7个月双颧部出现毛细血管扩张性红斑,渐累及耳廓和前臂,双小腿皮肤出现轻度鱼鳞病样外观,5岁时口唇出现水疱、糜烂,皮损夏季日光强烈时出现并渐加重,冬季自行缓解或消失.例2,例1胞弟.男,3岁,回族.颜面部反复起红斑2年.1岁时双颧部开始出现红斑,渐扩延至颊部,伴轻微瘙痒和脱屑,期间,小腿皮肤干燥、脱屑,呈鱼鳞样改变;皮损每于夏季来临时出现,且渐加重,随冬季到来皮损渐消失.2例各系统检查未发现异常,身高正常;实验室、病理及其他辅助检查无有意义的阳性发现,染色体检查正常.患儿父母为姨表近亲结婚,诊断为Bloom综合征.     

儿童重症急性痘疮样苔藓状糠疹1例

患儿男,10岁.因全身红斑、血疱及溃疡伴瘙痒1个月入院.1个月前患儿全身出现暗红斑,微痒,随后其上出现黄豆至甲盖大血疱,破溃后结黑痂,在外院以银屑病和玫瑰糠疹治疗无效,于2007年8月7日在我院行皮损组织病理检查,诊断为急性痘疮样苔藓状糠疹.予以静脉滴注甲泼尼龙28 mg/d,13 d后减至24 mg/d时全身大部分皮损消退,患者自动出院并自行停用糖皮质激素.3 d后皮损复发,在外院予甲泼尼龙40 mg/d,静脉滴注8 d后因疗效不明显而停用.停用2d后皮损尤断加重,并出现发热,体温39.2℃,于2007年9月2日来我院复诊.发病以来无腹痛及腹泻,无关节肿痛及黏膜损害.     

银屑病样二期梅毒误诊体会（附3例报告）

我科于1997年发现3例银屑病样二期梅毒误诊为银屑病,现报告如下。1 典型病例 例1女,23岁,工人,未婚。全身皮肤出现丘疹、斑丘疹4个月。无自觉症状,有时皮损可自行消退。1月前皮损数量增多并双     

色素性痒疹1例

患者女,躯干部出现皮疹伴瘙痒3个月。皮损可自行消退,消退后遗留色素沉着,皮损可反复出现。皮损组织病理示:表皮轻度角化亢进,表皮乳头瘤样增生,基底细胞灶状液化变性,真皮浅层血管周围淋巴、单核细胞浸润。诊断:色素性痒疹。     

伴传染性软疣样皮损的播散性隐球菌病1例报告

最近 ,我们见到 1例伴传染性软疣样皮损的播散性隐球菌病患儿 ,现报告如下。1　一般临床资料　患儿 ,男 ,7岁 ,主因“全身淋巴结肿大 ,伴皮损 ,发热 2个月” ,于 1999年 7月 2 2日就诊于我院门诊。 2月前 ,患儿右颈部出现淋巴结肿大 ,不痛 ,伴发热 37.5～ 39.0℃。此后双腋下及双侧腹股沟淋巴结肿大 ,头部、躯干、四肢出现丘疹结节渐增大 ,部分破溃、流脓。 3年来 ,患儿患有“肾病综合征” ,予强的松 35ｍｇ/ｄ ,治疗 2个月 ,后激素减量 ,10个月后停药。 2月前 ,“肾病综合征”复发 ,又口服强的松 30～ 40ｍｇ/ｄ,尿蛋白阴转 ,皮疹无好转。…     

5-氨基酮戊酸光动力疗法治疗寻常疣8例及跖疣12例临床观察

目的探讨5-氨基酮戊酸光动力(ALA-PDT)疗法治疗寻常疣及跖疣的疗效及安全性。方法对入选的8例寻常疣及12例跖疣患者予5-氨基酮戊酸光动力疗法治疗,随访3个月后评价疗效。结果 20例患者经3～7次治疗后均痊愈,且无明显不良反应,平均治疗2.8次,有9例治疗3次,8例治疗4次,2例治疗5次,1例治疗7次,均未见复发和不良反应。结论 5-氨基酮戊酸光动力疗法治疗寻常疣及跖疣疗效好,安全可靠。     

Successful treatment of verruca plantaris with a single sublesional injection of interferon-α2a

Background.  Interferons are molecules with antiviral effects, which have been used for the treatment of verruca for many years.
Aims.  To determine if sublesional interferon (IFN)-α injection offers an effective alternative treatment for common warts.
Methods.  We compared the results of single-dose sublesional IFN application in different types of verruca and with placebo for the treatment of single verruca plantaris lesions. In total, 53 patients (mean age 22.6 years) were enrolled in the study. Of these, 45 patients received a single sublesional injection of 4.5 MU IFN-α2a (three study groups), and eight patients with single verruca plantaris lesions were injected with physiological saline as placebo (control group). As local anaesthesia, liquid nitrogen was sprayed only on to the injection site for 3–4 s. The injection was made directly under the lesion through the border of the lesion, at with approximately a 45° angle from healthy skin.
Results.  At the 12-month follow-up in the group of patients with single verruca plantaris, there were 19 complete cures (7.2%) and 2 partial responses (8.3%), and 3 patients (12.5%) had no response. In the control group, only 2 patients (25%) had a partial response to treatment.
Conclusions.  These results suggest that a single sublesional dose of 4.5 MU IFN-α may be of value in the treatment of patients with verruca, especially in those with single verruca plantaris lesions.     

疣状表皮发育不良少见皮损1例

报告１例疣状表皮发育不良少见皮损，患者女性，３６岁，躯干，四肢疣状皮疹不断增多２４年，出现褐色斑片１年，除扁平疣样和寻常疣样皮损外，出现类似连圈状糠秕疹和脂溢性角化样的皮损。     

人乳头瘤病毒型别及载量与寻常疣临床特征相关性研究

目的 探讨人乳头瘤病毒型别、载量与寻常疣临床特征的相关性。 方法 提取48例寻常疣组织DNA;正反向测序通用引物PCR扩增片段,通过blast比对分型,并通过型别特异性引物PCR来验证和补充测序结果;实时荧光定量PCR相对定量ΔCt法检测HPV病毒载量;HE染色法观察病理变化。 结果 35例HPV PCR检测阳性的标本中HPV 7型32例;HPV 57型1例,为四肢末端多发;HPV 2和HPV 7混合感染2例,为头面部、躯干多发病例。单发组与多发组、病程 ＜ 6个月组与病程6个月至1年组病毒载量、空泡化细胞数目无明显差异,1年后病毒载量有下降趋势,病程 ＞ 2年的皮损,角化过度更明显,空泡化细胞减少。 结论 寻常疣的HPV感染型别主要是HPV 7;HPV 7型感染好发于头面部;对于病程1年内的寻常疣,HPV病毒载量及空泡化细胞数目与其数目、病程长短无明显相关性。     

Disseminated Epidermolytic Acanthoma with Disseminated Superficial Porokeratosis and Verruca Vulgaris in an Immunosuppressed Patient

A 40-year-old man who had received long term immunosuppressive treatment for 14 years following kidney transplantation developed multiple skin lesions on both antecubital fossae, scalp, and both lower extremities. Histopathologic findings from three skin regions revealed characteristic features of epidermolytic hyperkeratosis, verruca vulgaris, and disseminated superficial porokeratosis, respectively. Although immunocompromised individuals may demonstrate verruca vulgaris or porokeratosis, disseminated epidermolytic acanthoma (DEA) has not been reported to be associated with immunosuppressed status. We suggest that immunosuppression may play a role in the pathogenesis of DEA, as shown in our case.     

Detection of high-risk human papillomaviruses in verrucae of patients with mycosis fungoides and Sézary syndrome: a case series

Background  Mycosis fungoides (MF)/Sézary syndrome (SS) patients are immunocompromised and thus may be susceptible to high-risk human papillomavirus (HPV) infections that are difficult to treat.
Methods  Three patients with verrucous skin lesions, 2 of whom had coexisting squamous cell carcinoma (SCC) near the verruca biopsy site, had biopsies of verruca for histologic examination. HPV typing was performed on fresh verruca biopsies by nested polymerase chain reaction.
Results  A single type of high-risk HPV was identified in each patient's lesion.
Conclusions  HPV may have acted as a cocarcinogen in the development of SCC in two patients and extensive condyloma acuminatum in one.     

Melanoma mimicking plantar wart

A 58-year-old white man had an enlarging lesion on the sole of the right foot mistakenly diagnosed clinically and histologically as verruca vulgaris. Lack of response to therapy led to a repeat biopsy which showed malignant melanoma, acral lentiginous type, level IV. The lesion was surgically removed, and 11 months later there was no evidence of recurrence. In the differential diagnosis of lesions of the palms and soles, one should include acral lentiginous melanoma, especially if the lesion is pigmented.     

Extensive presentation of verruca plana in a healthy individual

A 27-year-old healthy man presented with non-itchy hyperpigmented skin lesions involving the trunk of duration 3 years. Examination revealed numerous coalescing, rough, slightly elevated brownish papules involving large areas of back, chest, and abdomen. There were no other cutaneous or systemic findings. Cutaneous biopsy was suggestive of verruca plana, which confirmed our clinical diagnosis. Here, we report this case of verruca plana due to its rare extensive involvement and unusual site in a non-immunocompromised individual.     

Verrucous psoriasis: a distinctive clinicopathologic variant of psoriasis

Psoriasis is capable of presenting in a variety of clinical and pathologic guises including a rarely described variant variably termed hypertrophic or verrucous psoriasis. Herein, we describe the clinical and pathologic attributes of a large series of patients with this unusual variant of psoriasis and distinguish it from other entities in the differential diagnosis. The histopathologic features and clinical and demographic attributes of a series of 12 cases from 12 patients were reviewed by a single dermatopathologist (MM). The 12 patients consisted of 7 males and 5 females with an average age of 61.8 years (males 38-93 years, females 41-71 years). Eight of the patients were Caucasian, 3 Hispanic and 1 African-American. Six of the lesions were located on the knees, 4 involved the elbows, and 2 were seen on the dorsum of the hands (metacarpal-phalangeal joint). The clinical appearance of the lesions consisted of flesh-toned to white mammillated plaques (8 cases) and coalesced papules (4 cases). Each of the biopsies showed regular psoriasiform epidermal hyperplasia with acanthosis, hyperkeratosis, and either spongiform neutrophilic or Munro micro-abscesses. In addition, each showed papillomatosis with bowing of the peripheral rete ridges toward the center of the lesion (buttressing). At high power, epidermal neutrophils were seen in particular surmounting the tips of the suprapapillary plates with accompanying serum. Hypergranulosis and koilocytic change were not observed in any of the lesions. Human papilloma virus (HPV) immunostaining and periodic acid Schiff (PAS) special staining for fungi were negative. Verrucous psoriasis is a distinctive variant of psoriasis with overlapping clinical and pathologic features that might prompt consideration of verruca vulgaris. The presence of epidermal papillomatosis and epidermal buttressing seen in these lesions is reminiscent of the histologic features of verruca vulgaris. Similarly, the presence of coalesced papules might prompt clinical consideration of verruca vulgaris as well. It is likely that this under recognized clinicopathologic entity represents a patterned response of the epithelium to repeated trauma/irritation typical of the anatomic locations that were encountered in this series. Recognition of this entity should preempt confusion with verruca vulgaris or other entities capable of producing wart-like epidermal changes.     

Irritated seborrheic keratoses and benign verrucous acanthomas do not contain papillomavirus DNA

Sections from paraffin-embedded tissues of lesions thought to represent verrucous lesions (benign verrucous acanthomas: BVA) as well as materials from controls including seborrheic keratoses (SK), irritated SK, and verruca vulgaris from areas other than the genitalia were analyzed for the presence of multiple human papillomaviruses (HPV) including types 6, 11, 16, 18, and 33 using DNA amplification methodology. HPV DNA sequences were not found in amplified samples of BVA, SK, and irritated SK samples, but were identified in those obtained from verruca vulgaris. Our results suggest that BVA, SK, and irritated SK are generally not associated with HPV DNA even though certain of these lesions may histologically mimic the architecture of verruca.