头皮席纹状胶原瘤1例

患者女,48岁,左侧头皮肤色结节4年。皮损组织病理示：真表皮乳头样增生,真皮内见由增粗、肥大,排列成席纹状的胶原纤维束组成的结节,其间可见少量成纤维细胞散在分布。诊断：孤立性席纹状胶原瘤。     

手术治疗复发性非典型性纤维组织细胞瘤1例

患者女,19岁,左前臂出现无痛性肿物1年。皮肤科情况:左前臂单发约1 cm×0.9 cm大小、质地中等硬度的皮肤肿物,与周围组织界限不清,表面无破溃及触痛。皮损组织病理示:肿瘤细胞呈席纹状排列、有病理性核分裂象及泡沫细胞,免疫组织化学CD34染色肿瘤细胞部分阳性,诊断为非典型性纤维组织细胞瘤。常规手术切除后2个月复发,再次扩大切除后,随访21个月未见复发。     

席纹状胶原瘤

报告1例席纹状胶原瘤。患者男,46岁。背部肿物40年余,缓慢增长,无自觉症状。无系统性疾病病史。皮损组织病理检查示表皮轻度萎缩,真皮内可见一边界清楚的结节,无包膜,病变均匀、局限,由大量透明样变的胶原束组成,胶原束之间见许多裂隙,排列成席纹状。诊断:席纹状胶原瘤。     

隆突性皮肤纤维肉瘤2例

报告2例隆突性皮肤纤维肉瘤。例1男,37岁,左侧肩部红色斑块20年;例2女,64岁,左侧腹股沟包块7年。皮损组织病理均示真皮全层大量的梭形肿瘤细胞,排列成席纹状或漩涡状,部分肿瘤细胞核大、深染,部分核分裂。均诊断为:隆突性皮肤纤维肉瘤。     

基底细胞癌

正患者男,61岁。主诉:左鼻翼黑色结节15余年,近1个月皮损明显增大。现病史:患者15余年前发现左侧鼻翼部一黑色斑片,不伴痛痒,未曾就诊,近1个月皮损明显增大,偶有痒感,于2016年8月来我科就诊。皮肤科检查:左侧鼻翼一0.6 cm×0.6 cm灰黑色结节,质硬,周边色素加深,皮损中央可见明显毛细血管扩张     

萎缩型隆突性皮肤纤维肉瘤误诊1例

患者女,30岁,左侧季肋部暗红色结节6年,伴疼痛6个月余。患者曾以"硬皮病、结节病"治疗效果欠佳。查体见左侧季肋部可见不规则形状的暗红色结节,大小约为3.5 cm×1.9 cm,皮损表面部分萎缩,略有凹陷,边缘隆起,呈囊性、质软,皮损中央血管较为明显。皮损组织病理示:表皮变薄,真皮浅层炎症细胞浸润伴少许肿瘤细胞,真皮深部肿瘤细胞呈车轮状或席纹状,肿瘤细胞可见核分裂象,肿瘤细胞向脂肪组织浸润,分割脂肪细胞,呈现蜂窝状;免疫组织化学:CD34(+)。诊断:萎缩型隆突性皮肤纤维肉瘤。明确诊断后建议患者行扩大切除术及游离皮瓣转移术,患者拒绝并坚持保守治疗,现在随访中。     

脂质化纤维组织细胞瘤

报告1例脂质化纤维组织细胞瘤。患者男,43岁。因右小腿肿块渐进性增大10年余就诊。皮肤科检查:右小腿伸侧近踝关节处有一2.5 cm×2.5 cm半圆球形暗褐色肿块,质硬,活动度差。皮损组织病理检查:肿瘤组织位于真皮层,主要由泡沫样细胞及多量玻璃样变性的胶原纤维构成,胶原纤维似骨基质样、金属丝样,肿瘤边缘处可见少量呈席纹状排列的梭形细胞。免疫组化检查示CD10(+),CD68(+),CD34(-)、波形蛋白(+),诊断为脂质化纤维组织细胞瘤。     

链霉素治愈鼻硬结病1例

患者女,69岁,汉族,云南省会泽县人。因鼻梁肿物激光治疗术后一m复发来诊。在会泽县医院病检为:鼻硬结病,用C02激光治疗,术后一m肿物如前。查:系统检查未发现异常;鼻梁可见约2 cm×1·5 cm肿物,边缘堤状突起,中心凹陷,有淡黄色分泌物无脓痂,右侧鼻翼发硬,鼻黏膜萎缩,左侧正常,鼻     

隆突性皮肤纤维肉瘤2例

报告2例隆突性皮肤纤维肉瘤。例1.女,31岁。因左侧大腿增生物15年就诊;例2.女,48岁。因左侧腹部皮下斑块20年就诊。皮损组织病理检查均示真皮中、下层大量梭形肿瘤细胞,排列成席纹、漩涡状或车辐状,部分肿瘤细胞核大、深染,可见核分裂象;免疫组化CD34均弥漫阳性,Ki-67(20%~30%+)、CD68散在(+)、CD163少数(+)。诊断:隆突性皮肤纤维肉瘤。     

硬斑病样型基底细胞癌1例

患者女,61岁。左侧面颊部淡黄色质硬斑块缓慢增大3年。皮肤科情况:左侧面颊部见约2cm×1.5cm大小斑块,轻度隆起,质地坚硬。皮损组织病理示:真皮内见多量由基底样细胞组成的瘤团,瘤细胞核大、浆少、染色嗜碱,周围细胞呈栅栏状排列,并见收缩间隙,团块周围间质胶原纤维增生。诊断为硬斑病样型基底细胞癌。     

Recurrent malignant fibrous histiocytoma with expression of cytokeratin.

A case of locally recurrent malignant fibrous histiocytoma was documented in a 70-year-old man. He first noticed a subcutaneous nodule forty years previously. The tumor was surgically removed four times during the last four years with local recurrence on every occasion. In the recurrent tumors, the tumor cells almost completely replaced the whole dermis and invaded skeletal muscles. They were composed of pleomorphic spindle cells arranged in a storiform pattern and bizarre histiocytic cells, which were present principally in the deeper portions of the tumor. Both types of tumor cells showed marked nuclear atypicality. In the primary tumor, surrounding a large necrotic area, spindle-shaped cells were arranged in a storiform pattern. These tumor cells exhibited only mild nuclear atypia. The recurrent tumor was strongly positive for vimentin and alpha-1-antichymotrypsin. Most tumor cells were also weakly positive for KL1, a monoclonal antibody for keratin. A Western-blot analysis revealed the presence of two bands (62 and 69 Kd) reacting with KL1 in the fractions which were obtained from the tumor according to the method for keratin extraction.     

Pacinian collagenoma: A distinct form of sclerotic fibroma

Sclerotic fibroma (storiform collagenoma) is a rare benign skin tumor. A solitary tumor, as well as multifocal lesions, are found either sporadically, or associated with Cowden syndrome. The tumor usually presents as clinically asymptomatic, slowly growing papule or nodule on the skin of the head, neck, and upper extremities. Microscopically the lesion is sharply demarcated, composed of hyalinized bands of collagen with low cellularity and a distinctive irregularly whorled or storiform pattern. We describe a case of a unique variant of this tumor in the scalp of a 33-year-old male. The tumor was microscopically composed of concentrically arranged collagen bundles with prevailing type III collagen, which resembled an enlarged Vater-Pacini corpuscle, with low density of CD34-positive and glucose transporter 1-negative spindle shaped cells. The specific microscopic appearance is suggestive of the term “Pacinian collagenoma” for this unique benign tumor.     

深部良性纤维组织细胞瘤一例

深部"良性"纤维组织细胞瘤是一种罕见的纤维组织细胞肿瘤,好发于四肢,本文报道1例.患者,女,56岁,左前臂无痛性皮下肿物4年,组织病理示境界清楚的单发性圆形皮下肿物,约1.8 cm×1.3 cm×0.6 cm,周围有纤维性假包膜,肿瘤细胞丰富,呈梭形或类圆形,编织状致密排列,细胞无明显异型性.免疫组化:CD34(+),...     

左腋下放疗后隆突性皮肤纤维肉瘤妊娠期迅速增大一例

患者女,30岁。5年前因左乳腺癌行保乳手术并接受放射治疗,在左腋下出现放射性皮炎。2年后,在放射性皮炎部位出现3个黄豆大小的鲜红色结节,逐渐增大,行手术切除3周后复发。妊娠后肿块迅速增大、隆起,终止妊娠后,肿块增大趋势得到明显遏制。皮肤科检查：左腋下方见18 cm × 14 cm类似椭圆形暗红色或鲜红色斑块,斑块表面光滑,中央为 10 cm × 9 cm × 5 cm大的鲜红色半球形实质性隆起,表面糜烂,结痂。组织病理：真皮中下层致密、单一的梭形细胞排列成漩涡状、席纹状。部分细胞核有异形性,少见核分裂象。少数区域瘤细胞排列成“青鱼骨”状。免疫组化染色：波形蛋白（+++）,肌动蛋白（+）,CD34阴性。诊断：放疗后隆突性皮肤纤维肉瘤（纤维肉瘤型）。     

Cutaneous sclerosing perineurioma of the digit

An 11-year-old Japanese girl noticed a small nodule, with mild tenderness, on the right index finger 5 years before visiting our outpatient clinic. She had no familial history of neurofibromatosis or past history of traumatic injury at the site of the tumor. Physical examination revealed a slightly elevated, subcutaneous, nodular tumor in the volar aspect between the proximal and distal interphalangeal joints of the digit (Fig. 1A). By magnetic resonance imaging examination, the tumor showed low density on both T1- and T2-weighted images, and was located just adjacent to the tendon with no invasive signs. The tumor was extirpated; at operation, it was well circumscribed and mobile without adhesion to adjacent tendon or nerve, and was easily removed. Grossly, the tumor was a well-circumscribed, firm nodule (10 mm x 8 mm x 5 mm in size) (Fig. 1B). The cut surface was whitish, homogeneous, and solid without cystic lesions. Histologically, it was an unencapsulated, paucicellular dense, fibrous nodule with a concentric circular arrangement of collagen bundles (Fig. 2A). Amongst the fibrous bundles, a small number of ovoid/epithelioid or plump spindle cells were arranged in a corded, trabecular, or whorled (onion bulb-like) pattern (Fig. 2B); a storiform pattern was not noted. These cells were relatively uniform and had a somewhat elongated, slightly hyperchromatic nucleus with fine granular chromatin. Neither nuclear pleomorphism nor multinucleated cells were evident, and necrosis and mitotic figures were not observed. Periodic acid-Schiff (PAS) stain after diastase digestion highlighted the corded or whorled pattern of the tumor cells by encasing them. For immunohistochemical examination, formalin-fixed, paraffin-embedded serial tissue sections were stained by a labeled streptavidin-biotin method. The tumor cells were positive for vimentin and epithelial membrane antigen (EMA) (Fig. 3A), and negative for pan-cytokeratin, carcinoembryonic antigen (CEA), CD34, alpha-smooth muscle actin, desmin, and CD68. Type IV collagen and laminin (Fig. 3B) were detected along the cords or whorls of the tumor cells, similar to the staining pattern of the diastase-PAS reaction. Schwann cells and axonal components, immunoreactive for S100 protein and neurofilament, respectively, were focally detected just adjacent to the cords or whorls, although the tumor cells per se did not express these proteins. Consequently, the tumor was found to be perineurial in origin and was diagnosed as cutaneous sclerosing perineurioma.     

浅表肢端纤维黏液瘤一例

患者男,43岁,左足跟肿块7年余.无明显不适,行走时偶尔有疼痛,逐渐增大.临床表现为左足跟1.5 cm×1.5 cm大小浅红色、质硬、境界清楚的肿块.病理检查可见黏液样基质中较多的梭形或星形细胞增殖呈席纹样或束状排列,其间可见有较多的小血管,梭形或星形细胞未见明显异形.免疫组化显示波形蛋白、纤维结合素、CD34和上皮膜抗原阳性,平滑肌抗体、S-100、神经微丝、结蛋白和CD99均为阴性.诊断为浅表肢端纤维黏液瘤.行足跟部肿块扩大切除术合并游离皮片移植术,术后随访5月余未见复发.     

Syringocystadenoma papilliferum associated with poroma folliculare

A 70-year-old woman had a dome-shaped with a keratinous mass nodule which measured 1.0 × 1.0 × 0.9 cm on the inner canthus. Multiple confluenced vesicles were seen in a small area of the tumor. Histological examination revealed that the tumor had two different portions. The larger portion was poroma folliculare and the smaller was syringocystadenoma papilliferum. We collected cases of syringocystadenoma papilliferum reported in Japan, but there were no other cases associated with poroma folliculare. We suggest that a teratogenic follicle developed poroma folliculare on one side and syringocystadenoma papilliferum on the other.     

Myoid differentiation and EMA expression in fibrosarcomatous dermatofibrosarcoma protuberans

Dermatofibrosarcoma protuberans (DFSP) is a relatively unusual, locally aggressive cutaneous tumor of intermediate malignancy. Fibrosarcomatous DFSP (FS-DFSP), a rare variant of DFSP, has a higher tendency for recurrence and metastasis. Recently, a small number of cases of another variant of FSDFSB characterized by areas of myoid differentiation have been reported. We present here a 35 yearold female patient with myoid differentiation in FS-DFSP. The tumor on the left scapular region had slowly grown over six years. Examination revealed a domeshaped, firm, nontender, violaceous dermal nodule. Histologically, it was composed of a monotonous spindle cell population arranged predominantly in a storiform pattern and to a lesser extent in a fascicular fibrosarcomatous pattern with a parallel arrangement of the cells. Immunohistochemically, the tumor cells showed diffuse expression for vimentin and CD34. In the center of the tumor areas with frequent mitosis, hypercellular and negative reactive for CD34 were seen. In addition, approximately 10% of the cells were positive for epithelial membrane antigen. Myoid differentiation was found around the blood vessels. The myoid areas were positive for smooth muscle actin and negative for desmin. It is possible that the presence of hyperplastic myofibroblasts is a reactive phenomenon to the proliferation of tumor cells. We believe that this finding around blood vessels may be present in DFSP or FS-DFSP. However, when myoid areas, myoid fascicles and myoid nodules are seen in the stroma, it may be a new morphological variant of DFSP and/or FS-DFSP.     

Superficial acral fibromyxoma: a clinicopathological analysis of 32 tumors including 4 in the heel

Aims: To examine a series of superficial acral fibromyxomas (SAFs) and discuss our experience with this new entity and its differential diagnosis in the past 5 years. Methods and results: Thirty‐two new cases of SAF were studied between 2001 and 2006. The patients included 22 males and 10 females with an age range between 23 and 82 years (mean 51, median 53) presenting with a solitary mass or nodule with an average size of 2 cm. The sites were the toes (n = 15) and fingers (n = 13) with 66.6% of tumors close to or involving the nail bed. Four tumors occurred in the heel where SAF has not been previously observed. Local recurrences developed in 3 of 14 patients (22%). Histologically, all tumors presented with spindle cells with a vague storiform and fascicular pattern embedded in a myxoid/fibromyxoid/collagenous stroma. A characteristic immunophenotype included CD34+, CD99+/? and EMA+ focally. One case showed moderate cytological atypia with 1 mitosis per 10 HPF, but a 4‐year follow up showed no evidence of recurrence. Conclusion: Thirty‐two new cases of SAF confirm this tumor as a reproducible entity. Occurrence in the heel, a new site for this tumor, was reported in four cases. Recurrence rate of this tumor may exceed 20%.