角化棘皮瘤样的钙化上皮瘤1例

临床资料患者女,70岁.4个月前无明显诱因右前臂出现1个绿豆大暗红色丘疹,无痛痒,皮疹逐渐增大,中央出现溃疡,并有黄色渗液流出.曾在外院给予中药湿敷(诊断不详),效果不佳.系统检查未见异常.皮肤科情况:右前臂近肘关节屈侧可见1个蚕豆大暗红色结节,中央破溃如火山口,未见明显脓性分泌物溢出.肿物硬无触痛(图1).诊断:角化棘皮瘤.活检过程中,皮损中央脱落黄豆大栓状物,疑诊为"传染性软疣"?组织病理示:棘细胞层轻度肥厚,皮损处呈火山口样外观,可见位于真皮深层的瘤团,下半部可见嗜碱性的基底样细胞,核圆形,染色深;并可见嗜碱性的基底样细胞逐渐消失形成的"过渡细胞"和细胞发生角化、呈嗜酸性但仍可见核的阴影所形成的"影细胞"(图2、3).诊断:钙化上皮瘤.     

手术开放创面联合光动力治疗角化棘皮瘤型高分化鳞癌一例

患者，女，95岁。鼻背部花生大粉红色结节1个月。皮肤科查体：鼻背部花生大粉红色结节，质硬，活动度差，边缘隆起，中央可见破溃结痂。组织病理示：角化棘皮瘤型高分化鳞状细胞癌。行肿物切除术，结合光动力治疗4次，伤口愈合良好。     

以脓疱疹及扁平湿疣为主要表现的二期梅毒1例

患者女,28岁,孕8周。面部及外阴出现皮疹,伴瘙痒和疼痛20余天。皮肤科情况:前额、鼻旁、口周及颈前可见散在分布绿豆至花生大斑丘疹和脓疱;头皮可见数个蚕豆大结节,部分结节破溃和流脓;外阴及肛周可见密集分布疣状斑块。RPR 1:32(+),TPPA(+)。诊断:梅毒(二期)。     

肺小细胞癌皮肤转移1例

患者男,69岁。背部偏左侧出现肿物半年,破溃半月。皮肤科情况:背部偏左侧可见一2.0cm×10.0cm×8.0cm大肿物,质硬,表面破溃,左侧腋下淋巴结肿大,如鸽蛋大。皮损组织病理示:胶原纤维束间见密集肿瘤样细胞浸润,此种细胞体积较小,呈圆形,胞浆少,并见个别异形细胞。免疫病理示:肿瘤细胞LCA阴性,CgA阳性,CD56阳性,Syn阳性,TTF1阳性,AE1/AE3表皮阳性,肿瘤细胞胞浆内见点状阳性,CK20阴性。诊断:肺小细胞癌皮肤转移。CT检查提示肺部和胰腺有占位性病变,行皮肤肿瘤切除术,术后患者消瘦、纳差,1个月后死亡。     

溶脂术后皮肤产免疫分枝杆菌感染2例

女, 58岁, 因背部红斑、皮下结节半月于2020年7月22日就诊。自诉半月前在私人美容诊所行"背部溶脂术"(注射成分不详), 随后溶脂部位出现米粒至豆粒大小红色丘疹、结节, 部分皮疹表面破溃后有脓性分泌物渗出, 有明显压痛。于外院行脓性分泌物培养, 提示浅黄色分枝杆菌, 予口服抗生素治疗1周(方案不详), 自觉治疗效果欠佳, 皮疹及脓性分泌物仍增多, 遂就诊于我院。皮肤科检查:左侧肩背部可见散在豆粒大小浸润性红斑、结节(图1), 质韧, 压痛明显, 部分红斑表面破溃结痂, 境界清楚, 表面未见明显分泌物。肩背部红斑结节组织病理:表皮轻度肥厚, 真皮内可见片状密集的中性粒细胞、淋巴细胞、组织细胞、浆细胞及多核巨细胞浸润, 有肉芽肿形成(图2A)。抗酸染色:找见少量抗酸杆菌(图2B);PAS染色阴性。肩背部皮损组织真菌培养阴性。肩背部皮损组织细菌培养:非结核分枝杆菌(nontuberculous mycobacteria, NTM)复合群。     

新生儿先天性自愈性朗格汉斯组织细胞增生症1例

患儿女,9 h,以"皮疹9 h"就诊。生后即发现全身散在黄豆大小的暗紫色皮疹,少许皮疹随后破溃。查体:全身皮肤散在小米至绿豆大小的紫黑色丘疹,压之不褪色,周围皮肤无红晕,疹间皮肤正常,部分皮疹破溃。组织病理示:网篮状角化过度,真皮内可见上皮样细胞肉芽肿,周围淋巴细胞浸润,S100(+)、CD1a(+)、CD68(+)、CD207(+)。随诊:随诊至今,患儿3个月,在月龄2个月时皮疹完全消退,部分有轻度色素沉着,无新发皮疹。现生长发育与同龄儿一致。符合先天性自愈性朗格汉斯组织细胞增生症(CSHLCH)。     

获得性反应性穿通性胶原病

报告1例获得性反应性穿通性胶原病。患者女,44岁。全身红斑、斑丘疹及溃疡半年,进行性加重3个月,伴痒痛感。皮肤科检查:胸部、背部及双小腿散在黄豆至蚕豆大红斑和结节,中等硬度,部分皮损破溃,中央出现脐凹伴溃疡,并可见白色角质样物质排出;外阴中度水肿,表面可见糜烂。背部皮损组织病理检查:局部表皮缺失形成浅层溃疡,溃疡基底内可见大量胶原纤维,有外排现象,溃疡内大量中性粒细胞及坏死组织;真皮浅层炎性细胞浸润,以淋巴细胞及组织细胞为主,血管增生较明显,溃疡下方胶原破坏,排列不规则。Masson染色示变性的胶原纤维从表皮穿出。诊断:获得性反应性穿通性胶原病。     

上皮样肉瘤1例

患者男,19岁。右小腿皮疹伴疼痛1年,皮疹切除术后约3个月时右足底部出现皮疹,伴疼痛,部分破溃。组织病理示肿瘤团块呈结节状,结节由上皮样细胞及呈漩涡状排列的梭形细胞组成。免疫组化示波形蛋白(+),EMA(+)。诊断:上皮样肉瘤。     

表现为乳房外Paget病的异时性双重原发癌1例

报告异时性双重原发癌1例。患者女,60岁。3年前经尿道膀胱肿物电切术,切除物组织病理示膀胱移行细胞癌Ⅱ级。半年前出现外阴部红斑、丘疹,逐渐扩大。以乳房外Paget病行Mohs切除术。诊断:异时性双重原发癌。     

外阴部化脓性汗腺炎1例

<正>1临床资料患者女,21岁,学生。外阴肿痛、结节、破溃反复发作5年。5年前患者发现右侧小阴唇、阴蒂红肿,表面可见豆粒大丘疹,有脓头,走路不便,挤压痛,1个月后到当地医院就诊,给予"甲硝唑"口服治疗,并做开放式手术,术后1个月复发。脓液破溃后形成瘢痕,以后逐渐出现结节、破溃、瘢痕,皮损逐渐加重。否认性生活史。皮肤科情况:外阴部及大、小阴唇肥厚瘢痕,外阴部、肛周散在豆粒至花生米大小结节,形成核桃大小斑块、脓肿,表面可见脓头。间或有花生米大小溃疡,可见     

A Case of Cutaneous Inflammatory Myofibroblastic Tumor

Pseudo-inflammatory tumors are also known as plasma cell granuloma, inflammatory pseudo-tumor and inflammatory myofibroblastic tumor, and these tumors are a group of highly variable proliferations of myofibroblastic cells that are associated with a prominent inflammatory infiltrate. This tumor is known to most commonly occur in the lungs, bladder and gastrointestinal system with only a few cases having been reported in the skin. A previously healthy 26-year-old man presented with a 6-year history of an intermittently pruritic lesion on his back. On the histologic examination, there were spindle cells in fascicles and a mixed inflammatory cellular infiltrate of plasma cells and lymphocytes. A diagnosis of inflammatory fibroblastic tumor was made and the nodule was surgically removed. We report here on an additional case of this rare cutaneous entity, and it is probably the first such report from Korea.     

HIV感染合并泛发性顽固性传染性软疣1例

报道1例HIV感染者合并泛发性、顽固性传染性软疣。患者女,25岁,因躯干、外生殖器、双大腿内侧皮疹2个月就诊。患者4个月前确诊HIV感染,经高效抗逆转录病毒治疗(HAART)2个月。皮肤科检查：右侧乳晕、右肋间、腹部、耻骨部、大阴唇、小阴唇、肛周、双大腿内侧大量丘疹、结节,以及部分斑丘疹、脓疱、糜烂、痂。乳晕、外生殖器处皮损组织病理均提示：细胞胞浆内均可见嗜酸性病毒包涵体,软疣小体形成,可见一些嗜碱性透明角质颗粒,真皮浅层少量慢性炎细胞浸润。皮损随着HAART逐渐增多、增大。诊断：HIV感染合并泛发性、顽固性传染性软疣。治疗：予以微波治疗联合咪喹莫特乳膏外用,同时对患者进行心理干预等综合治疗。3个月后随访,皮损已基本消退,取得满意疗效。     

Eccrine porocarcinoma arising in a seborrheic keratosis evaluated with dermoscopy and treated with Mohs' technique

A 78-year-old white woman returned for a routine 6-month skin cancer examination. She had a history of actinic keratosis and multiple basal cell carcinomas. She had no personal or family history of dysplastic nevi or melanoma. The patient was asymptomatic and unaware of any new or changing skin lesions. The patient had multiple lentigines, hemangiomas, and actinic and seborrheic keratoses on all sun-exposed areas. There were no less than 10 seborrheic keratoses on the right mid-back, and one was found to have a 1-cm, reddish nodule asymmetrically located within it (Figs 1 and 2). A clear papule on the left preauricular area was found on biopsy to be a basal cell carcinoma. The nodule on the back was still present 1 month later and it was felt that further evaluation was indicated. As melanoma has been reported to develop in seborrheic keratoses, we decided to examine the lesion using digital dermoscopy. With digital dermoscopy, a well-demarcated reddish nodule was asymmetrically located within a brown lesion. It blanched significantly with pressure. Within the nodule, there were dotted and irregular linear vessels (atypical vascular pattern; also known as polymorphous vascular pattern) and regular-appearing brown dots. Surrounding the reddish nodule, there were pale and pigmented, comedo-like openings, fissures, and ridges (brain-like appearance). Some of the follicular openings appeared to be within the wall of the nodule (Figs 3 and 4). Comedo-like openings, fissures, and ridges are primary dermoscopic criteria for the diagnosis of a seborrheic keratosis; however, the vascular pattern seen has not been reported in seborrheic keratosis. Due to the patient's age and the rarity of significant pathology arising in a seborrheic keratosis, a shave biopsy was performed. To our surprise, the specimen was interpreted by an experienced dermatopathologist as a well-differentiated eccrine porocarcinoma. Due to the high local recurrence rate and metastatic potential of this carcinoma, the patient was referred for Mohs' surgery. Both the basal cell carcinoma and the eccrine porocarcinoma were excised in one stage. A metastatic work-up was negative and the patient appears to be doing well.     

Aggressive digital papillary adenocarcinoma on the palm with pulmonary metastases

A 41-year-old Japanese male had aggressive digital papillary adenocarcinoma with pulmonary metastases. He had an asymptomatic, solitary, dome-shaped, skin-colored firm nodule on his left palm for half year. The tumor consisted of multiple lobules of anaplastic epithelial cells with central necrosis. The neoplastic cells were immunohistochemically positive for cytokeratin and S-100 protein. Two years after the lesion was removed, pulmonary nodular lesions were found on chest X-ray. On histopathological examination, the pulmonary biopsy specimens showed lobular proliferation of acantholytic tumor cells and some ductal structures associated with papillary projections. Five years after the initial removal of the lesion, the patient was referred to our hospital because of a recurrent skin nodule on his left palm. The recurrent skin tumor was found to have lobular proliferation of anaplastic cells. On immunohistochemistry, the pulmonary metastasis and the palmar skin nodules were identical. The tumor was diagnosed as an aggressive digital papillary adenocarcinoma. This report is a rare case of aggressive digital papillary adenocarcinoma that was diagnosed based on the histopathology of the pulmonary metastases, which showed ductal structures associated with papillary projections.     

Apocrine hidradenocarcinoma showing Paget's disease and mucinous metaplasia

A 54-year-old man presented with a solitary, erythematous, rapidly growing 1-cm nodule on his scalp that had arisen over the previous 3 months. He had no history of skin cancer. An excisional biopsy of the lesion showed a fairly well-circumscribed but focally invasive tumor consisting of areas of typical-appearing clear cell hidradenoma as well as areas with mucinous goblet-type cells and cells with eosinophilic cytoplasm and decapitation-type secretion. There was marked cellular atypia, numerous atypical mitotic figures and focal necrosis. The tumor cells focally involved the overlying epidermis (Paget's disease). Large areas of mucin were identified throughout the lesion. The tumor cells stained with markers for cytokeratin 7 and focally for EMA and CEA, confirming ductal differentiation. The goblet cells and mucinous areas stained with mucicarmine and PASD. The patient was diagnosed with hidradenocarcinoma with mucinous differentiation. Associated Paget's disease has only rarely been reported, and mucinous metaplasia is a previously unreported feature in hidradenocarcinoma.     

Inflammatory myofibroblastic tumor of the skin.

We report a case of inflammatory myofibroblastic tumor (IMF) of the skin in a female with a history of Wegeners granulomatosis. The patient had a painless, erythematous, and indurated lesion of the left elbow. The resected specimen revealed a 4 cm x 3 cm nodule involving the entire dermis and superficial portions of subcutis with a stellate profile at scanning magnification. There were spindle cells in fascicles and whorls and a mixed inflammatory cell infiltrate of plasma cells, lymphocytes, neutrophils, and eosinophils. The spindle cells were immunoreactive for vimentin, muscle specific actin, and smooth muscle actin. The polyclonal and polymorphous nature of the inflammatory cells was confirmed by immunohistochemical studies. This is the first case of IMF of the skin documented by immunostaining.     

反应性结节性增生1例

报告1例反应性结节性增生。患者男,57岁。左手无名指结节3年,无自觉症状。给予手术切除治疗。组织病理检查：真皮内有大量交叉和波浪状排列的成纤维细胞和胶原纤维,其周围无包膜,与周围组织分界不明显;边缘血管周围可见少量单一核细胞浸润。     

Exophytic and ulcerated lesion on the leg

A healthy, 34-year-old male presented with a 1-year history of an exophytic lesion on the leg during. On physical examination there was a 2 cm x 3 cm diameter nodule with pinkish, crusted ulceration on its surface; it was attached to skin by a pedicle. It had grown rapidly in the last month. After surgical excision the histological study confirmed the diagnosis of a polypoid dermatofibroma.     

复发性恶性纤维组织细胞瘤

报告1例切除14年后复发的恶性纤维组织细胞瘤。患者男，62岁。14年前行右胫前恶性纤维组织细胞瘤切除术，术后恢复良好。3个月前右胫前原手术部位又出现一肿块，逐渐增大，3d前肿块表面皮肤破溃，无明显自觉症状。肿块组织病理检查：肿瘤细胞排列呈梭形或星形，可见核分裂相及核瘤巨细胞，肿瘤细胞位于黏液样基质中，间质血管丰富，出血明显。     

无黑素性黑素瘤伴全身转移1例

报道无黑素性黑素瘤全身转移1例。患者男 ,52岁 ,农民。左下肢有一米粒大小皮色肿物10年 ,增长缓慢。5个月前在基层医院行手术切除后很快发生局部淋巴结转移和全身转移。组织病理见真皮内瘤细胞呈团块状或巢状 ,小血管内可见肿瘤细胞浸润 ,HE染色未见黑色素。免疫病理S100( ) ,HMB45( )。