对“k免疫表型为CD8~+、CD4~-、CD56~+蕈样肉芽肿1例”一文的商榷

<正>笔者反复拜读我刊2010年24卷12期甄希、于建斌、张江安等老师著"免疫表型为CD8+、CD4-、CD56+蕈样肉芽肿1例"[1]收益很深,另一方面笔者感本例患者可能是Paget样网状细胞增生病。关于Paget样网状细胞增生病,《临床皮肤病学》[2]这样描述:"目前认为很可能是蕈样肉芽肿的一种限局型,有明显亲表皮性。临床表现通常单发,缓慢扩大,但偶见数个损害,密集存在。好发于四肢,主要在下肢。     

对“免疫表型为CD8+、CD4-、CD56+蕈样肉芽肿1例”一文的商榷

笔者反复拜读我刊2010年24卷12期甄希、于建斌、张江安等老师著"免疫表型为CD8+、CD4-、CD56+蕈样肉芽肿1例"[1]收益很深,另一方面笔者感本例患者可能是Paget样网状细胞增生病.关于Paget样网状细胞增生病,《临床皮肤病学》[2]这样描述:"目前认为很可能是蕈样肉芽肿的一种限局型,有明显亲表皮性.临床表现通常单发,缓慢扩大,但偶见数个损害,密集存在.好发于四肢,主要在下肢.皮损无自觉症状,表现为红色鳞屑性斑块,有时表面角化,边缘环状,稍隆起,中央有自愈倾向.病理变化表皮内尤其下部,有很多单一核细胞浸润……胞浆很少,通常呈晕状.常见2～3个细胞核排列成巢,周围有不着色晕,因此很象Pautrier微脓肿.真皮仅见非特异性浸润."     

外阴Paget样网状细胞增生症

报告1例外阴Paget样例状细胞增生症．患者女，70岁，外阴红斑，增生，破溃，渗液2年，皮肤科检查见外阴及其周围有一11cm×10cm浸润性暗红斑，边界清楚，边缘略隆起，皮损组织病理检查示表皮下部和真皮上部可见不典型单核细胞浸润，多个异形细胞聚集成巢，甚似Pautrier微脓肿，免疫组化染色结果示CD3、CD43、Ki-67均（＋），CD4、CD8、CD20、CD79α、DC30均（-）。诊断：阴外Paget样网状细胞增生症。[编者按]     

皮肤CD8+T细胞淋巴瘤

皮肤CD8+T细胞淋巴瘤罕见,常见于成人.皮肤损害可表现为蕈样肉芽肿(MF)样、Sezary综合征样、全身性银屑病样、播散性湿疹样网状细胞增生病(PR)、限局性PR和皮肤结节等.约半数病例为侵袭性或惰性.瘤细胞常示向表皮性和主要浸润于皮肤附属器周围,示CD8+、CD7+、CD3+,但常丢失CD2和CD5,不常表达活化抗原(CD25、CD30、Iα).此瘤需与富于CD8+T细胞的疾病如皮肤红斑狼疮、银屑病等鉴别,以及与MF之反应性CD8+细胞区别.     

褶皱部位异色病样蕈样肉芽肿

报告褶皱部位异色病样蕈样肉芽肿1例。患者女,39岁。因褶皱部位皮疹17年就诊。皮肤科检查:双侧腋下、肘窝、乳房皱襞、腹部、腹股沟、腘窝及足踝内侧对称鳞屑性网状斑片,其间可见点、片状色素减退,伴皮肤萎缩及毛细血管扩张。皮损组织病理检查:较多淋巴样细胞侵入表皮,部分核深染,可见Pautrier微脓肿样结构。免疫组化示CD8、CD3、CD4、CD5及CD7均阳性;CD20及CD30阴性。诊断:异色病样蕈样肉芽肿。     

面部皮肤B细胞假性淋巴瘤1例

报告1例发生于面部的假性淋巴瘤。患者女,50岁,因“左侧面颊部浸润性淡红斑3个月”就诊。皮肤科检查：左侧面颊见一浸润性斑块,边界欠清,稍隆起皮面。皮损组织病理示真皮内淋巴细胞、浆细胞团块样浸润,可见淋巴滤泡生发样结构。免疫组化检测：CD3示T细胞散在阳性,CD20示B细胞团块状阳性,CD21示FDC结构完整,CD1a示散在个别阳性,CD68示散在个别阳性。诊断：皮肤B细胞假性淋巴瘤。治疗：局部予曲安奈德注射液,同时外用0.1%他克莫司软膏治疗。治疗3个月后皮损消退,随访半年未见复发。     

Paget样鲍温病1例

患者女,78岁,右大腿暗红色斑片半年,偶尔痒痛。皮损组织病理示:表皮内查见Paget样细胞呈巢状排列,并有压迫、挤压邻近表皮细胞的倾向,免疫组化示CK5/6灶性阳性,CK7,GCDFP-15,CEA,HMB45阴性,诊断Paget样鲍温病。     

种痘样水疱病样T细胞淋巴瘤伴发原发性皮肤CD30阳性大细胞淋巴瘤1例

患者女,17岁。全身反复起丘疹、水疱、坏死、凹陷状瘢痕伴瘙痒、发热15年,四肢起肿块2年。血清抗EBV-IgM(-),抗EBV-IgG(+)。肿块处皮损组织病理示真皮中下层和皮下组织见弥漫性致密的瘤细胞浸润,细胞核呈间变性;免疫组化示CD3(+),浸润的大细胞CD30(+),CD43(+),80%浸润细胞Ki-67(+)。水疱处皮损组织病理示表皮网状变性及多个水疱,真皮和皮下组织可见血管和附属器周围以淋巴细胞为主的、伴少量嗜酸粒细胞浸润,部分浸润细胞呈明显异形性;免疫组化示CD3(+),CD30(-),CD43(+),Ki-67(+)。诊断:种痘样水疱病样T细胞淋巴瘤伴发原发性皮肤CD30阳性大细胞淋巴瘤。确诊后建议患者转肿瘤科化疗,随访中。     

肉芽肿性蕈样肉芽肿二例并文献复习

报道2例以局部浸润性斑块为主要表现的肉芽肿性蕈样肉芽肿并复习相关文献.2例患者均表现为红斑、斑块,皮损组织病理检查见真皮内淋巴样细胞及巨细胞浸润,患者1免疫组化示CD2、CD3、CD5、CD7阳性,患者2 CD2、CD3、CD4阳性及CD68组织细胞阳性.诊断:肉芽肿性蕈样肉芽肿.患者1口服阿维A及肿块局部浅层X线照射...     

汗孔角化症继发Paget样Bowen病一例

报道一例继发于汗孔角化症的Paget样鲍温病,患者为老年男性,因右大腿红色斑块3年余就诊。患者既往有汗孔角化症10余年,3年前一皮损逐渐增大,出现浸润, 皮损组织病理改变示棘层肥厚,角质形成细胞排列紊乱,部分角质形成细胞有异型性,部分细胞胞质丰富淡染似Paget细胞,核呈圆形或椭圆形。免疫组化染色示CK5/6阳性,HMB-45、CK7及CEA阴性。     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Self‐resolving superficial primary cutaneous mucormycosis in a 7‐week‐old infant

A 7‐week‐old girl, born at 30 weeks' gestational age, presented to clinic for evaluation of a crop of vesicular lesions that were noted after removal of a bandage that had been in place for 4 days. A punch biopsy of the lesion revealed fungal elements that were later identified as Rhizopus spp. The lesion began to self‐resolve, and no further treatment was needed, with full resolution of the lesion by 1 month after presentation. Clinicians should be aware of the variable presentations of mucormycosis and consider fungal infection in the differential diagnosis when evaluating vulnerable patients with skin eruptions.     

Pathogenic role of IL-17 in psoriasis and psoriatic arthritis

Psoriasis is a chronic inflammatory skin disorder resulting from a complex network of cytokines and chemokines produced by various immune cell types and tissue cells. Emerging evidence suggests a central role of IL-17 and IL-23/T17 axis in the pathogenesis of psoriasis, giving a rationale for using IL-17-blocking agents as therapeutics.Three agents targeting IL-17 signaling are being studied in Phase III clinical trials: secukinumab and ixekizumab (IL-17 neutralizing agents), and brodalumab (IL-17 receptor antagonist). Preliminary results are highly promising for all anti-IL17 agents, creating fair expectations on this class of agents as the new effective therapeutic approach for the treatment of psoriasis.