透明细胞棘皮瘤

报告1例透明细胞棘皮瘤.患者女,72岁.左踝外侧约豌豆大的孤立性结节30余年伴痒2年.皮损组织病理检查:表皮内可见边界清楚的肿瘤组织,瘤细胞胞质透明、肿胀.诊断:透明细胞棘皮瘤.     

透明细胞汗腺瘤1例

患者女,34岁。左耳前皮下结节1月余。皮肤科情况:左耳前可见一皮下结节,肤色,表面光滑,质地中等,无压痛。皮损组织病理示:真皮内可见大小不等肿瘤细胞团块,境界清楚,和表皮不相连;肿瘤团块由两种细胞组成:透明细胞及嗜碱性细胞。诊断:透明细胞汗腺瘤。     

皮下结节上囊性物——水疱型毛母质瘤1例

诊断:水疱型毛母质瘤(bullous pilomatricoma,BP). 组织病理所见:表皮大致正常.真皮层见肿瘤细胞团块,边界清楚,肿瘤细胞无异形性.肿瘤细胞团块由外至内可见典型的嗜碱性细胞、过渡细胞和影细胞(图2),影细胞小叶中未见钙化灶.     

成人型黄色肉芽肿20例临床和组织病理分析

目的:总结成人型黄色肉芽肿的临床表现及组织病理特点。方法:回顾性分析第四军医大学西京皮肤医院于2005年10月—2014年3月诊断的20例成人型黄色肉芽肿患者的临床表现和组织病理特点。结果:20例患者中,男15例,女5例,平均发病年龄为39岁,其中19例为单发皮损,1例为多发。皮损多见于头面颈部,尚未发现皮肤以外器官受累。组织病理表现为表皮轻度萎缩变薄,真皮可见境界清楚但无包膜包绕的细胞团块,由数量不等的组织细胞、Touton巨细胞及多种炎性细胞组成,免疫组化结果显示皮损处浸润细胞CD68阳性,CD1a和S-100蛋白阴性。结论:成人型黄色肉芽肿大多为单发皮损,组织病理学表现为表皮轻度萎缩变薄,真皮可见境界清楚但无包膜包绕的细胞团块,早期为单一形态、无泡沫化的组织细胞浸润,成熟期组织细胞出现泡沫化,伴有Touton巨细胞和多种炎性细胞,晚期常见梭形细胞浸润。     

透明细胞汗腺瘤1例

患者女,20岁。右额结节2年,于2016年12月26日就诊于西安交通大学第二附属医院皮肤科。患者2年前无明显诱因右额部出现一绿豆大丘疹,未予诊治,丘疹缓慢增大。偶有瘙痒。患者既往体健,家族无类似疾病患者。体格检查:一般情况好,各系统检查无异常。皮肤科检查:右额部见一处孤立的直径约5 mm大蓝黑色丘疹,表面光滑(图1A),边界欠清楚,与周围组织粘连,活动度欠佳。皮损组织病理:真皮内见有包膜肿瘤组织,境界清楚,可见大的空泡化透明细胞,胞核小,深染,位于边缘,胞膜清楚(图1B^D)。诊断:透明细胞汗腺瘤。治疗:局部浸润麻醉下手术切除治疗。术后创口一期愈合,随访至今未复发。     

倒置性毛囊角化病1例并文献复习

患者男,69岁,左侧面部结节2年。皮损组织病理示:角化过度,少量角化不全,角质形成细胞呈内生性生长,底部界限清楚,周边为基底样细胞,中央主要由角质形成细胞组成,可见鳞状漩涡,细胞异型性不明显,真皮内多量淋巴细胞、浆细胞浸润。诊断:倒置性毛囊角化病。     

流脑疫苗接种后毛母质瘤1例

患者女,6岁,右上臂外侧肿物半年余。皮肤科情况:右上臂外侧见一约5.0 cm×2.0 cm×1.0 cm大小椭圆形淡红色肿物,边界清楚,质稍硬,可推动,无触痛。皮损组织病理示:基底样细胞增生并过渡为影细胞,伴异物肉芽肿形成及炎细胞浸润。诊断:毛母质瘤。     

息肉性毛母质瘤1例

患者男,20岁。左侧背部出现息肉状损害半年余。皮肤科情况:左侧背部可见一约鸡蛋大半透明的大疱状损害,其中央可触及一约蚕豆大形状不规则结节,质坚,无明显压痛。手术切除物组织病理示:真皮内可见大量境界清楚的由影细胞、嗜碱性细胞和过渡细胞组成的细胞团块。诊断:息肉性毛母质瘤。     

丘疹型结节病一例

患者女,56岁。面部、四肢起红色丘疹2个月。查体见面部、四肢散在绿豆至黄豆大小丘疹,边界清楚,表面光滑,质地中等。皮损组织病理示:真皮内上皮样细胞构成的裸结节,境界清楚,周围少量淋巴细胞浸润,无干酪样坏死。诊断:丘疹型结节病。     

发生于手部的栅栏状有包膜神经瘤

报告1例发生于手部的栅栏状有包膜神经瘤。患者男,82岁。右手拇指肤色结节10余年。皮肤科检查:右手拇指外侧一边界清楚,直径0.5 cm的肤色结节,表面光滑。皮损组织病理检查:表皮大致正常,真皮中部见边界清楚的圆形或卵圆形结节,周围有增厚的胶原纤维包膜,其内为相互交织的梭形细胞束,梭形细胞胞核细长,可见裂隙。免疫组化:肿瘤细胞S-100蛋白(+)及神经束膜细胞上皮膜抗原(EMA)(+)。诊断:栅栏状有包膜神经瘤。     

Clear cells in acral melanoma

Acral melanoma may present clinically and histologically with atypical features causing a delay in proper diagnosis. The aim of the present study was to assess the frequency of a histological variant with clear cell changes. Clinical information, hematoxylin & eosin stained paraffin sections and immunohistochemical staining profiles were reviewed in 49 cases of acral melanoma. Twenty-one (43%) specimens contained tumor cells with clear cell changes in focal areas, whereas in 7 (14%) specimens clear cells were the major tumor constituting cells. The tumor thickness ranged from melanoma in situ to 14 mm. Immunohistochemistry demonstrated weak staining for S100 and HMB45 as well as strong positivity for Melan A and NK1C3. Recognition of clear cell features is important since differential diagnosis includes a variety of other clear cell malignancies, among them metastasis from renal cell carcinoma, clear cell sarcoma and hidradenocarcinoma.     

Clear cell hidradenoma: a tumor with basaliomatous changes in the overlying epidermis and follicular infundibula of surrounding skin.

We report a clear cell hidradenoma on the cheek of a Japanese man. We performed the primary operation on the flesh-colored tumor, which had surface telangiectasia. The histopathologic features of the tumor, which indicated an intradermal nodular hidradenoma, consisted mainly of typical clear cells with small numbers of eosinophilic fusiform cells. Most clear cells reacted negatively for CEA, EMA, S-100 protein and KL-1 keratin, but those in and around the cystic and ductal structures reacted positively for CEA, EMA and KL-1 keratin. Ultrastructurally, these clear cells had numerous microvillus processes, abundant intracytoplasmic glycogen granules, and numerous mitochondria. In addition, buds of hyperpigmented keratinocytes hung from the overlying epidermis and thin cords of hyperpigmented keratinocytes proliferated around the follicular infundibula beside the tumor. Within two months of the primary operation, growth of the tumor into the overlying epidermis recurred rapidly. We discuss the histological features of the combination of clear cell hidradenoma with basaliomatous changes of the overlying and surrounding skin and the highly aggressive recurrence of this type of tumor after primary treatment.     

IN SITU POROCARCINOMA: A CASE WITH MALIGNANT EXPRESSION IN CLEAR TUMOR CELLS

A healthy 84-year-old man visited our clinic with elevated lesions on the dorsal aspect of the left hand (Fig. 1). The previous year, he had been in a traffic accident in which he had received an injury to the hand. This injury had since repeatedly shown erosion, but the present lesions had appeared a month before the first clinic visit. These lesions consisted of a tumor, about 2 × 3 cm in size, with neighboring satellite nodules. They were asymptomatic, slightly reddish and yellowish, and had scales. Histopathologic examination revealed the following features: (1) a tongue-like tumor mass connected to the epidermis. The tumor foci were localized in the epidermis, from which they were sharply demarcated. Cell infiltration and senile elastosis were found in the stroma. (2) The tumor consisted of deeper layers of basaloid cells and of superficial layers of large cells with clear cytoplasm (Fig. 2A). The clear tumor cells showed prominent cellular and nuclear atypia: they were disordered, of unequal size, had irregular chromatin straining, and were marked by mitotic figures and cell clumping (Fig. 2B). The basaloid cells showed nuclei that stained intensely with hematoxylin and displayed less prominent atypia than the clear cells. (3) On PAS staining of clear cells, PAS-positive granules were digested with diastase. (4) Several duct-like structures were seen in the tumor nests. The tumor cells seemed to be proceeding from outer cells around the lumen of these structures. (5) The basement membrane between the tumor and the dermis was intact. No invasion by tumor into the dermis was seen. These findings were all consistent with porocarcinoma in situ. Immunohistochemically, epithelial membrane antigen (EMA) was strongly positive in the cell membrane of the clear cells. However, staining of basaloid cells was only weakly positive or negative (Fig. 3). These results and the previously reported results of EMA staining⁴ suggest that the appearance of the clear tumor cells in porocarcinoma indicate malignancy.     

A Case of Clear Cell Eccrine Porocarcinoma

Eccrine porocarcinoma (EP) is a rare malignant tumor arising from the intraepidermal eccrine duct. The tumor cells frequently contain glycogen, but prominent clear cell changes in EP are rarely reported. A 78-year-old woman presented with a slightly pruritic, erythematous, verrucous plaque on her left thigh. Histopathological examination revealed intraepidermal tumor cell nests composed of small basaloid cells and duct-like structures lined by periodic acid-Schiff (PAS)-positive cuticles. Besides the typical findings of EP, clear cell changes were predominantly observed in the tumor cell aggregations. Herein we report a case of the clear cell variant of EP rarely reported in previous literature.     

Eccrine Porocarcinoma

Eccrine porocarcinoma is an extremely rare malignant skin tumor arising from the eccrine sweat duct unit (acrosyringium). It presents histologically with nests of clear tumor cells in the epidermis and superficial dermis. In addition such clear tumor cells lie isolated high up in the epidermis, closely resembling Paget cells. The various tumors, which may originate from the acrosyringium and the histologic differential diagnosis of eccrine porocarcinoma are discussed.     

Myxoid clear cell sarcoma

Clear cell sarcoma is a rare soft-tissue tumor presenting typically in the extremities of young adults. It has been also known as malignant melanoma of the soft parts because of the presence of melanin and cytoplasmic melanosomes. However, clear cell sarcoma is, at present, usually considered as a unique lesion because the t(12;22)(q13;q12) translocation is present only in clear cell sarcoma. Myxoid malignant melanoma is now a well-recognized morphologic variant of malignant melanoma. However, a myxoid variant of clear cell sarcoma has not been well described yet. We report a case of myxoid clear cell sarcoma occurring on the heel in a 22-year-old man. The tumor was composed of nests and fascicles of oval to fusiform cells with clear to pale eosinophilic cytoplasm, often separated by fibrous septa. The tumor cells were reactive for S-100 protein, HMB-45, and MART-1. Variably sized cysts lined by one or several layers of tumor cells were observed. Alcian blue and mucicarmine stains demonstrated prominent mucin deposition in the tumor stroma and especially in the lumen of the cysts. Fluorescence in situ hybridization for the Ewing sarcoma gene showed rearrangement in nearly all of the neoplastic cells.     

Syringomas of the clear cell type--an ultrastructural observation

A case of a 72-year-old female with multiple syringomas of the clear cell type is reported. Ultrastructural observations revealed the following findings: 1) The tumor cells had the ordinary morphological features of usual syringoma cells. 2) The clear cells were rich in glycogen granules and various vacuoles. 3) Massive accumulations of glycogen granules surrounded by the unit membrane were occasionally observed. These electron microscopic findings were compatible with the light microscopic appearance of the clear cells. The tumor cells possessing characteristic clear cytoplasm can speculatively be regarded as altered syringoma cells with glycogen accumulation. The abnormal accumulation of the glycogen granules might be due to a kind of disorganized metabolism caused by diabetes mellitus in the syringoma cells.     

Clear cell syringoid carcinoma: an ultrastructural and immunohistochemical study

Syringoid carcinoma (syringoid "eccrine" carcinoma or eccrine epithelioma) is a rare cutaneous tumor with some controversy regarding its correct definition. It may also be difficult to differentiate from its benign counterpart (syringoma), other adnexal carcinomas, and cutaneous metastasis from adenocarcinomas. We present a case of a syringoid carcinoma of the clear cell variant complemented with an immunohistochemical and ultrastructural study, the latter revealing cytoplasmic accumulation of glycogen and presence of intercellular and intracellular lumina in clear tumor cells, as well as diverse hallmarks of malignancy (i.e., perineural invasion, tumor necrosis, and deep invasion). Clear tumor cells showed cytoplasmic and membranous immunoreactivity to epithelial membrane antigen, carcinoembryonic antigen, keratins, and S-100. Our ultrastructural and immunohistochemical results support the ductal differentiation of the glycogen-filled clear cell tumor population.     

Eccrine syringofibroadenoma of clear cell variant: an immunohistochemical study

Eccrine syringofibroadenoma is a rare eccrine tumor first described by Mascaro in 1963. The clear cell variant was reported by Fretzin in 1995. We describe a hemorrhagic papule on the knee of a 64-year-old woman. Microscopic examination revealed epidermal-based anastomosing thin epithelial cords with ductal structures surrounded by a fibrovascular stroma. Multiple nests of glycogen-containing clear cells were also present. The tumor cells forming the epithelial cords expressed keratin. The eccrine ductal structures and clear cells additionally expressed gross cystic disease fluid protein-15 (GCDFP-15). Reactivity with antibodies against estrogen receptor or progesterone receptor was negative. These results favor the dual differentiation of the clear cell variant of eccrine syringofibroadenoma toward ductal and secretory portions of the eccrine sweat gland.