毛囊黏蛋白病一例

患者女,60岁,因面部结节、斑块1年余就诊.患者以面部结节和浸润性斑块为皮损表现.皮肤科检查:前额见皮色和淡红色结节,左下颏见浸润性斑块,上覆黄色痂皮.组织病理检查示,真皮及皮下血管、附属器周围以淋巴细胞为主的炎症细胞浸润,毛囊上皮网状变性,并形成囊腔,经阿新蓝染色见囊腔中大量黏蛋白沉积.治疗方面给予阿维A和泼尼松口服,局部外用莫米松乳膏联合异维A酸凝胶等治疗,2个月后痊愈.     

皮肤支气管源性囊肿1例

 报告成人皮肤支气管源性囊肿1例。患者男，22岁，左颈部皮疹3年。皮肤科检查：左颈部皮肤见一约0.2 cm×0.2 cm大小的淡红色丘疹，边界清楚，中间可见破口，未见明显液体流出。皮肤镜检查：非偏振光下淡红色背景，可见湿润性破损口；偏振光下淡红色背景，镜下见中央破损口，外周红白色无结构区，绕以扩张的分支状血管。皮损组织病理学检查：真皮层见一角囊肿及一腺腔，腺腔内衬假复层纤毛柱状上皮，可见个别粘液细胞。腺腔周围见淋巴细胞浸润。真皮上方表皮呈息肉样突起，表皮鳞状上皮组织局部与复层柱状上皮组织相移行。诊断：皮肤支气管源性囊肿。外科手术切除后随访3个月，未见复发。     

Membranous lipodystrophy associated with insulin lipoatrophy

A 60-year-old Korean woman had been diabetic since she was 40 years old. Initially, she was injected with beef insulin; after a few years of good response, her blood sugar became erratic and uncontrollable. Purified pork insulin was added. She had been receiving daily 55 units NPH purified pork insulin in the AM and 45 units of lente purified insulin in the PM. She was advised and trained to inject at different sites, but she did not necessarily do so, and she had injected repeatedly at the same site on the right buttock. Gradually, atrophic patches developed on the right buttock. On physical examination, two coin-sized, annular, depressed, and atrophic lesions with a hypopigmented surface were seen on the buttock. These were painless and spongy on palpation. She had no history of any vascular or connective tissue disease or evidence of infection or trauma.
Laboratory work-up revealed normal complete blood count and differential count and normal urinalysis, and an SMA 18 screen showed a blood sugar of 200 mg/dL. An incisional biopsy was carried out at the site of the right buttock; histologic sections showed numerous lobules of small lipocytes with proliferation of capillaries, degenerative loss of adipose tissue, and multiple cysts of irregular shape and variable size. The wall of the cysts characteristically showed anuclear, homogeneous, eosinophilic material. There was slight infiltration of mononuclear cells around the blood vessels in the fat lobule (Figs 1–3).     

Mast cells in solitary glomus tumors: a possible algogenic role.

Mast cells in three cases of solitary glomus tumor were examined by light and electron microscopy. As seen by light microscopy, a number of round, oval or elongated mast cells were distributed throughout the stromal connective tissue and showed slight or moderate metachromasia when stained with toluidine blue (pH 4.1). Electron microscopy revealed various types and degrees of degranulation of mast cell granules, and also disclosed a close correlation between mast cells and non-myelinated nerve fibers. These findings suggest that mast cells may play an algogenic role in solitary glomus tumors, probably mediated by the contents, mainly histamine, concentrated in their granules.     

Molluscum contagiosum occurring in an epidermal cyst--report of 3 cases.

We present three unusual cases of molluscum contagiosum occurring in epidermal cysts. All of them are asymptomatic, elevated, oval nodules diagnosed clinically as epidermal inclusion cyst or prurigo nodularis. Histology showed true epidermal cysts containing molluscum bodies throughout the cyst wall and some type of laminated material within the cyst itself. The lesion, in all three cases developed in the pubic area of young adult men.     

HPV-related follicular cysts.

Five examples of follicular cysts with papillary projections protruding into the lumen are given. In all cases, the lining was epidermoid. The cystic cavity contained compact, eosinophilic keratinous material. Groups of vacuolated keratinocytes with overlying tiers of parakeratotic cells were seen on the top of the crests. In the intervening valleys, there were irregular clumps of keratohyaline granules. These changes are diagnostic cytopathogenic effects of viral papillomas. However, papillomavirus common antigens were not identified by immunohistochemistry.     

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.     

结节性胶样粟丘疹2例

例1女,39岁,右额角可见蚕豆大的淡黄色结节,周边散在分布绿豆大丘疹4年;例2女,41岁,左颊部可见一1.5cm×2.5cm大淡红色斑块,表面覆少许鳞屑。该2例均日晒后皮损加重,但无疼痛和瘙痒。皮损组织病理:例1示真皮上层胶原组织增生,可见嗜伊红色无结构均质性胶样物质,其间有裂隙;例2示表皮大致正常,真皮内可见大量粉红色均质性物质胶样团块,轻度嗜伊红改变,其间可见裂隙。2例结晶紫染色均(-)。     

Milker's nodules. Pathogenesis, tissue culture, electron microscopy, and calf inoculation.

We report the occurence of milker's nodules in nine patients. In man, the disease goes through maculopapular, target, acute weeping, nodular, papillo-matous, and regressive stages. Papular and papillomatous stages were noted following vaccination of a calf with material prepared from a human lesion. A viral agent was isolated in cultures of bovine kidney cells and human skin fibroblast cells. Cytoplasmic inclusions were frequently seen in the infected bovine kidney cells. Electron microscopy revealed viroplasm, partially encapsulated viroplasm, encapsulated viroplasm, and oval particles with spires around the outside.     

类脂蛋白沉积症一例

摘要：患者男,34岁,哈萨克族人,身上起皮疹伴声音沙哑20余年。体检：心、肺、腹部检查无阳性体征。声音嘶哑明显。毛发稀疏,头皮、面、颈部皮肤可见粟粒大小的肤色丘疹弥漫分布,表面光滑,呈蜡样,可见瘢痕改变,眼睑增厚,睫毛稀疏,睑缘可见串珠状蜡样丘疹。双肘、臀部可见对称分布的疣状增生的肥厚性浸润性粉红色结节或斑块,呈脑回状。鼻咽喉镜示：双侧声带增生性肥厚,会厌表面不规则增厚而不光滑。口咽粘膜可见弥漫性淡黄色沉积物,表面凹凸不平。活检组织病理：（肘部和会厌）真皮全层或粘膜固有层可见弥漫的均质红染的透明样物质沉积,血管周围可见同样物质沉积。PAS染色：透明样物质强阳性,甲紫及刚果红染色：阴性。诊断：类脂蛋白沉积症。     

线状苔藓伴皮肤钙沉着症并表皮囊肿一例

患者女,14岁。11年前右下肢内侧出现一线状排列的淡红色扁平丘疹,上覆少许鳞屑,逐渐向两端扩展,未予治疗。5年前原发皮损处开始出现坚实的皮下结节。就诊前10d局部皮损出现溃破,并有红肿痛,异物排出,一直未予处理。皮肤科检查：右下肢内侧及腹部可见线状排列萎缩性暗红斑,其下可触及深在结节状物质,活动度尚可,有粘连,触之硬,压之疼痛。局部隆起于皮面,溃破处有块状、质硬、白色物质排出。组织病理检查：右大腿内侧皮损：表皮角化过度伴灶性角化不全,灶性基底细胞液化变性,真皮浅层较多的淋巴细胞浸润,真皮浅中层见深蓝色的无定形物质。右小腿内侧皮损：表皮灶性角化不全,灶性基底细胞液化变性,真皮乳头及真皮中深部血管及附属器周围淋巴细胞呈片状及团块状浸润,真皮深部及皮下脂肪层可见块状及细碎状的深蓝色钙沉积。右股（大腿）内侧皮损表现为线状苔藓伴皮肤钙沉积症,右小腿内侧皮损表现为线状苔藓伴皮肤钙沉着症并表皮囊肿。结合临床与病史,诊断为线状苔藓伴皮肤钙沉着症并表皮囊肿。治疗：先后分2次予以手术全部切除。     

Differences between polarized light dermoscopy and immersion contact dermoscopy for the evaluation of skin lesions

OBJECTIVE: To evaluate dermoscopic features and patterns of skin lesions by using conventional and polarized light dermoscopy (PD). DESIGN: Observational study. SETTING: Dermatology clinic at Memorial Sloan-Kettering Cancer Center. PATIENTS: Ninety patients with skin lesions. INTERVENTIONS: Skin lesions were imaged via conventional nonpolarized light contact dermoscopy (NPD), polarized light contact dermoscopy (PCD), and polarized light noncontact dermoscopy (PNCD). MAIN OUTCOME MEASURES: The images from the 3 modalities were evaluated by 3 dermoscopists for colors, structures, and patterns. Level of agreement between modalities was assessed by percentage agreement and the kappa statistic. Qualitative differences between modalities were also assessed. RESULTS: Ninety lesions comprising 55 melanocytic and 35 nonmelanocytic lesions were reviewed. There was excellent agreement for overall dermoscopic patterns between modalities, with kappa values ranging from 0.88 to 1.00. There was moderate to excellent agreement for most dermoscopic colors, with the exception of blue-white veil and pink (red) color. Most dermoscopic structures had fair to perfect agreement, with the exception of milialike cysts. Qualitative assessment suggested that melanin appeared darker and blue nevi had more shades of blue on PD compared with NPD images; vessels and red areas were better visualized with PD, suggesting that PD may be helpful in identifying malignancies; milialike cysts and comedolike openings were better visualized with NPD, suggesting that NPD is more helpful for identification of seborrheic keratosis; peppering, lighter colors, and blue-white areas were more evident under NPD, facilitating recognition of regression areas; and shiny-white streaks, possibly representing fibrosis, were seen more clearly under PD. CONCLUSIONS: The capabilities of NPD, PCD, and PNCD are not equivalent, but complementary. Further studies are needed to evaluate the effect of these differences on clinical diagnosis.     

多发性边缘离心性角化棘皮瘤一例

报告国内首例多发性边缘离心性角化棘皮瘤（keratoacanthoma centrifugum marginatum）。患者女,37岁,以面部陆续出现丘疹和斑块4个月而就诊。皮肤科检查：患者面部散在数十个大小不等、边界清楚的淡红色或近肤色、火山口状丘疹及地图状斑块;丘疹中央呈脐凹状并有灰褐色角质状物;斑块边缘呈堤状隆起,内侧覆较厚褐色痂样角质物,中央部分消退;组织病理示：角化过度和角化不全,表皮呈条索状向真皮不规则延伸,可见鳞状涡和角囊肿样结构,肿瘤细胞胞质嗜酸性毛玻璃样,符合角化棘皮瘤特征;结合临床与病理诊断为多发性边缘离心性角化棘皮瘤。口服阿维A及外用维A酸治疗后痊愈,随访3年未复发。     

Malignant melanoma with preserved hairs: A snap shot could suggest the development from an acquired melanocytic nevus

A 63-year-old man presented with a dome-shaped, black nodule on his right forehead, where hairs were preserved. The black surface tone measured 7 mm in diameter and spread irregularly from the periphery of the nodule. He had been conscious of the preceding, black macule for approximately 50 years. A snap shot of the patient in adolescence showed a tiny, black macule, which was a few millimeters in diameter. Histological examination demonstrated irregular proliferation of melanoma cells from the epidermis to the dermis. Partially, there were well-circumscribed, oval nests composed of nevus cells in the acanthotic epidermis and follicles. Nevus cells were also seen in the dermal component, presenting a burnt-out appearance. In this case, the small final size, the preserved hairs and the snap shot suggested a preceding, acquired melanocytic nevus. Malignant melanoma could arise from acquired melanocytic nevus.     

Low-grade adnexal carcinoma of the skin with multidirectional (glandular, trichoblastomatous, spiradenocylindromatous) differentiation

The conjoint occurrence of follicular, sebaceous, or apocrine differentiations in a cutaneous adnexal neoplasm is a known event, more often encountered in benign neoplasms, whereas reports of cutaneous malignant adnexal tumors with bilineage or trilineage differentiation are few. A new case of a cutaneous malignant adnexal neoplasm with multidirectional differentiation is reported here. A 57-year-old woman presented with a long-standing, slowly growing, asymptomatic solitary tumor the size of a large nut in the coccygeal area, which was surgically excised. Ten years after the surgery, there was no evidence of recurrence or metastasis. Microscopically, the neoplasm was located in the dermis with focal extension into the subcutis. It was asymmetric, horizontally oriented, and mostly composed of small nodules that varied in shape from round and oval aggregations to elongated strands and irregular islands; the nodules were either clustered, formed a jigsaw puzzle-like pattern or were dispersed. The nodules were composed of small basaloid cells sometimes intermixed with larger cells with ample cytoplasm forming glandular structures. Rare nodules resembled elements seen in a spiradenoma by containing scattered lymphocytes and globules of hyalinized eosinophilic basal membrane material. The stroma was paucicellular, but focally it resembled that seen in perifollicular mesenchyme. Mitotic figures, including abnormal ones, were infrequent, but mild nuclear pleomorphism, nuclear crowding, and individual cell necrosis were easily appreciable in both small basaloid cells and cells with clear cytoplasm. Perineural invasion was apparent. We classified this tumor as a well-differentiated adnexal carcinoma demonstrating combined follicular and apocrine differentiation. It differs from previously published cases of malignant adnexal tumors with multidirectional differentiation and further exemplifies the spectrum of diversity encountered in malignant proliferations with differentiation toward the folliculosebaceous-apocrine unit.     

面部多发性毛发平滑肌瘤一例

【摘要】 报告1例面部多发性毛发平滑肌瘤。患者男,43岁,右侧面部及额头部红色斑丘疹,伴冬季疼痛20年余,近4年加重。临床表现为粟粒至黄豆大小,高出皮面的丘疹和结节分布于右侧面颊部以及额部右侧,呈淡红色至红色,簇集状,质地坚实,基底稍呈浸润状。冰块实验阳性。患者无其他系统疾病。皮损组织病理检查：表皮大致正常,真皮内见肿瘤细胞不规则聚集或交织成束,肿瘤细胞细长,胞浆嗜酸,胞核两端钝圆或呈雪茄样,免疫组化显示平滑肌强阳性的特征：Desmin和SMA（+）,结合临床诊断多发性毛发平滑肌瘤。由于该患者皮损面积大,未能手术切除,随访。     

S-100-negative atypical granular cell tumor: report of a case

A 38-year-old man presented with a solitary, round, 1.2 x 1.2 cm, bluish-colored, dome-shaped, hard nodule on the left side of the neck, which had grown over 2 months (Fig. 1). The nodule was nontender and nonmovable. Light microscopy revealed that the neoplasm was situated in the reticular dermis with extension into the papillary dermis. The tumor showed expansile growth with smooth and round borders, and was made up of sheets of cells arranged in nests or lobules separated by thin delicate connective tissue septa. The tumor cells were round, oval, or polygonal in shape with distinct cellular borders. The cells had abundant eosinophilic granular cytoplasm, and considerable variation of cellular and nuclear size was noted (Fig. 2a). The tumor cell nuclei were vesicular and some had pleomorphism (Fig. 2b). Sometimes multiple nucleoli were seen. Mitoses and necrosis were virtually absent. Immunohistochemical staining revealed that some of the cytoplasmic granules stained positively with periodic acid-Schiff (PAS) after diastase treatment. Tumor cells showed strong reactivity for CD68 and neuron-specific enolase, and negative results for S-100, factor XIIIa, cytokeratin, desmin, CD34, and smooth muscle actin. Electron microscopy revealed that the tumor was composed of polygonal cells with round to irregular nuclei, and the cytoplasm contained numerous secondary lysosomes. The tumor was completely excised.     

Endothelial cell crystalloids in newborn human foreskin

This study describes the presence of crystalline inclusions in the endothelial cells of foreskins. They were found in 9 normal full-term newborn infants, without maternal medication or complication during pregnancy and delivery. These cytoplasmic crystalloids occurred in 10% of endothelial cells of small blood vessels. The diameter of the inclusions ranged from 0.3 to 1.5 micron and they appeared as round, oval, hexagonal or irregular polygonal in shape. These inclusions were surrounded by a triple membrane and their contents demonstrated granular, homogeneous and crystalloid-like material with a regular periodicity of dense and less dense layers measuring about 20-25 nm. Similar crystalloids in the endothelial cells were observed in the normal upper lip skin of a 6-week-old girl, although they were present in much smaller numbers than in foreskin. No endothelial inclusions were found in normal skin taken from 11 body areas in 29 patients aged 2.5 to 56 years. The nature and function of these cytoplasmic crystalloids are unknown.     

Raccoon Heartworm Causing a Leg Mass

Case 1: A 38 year‐old man presented with a painless right post auricular mass, slowly growing for ten years. Clinical impression was a salivary gland lesion. The excised mass measured 3 cm and was gelatinous. Case 2: A 28 year‐old man presented with a lump in the region of the left heel, slowly growing for several years. Excision revealed a lobulated pink‐gray mass measuring 2 cm. In both cases, histology demonstrated a circumscribed encapsulated proliferation of tumour cells surrounded by abundant myxoid stroma. There were almost exclusively hyaline cells with plasmacytoid features, arranged predominantly in nests and sheets with abundant pink cytoplasm and hyaline inclusions. Round to oval nuclei with occasional small nucleoli and rare mitotic figures were seen. Both cases stained strongly positive for low molecular weight cytokeratin, S 100 and vimentin and were negative for desmin, smooth‐muscle actin and muscle‐specific actin. We describe two cases of hyaline cell‐rich chondroid syringoma, a histologically benign entity. The importance in recognizing this entity is that these tumors can easily be confused with malignant neoplasms including malignant melanoma, myxoid chondrosarcoma and alveolar soft part sarcoma. Follow up for a year has shown no evidence of metastases or recurrence in both cases.     

Late onset dermal melanocytosis: an upper back variant

Seven elderly Japanese men with blue macules on their upper backs are reported. Histological examination showed this pigmentation to be melanosis due to the presence of spindle-shaped or oval pigment-laden cells in the dermis. Electron microscopy revealed the cells to be compatible with dermal melanocytes. We assume that this condition belongs to the category of late onset dermal melanocytosis and is an upper back variant. This concept has not been proposed before.