双胞胎同患毛发上皮瘤

双胞胎女患者,11岁。颜面部多发性肤色、质硬丘疹8年。皮损组织病理示:表皮轻度萎缩,真皮内见由基底样细胞组成的瘤团,瘤团呈束状或筛孔状,有角质囊肿,周围细胞呈栅栏状排列,瘤团由增生明显的纤维组织互相分隔。患者临床表现及组织病理学改变均符合毛发上皮瘤。     

家族性多发性毛发上皮瘤1例

患者男,29岁。头皮皮色丘疹、结节4年。皮损组织病理示:表皮轻度萎缩,真皮内见由基底样细胞组成的瘤团,瘤团呈束状或筛孔状,有角质囊肿,周围细胞呈栅栏状排列,瘤团由增生明显的纤维组织互相分隔。家族中有类似疾病史。诊断为家族性多发性毛发上皮瘤。     

16例单发性毛发上皮瘤临床与病理观察

目的：探讨单发性毛发上皮瘤的临床表现、病理特征、诊断要点及预后。方法：所有病例行局部皮肤肿瘤切除,常规组织切片、染色,随访观察2年。结果：16例病理诊断为单发性毛发瘤病例中,其中有14例临床误诊。15例术后无复发,1例继发鳞癌。组织病理有典型的形态特征,镜下与基底细胞癌相似,可表现有基底样细胞组成的小叶结构或团块结构,瘤巢周边细胞呈栅状排列,但有向毛发分化的倾向和角质囊肿形成等。结论：单发性毛发上皮瘤临床极易误诊,组织病理学特征是本病确诊的主要依据。     

脂溢性角化病并发基底细胞上皮瘤

报告1例脂溢性角化病并发基底细胞上皮瘤.患者女,60岁.鼻右侧出现新生物2个月,无痛痒.皮损组织病理检查示表皮角化过度,棘层肥厚,乳头瘤样增生,伴角囊肿形成,增生表皮由鳞状细胞和基底样细胞组成,其基底部与两侧正常表皮位于同一平面上;真皮浅层有基底样细胞形成的肿瘤团块,周边细胞呈栅栏状排列.依据临床和组织病理学改变,确诊为脂溢性角化病并发基底细胞上皮瘤.     

皮肤镜及反射式共聚焦显微镜辅助诊断儿童结缔组织增生性毛发上皮瘤1例

患儿女，11岁，下颌肿物5年。皮肤科情况：下颌黄豆大小丘疹，色黄、质硬，边界清楚，中央略凹陷，其上可见针尖大小粟丘疹样突起。皮损组织病理检查示：真皮浅层可见上皮样条索及角囊肿，间质胶原纤维致密、增生。反射式共聚焦显微镜(RCM)检查示：真皮浅层可见多个低折光圆形、长形瘤细胞团块，瘤团内可见大小、形态相似的低折光鱼子样细胞，中央可见中高折光均质团块，周围包绕明亮的胶原纤维束呈平行排列，部分瘤团内可见高折光多边形小团块结构。皮肤镜检查示：皮损区边界清楚，呈象牙白色背景，边缘见线状血管及黄白色圆形结构灶性分布，中央少量薄层鳞屑。诊断：结缔组织增生性毛发上皮瘤(desmoplastic trichoepithelioma, DTE)。RCM和皮肤镜对疑似DTE患者，能在无创诊断、鉴别诊断及病理取材定位方面提供较可靠的辅助诊断价值，尤其对儿童患者及面部皮损具有较高临床应用价值。     

反射式共聚焦显微镜在儿童毛发上皮瘤的诊断价值

目的 总结儿童毛发上皮瘤在反射式共聚焦显微镜(RCM)下图像特征,探讨RCM的诊断价值.方法 选择临床拟诊为毛发上皮瘤患儿15例,行RCM及组织病理学检查.结果 经RCM及组织病理学检查证实,15例患儿中毛发上皮瘤13例,传染性软疣1例,汗管瘤1例.13例确诊为毛发上皮瘤患儿RCM表现:表皮大致正常,真皮浅层见瘤体团块...     

右颞部耳郭上方淡红色斑块——皮脂腺痣并发毛母细胞瘤

诊断:皮脂腺痣并发毛母细胞瘤. 皮损组织病理:表皮呈乳头瘤样增生,真皮内见大量分化成熟或近乎成熟的皮脂腺.中央区瘤团由基底样细胞组成,形成索条状、团块状,瘤团周围细胞核排列呈栅栏状,瘤团间有纤维基质分割.     

多发性家族性毛发上皮瘤1例及家系调查

先证者女,27岁。两侧鼻唇沟对称性分布丘疹15年。鼻翼部皮损组织病理示:真皮内有形状不规则的基底样瘤细胞呈栅栏状排列,散在分布角囊肿。诊断:多发性家族性毛发上皮瘤。家族中有5人罹患该病。     

累及耳部的毛发上皮瘤1例并文献复习

患者女,49岁,面中线、耳廓部位皮色丘疹、结节30余年。外耳道及听力无受累,实验室检查未见异常。取耳部及面部皮损行组织病理示:表皮萎缩,真皮内较多境界清楚的嗜碱性肿瘤细胞团块形成,由基底样细胞组成,呈筛孔状或束状,周围纤维化明显,可见角囊肿形成,团块周边细胞呈栅栏状排列。患者有可疑家族史。诊断:毛发上皮瘤,累及耳廓。     

儿童常见丘疹性疾病反射式共聚焦显微镜图像特征分析

目的 探讨反射式共聚焦显微镜（RCM）在儿童常见丘疹性疾病（光泽苔藓、扁平疣、线状苔藓、粟丘疹、传染性软疣、毛发苔藓）中的临床应用价值。方法 收集579例以丘疹为临床表现的门诊儿童病例,利用RCM分别观察皮损处及皮损周边正常皮肤的镜下结构,分析总结6种丘疹性疾病RCM图像的基本特征及鉴别要点。结果 经RCM检测后确诊光泽苔藓236例,扁平疣70例,线状苔藓123例,粟丘疹40例,传染性软疣53例,毛发苔藓57例。6种疾病均具有典型RCM特征,光泽苔藓可见扩大的真皮乳头,内有致密炎细胞及噬色素细胞浸润;扁平疣的颗粒层及棘层细胞呈同心圆状排列,似玫瑰花团样;线状苔藓棘层灶性水肿,基底细胞无或局灶性液化变性,真皮浅层中等量炎细胞呈簇状分布;粟丘疹在真皮可见境界清晰的圆形或椭圆形结构,内含高折光物质,且内容物折光不均匀;传染性软疣在RCM下可见完整的囊腔样结构,内有较高折光的软疣小体;毛发苔藓的毛囊漏斗部扩张,可见中低折光的近似角质样物质。6种疾病RCM下鉴别要点在于连续纵扫下皮损部位的结构特征（模式、折光度）。结论 RCM在儿童丘疹性疾病的诊断中具有较高临床应用价值。     

Confocal microscopy of recurrent naevi and recurrent melanomas: a retrospective morphological study

Background Repigmentation within a scar after different procedures (shave biopsy, partial excision, cryotherapy, laser) is a challenging diagnostic situation. Objectives To determine distinct dermoscopic and confocal microscopic features in a series of histopathologically proven melanocytic proliferations within a scar. Methods Clinical, dermoscopic and confocal microscopic images were acquired before surgical excision in seven patients with repigmentation within a scar. The evaluation of the dermoscopic and confocal features was performed in blind to the final histopathological diagnosis that was obtained in all cases. Results Dermoscopically, the repigmentation in recurrent naevi (three patients) was confined within the scar while it extended beyond the scar in melanomas. This clue was more evident upon reflectance confocal microscopy (RCM). Confocally, recurrent naevi failed to exhibit prominent pagetoid or lateral spread of melanocytes and atypical nests at the junction, even though some cases showed atypical cells in the junctional component. However, these were few in number and cytologically monomorphous and allowed the diagnosis of a benign neoplasm with confidence. On the other hand, melanomas arising on a scar (four patients) revealed dendritic‐shaped melanocytes arranged in sheets, and pagetoid and lateral spread of dendritic cells extending beyond the scar. Those confocal aspects were well correlated with the histopathological findings. Conclusions The integration of clinical, dermoscopic and RCM aspects offers the possibility to discern reliably the nature in cases of repigmentation on a scar.     

反射式共聚焦显微镜与组织病理诊断色素减退性蕈样肉芽肿八例

目的 探讨色素减退性蕈样肉芽肿在反射式共聚焦显微镜(RCM)下的图像特征.方法 选择经组织病理学和免疫组化确诊的8例色素减退性蕈样肉芽肿患者,同一皮损进行RCM扫描及组织病理检查.结果 8例患者RCM表现:轻度角化,表皮内见单个或聚集分布的卵圆形或类圆形中等折光的多形单个核细胞、核周伴弱折光空晕;基底层色素环折光减弱;真皮乳头较多大小不等的多形单个核细胞浸润;部分表皮内可见圆形或类圆形中等折光单个核细胞聚集呈囊泡样结构.RCM与组织病理有较好的一致性.结论 RCM是辅助诊断或鉴别诊断色素减退性蕈样肉芽肿的无创性皮肤影像学检查方法.     

黑棘皮病皮肤镜与反射式共聚焦显微镜特征分析

目的:分析黑棘皮病皮肤镜和反射式共聚焦显微镜（RCM）特征,探讨皮肤镜和RCM对黑棘皮病的辅助诊断价值。方法:收集2018年1月至2019年12月在杭州市第三人民医院皮肤科门诊就诊的黑棘皮病患者63例,选取5例健康个体作为对照,采用皮肤镜及RCM检查每例患者的颈部和腋下2处皮损。对3例患者在观察部位取材并进行常规的组织...     

Correlation of dermoscopic structures of melanocytic lesions to reflectance confocal microscopy

OBJECTIVE: To determine the utility of reflectance confocal microscopy (RCM) in the in vivo evaluation of dermoscopic structures of melanocytic lesions. DESIGN: For each described dermoscopic feature, we evaluated by RCM at least 2 melanocytic lesions. A digital camera connected to the confocal computer enabled direct analysis of the dermoscopic structures. To ascertain precision of correlation, the orientation of the dermoscopic and RCM images were compared using a superimposed grid. SETTING: Dermatology clinic specializing in pigmented lesions. Patients Eleven patients with melanocytic lesions, including 2 melanomas, 1 Spitz nevus, 7 dysplastic nevi, and 1 compound nevus. Main Outcome Measure Direct correlation of structures seen using dermoscopy with those seen using RCM. RESULTS: There was a good correlation between the global dermoscopic pattern and findings on the 4 x 4-mm mosaic of confocal images at the level of the dermoepidermal junction. The atypical network correlated with variability in the size and shape of dermal papillae. Globules corresponded with aggregates of bright cells, and darker shades of brown on dermoscopy appeared brighter on RCM. In peripheral streaks, RCM showed dense aggregates of pleomorphic cells of variable brightness and ill-defined cellular borders. These aggregates were continuous with the bright mesh that composed the central bulk of the lesion. A blue-white veil correlated with disruption of the rimmed papillae meshlike pattern and sometimes with the presence of bright cells corresponding to melanophages. CONCLUSION: Correlating dermoscopic structures to RCM features is possible and a necessary step toward understanding the potential benefits of RCM in the clinical setting.     

反射式共聚焦显微镜在儿童皮肤扁平苔藓诊断中的应用

目的 探讨儿童皮肤扁平苔藓反射式共聚焦显微镜（reflectance confocal microscopy,RCM）下影像特征及其在儿童扁平苔藓早期诊断中的意义。 方法 应用RCM对35例儿童扁平苔藓皮损进行扫描,并在同一位置取材,进行常规组织病理检查,比较RCM影像学特征与组织病理学特征。所有病例均经临床表现与组织病理检查明确诊断。 结果 35例扁平苔藓患儿的典型RCM图像显示：表皮见细胞水肿形成低折光暗区,可见颗粒层和棘层的清晰过渡,见中度折光的炎症细胞浸润,这些改变对应病理学颗粒层楔形增厚;真表皮交界不清,真皮乳头环模糊或缺失,炎症细胞浸润,围绕交界处大多呈现薄片状结构,这些改变对应病理学界面皮炎的改变;真皮内炎症细胞带状浸润,浸润厚度可以测量,包括大的、高折光、椭圆形或星形噬色素细胞,小的、中度折光的圆形淋巴细胞;真皮乳头层见纵行分布的扩张血管,血管周围炎症细胞、噬色素细胞浸润。RCM图像与组织病理结果具有较好的一致性。 结论 RCM实时、无创扫描技术可以作为儿童扁平苔藓诊断的辅助影像学检查手段。     

皮脂腺痣皮肤镜及反射式共聚焦显微镜特征分析

【摘要】 目的 探讨不同年龄患者皮脂腺痣的皮肤镜及反射式共聚焦显微镜特征。方法 2016年1 - 12月将武汉市第一医院皮肤科门诊经组织病理学确诊的83例皮脂腺痣患者,按年龄分成4组,采集、分析其皮肤镜及反射式共聚焦显微镜图像特征。结果 < 10岁组21 例,皮损在皮肤镜下表现为橘色背景下独立分布、较为一致的黄红色、球块状结构,似鹅卵石样排列,伴血管增生、扩张;反射式共聚焦显微镜下可见皮脂腺发育不全, 仅见幼稚毛囊。10 ~ 20岁组28例,皮肤镜下可见聚集分布、与毛囊无关、大小不同的黄色圆形、卵圆形结构,伴毛细血管扩张;反射式共聚焦显微镜下可见,真表皮交界处及真皮浅层葡萄串样皮脂腺结构,中央为管状/柄样结构,外周为簇集分布、鱼籽/蛙卵样增生的皮脂腺小叶,其上方表皮往往呈疣状/乳头瘤样增生。21 ~ 59岁组30例,影像学表现同10 ~ 20岁组。≥ 60岁组4例,影像学特征主要为乳头瘤样增生。结论 皮脂腺痣是一种动态发展的疾病,不同年龄阶段影像学表现不尽相同;在皮肤镜及反射式共聚焦显微镜下均具有特征性结构,可作为有效的无创性诊断方法。     

Small‐diameter melanocytic lesions: morphological analysis by means of in vivo confocal microscopy

Background Small‐diameter melanocytic lesions represent a diagnostic challenge for clinicians, as they do not follow the ABCD rule for diagnosis and do not always display reliable histopathological criteria. Objectives To analyse the confocal features of small‐diameter lesions (naevi and melanomas with diameter ≤ 5 mm) to determine whether they show specific morphological criteria. Methods Twenty‐four melanomas and 72 naevi were subjected to dermoscopic and confocal evaluation along with histopathology. Significant dermoscopic and confocal differences between melanomas and naevi were evaluated by means of the Pearson χ² test. Odds ratios and 95% confidence intervals were calculated for each parameter. Binary logistic regression was performed to identify the reflectance confocal microscopy (RCM) independently significant features for melanoma diagnosis. Results The seven‐point checklist dermoscopic score was ≥ 3 in 22 melanomas and in 33 naevi. The combination of cells’ pleomorphism and architectural disorder (i.e. nonspecific pattern or irregular junctional nests upon confocal examination) are the most striking criteria for consistent diagnosis of small melanoma. The presence of atypical cells, more than five atypical cells per mm², and roundish atypical cells at the dermoepidermal junction showed the highest odds ratios. From logistic regression, the presence of at least five pagetoid cells per mm², tangled lines within the epidermis, and atypical roundish cells at the dermoepidermal junction resulted in the three independent confocal parameters that characterized small melanomas. Conclusions Small melanomas frequently reveal specific dermoscopic and confocal features. Moreover, the combination of dermoscopy and RCM can lead to a correct diagnosis of a number of naevi that share some morphological aspects with melanomas.     

Reflectance confocal microscopy accurately discriminates between benign and malignant melanocytic lesions exhibiting a ‘dermoscopic island’

Background The ‘dermoscopic island’ is a term that was recently proposed to design an area of a pigmented lesion with a uniform dermoscopic pattern different from the remainder of the lesion. The positive predictive value of this sign for the diagnosis of melanoma is about 50%. Objective The purpose of our study was to see if reflectance confocal microscopy (RCM) permitted to accurately distinguish between nevi and melanoma in such lesions. Methods Five lesions of five consecutive unselected patients, with a dermoscopic island but no feasible clear cut diagnosis on the basis of dermoscopy alone were examined by RCM before excision for histopathological evaluation. Results Two lesions corresponded to nevi, and three lesions were early melanomas arising on a benign naevus in one case, and on a dysplastic naevus in two cases. In all five cases, RCM permitted to make the correct diagnosis, with a very good correlation with conventional histopathology. Conclusion Reflectance confocal microscopy appears as a promising tool not only to enhance the early diagnosis of melanoma but also to avoid unnecessary excisions of lesions with a dermoscopic island.     

阴囊Paget病与湿疹皮损反射式共聚焦显微镜图像对比分析

目的 分析比较阴囊Paget病与湿疹皮损在反射式共聚焦显微镜(RCM)下的影像特征.方法 对5例临床怀疑为阴囊Paget病和5例阴囊湿疹男性患者的皮损进行RCM扫描,再取该处皮损行组织病理检查,对比分析两者RCM图像与组织病理表现.结果 5例Paget病患者,RCM图像可见表皮结构紊乱,正常的蜂窝状结构消失,棘层内可见单个或成巢分布的Paget样细胞.5例阴囊湿疹患者RCM扫描显示棘细胞间水肿,可见网状变性的水疱,偶见脓疱形成.结论 阴囊Paget病RCM影像特征与阴囊湿疹明显不同,应用RCM筛查有利于Paget病的早期诊断.     

Paget病皮肤镜及反射式共聚焦显微镜特征分析

目的 探讨Paget病在偏振光皮肤镜(PD)及反射式共聚焦显微镜(RCM)下的特征。方法 选取2019年1月至2021年10月门诊就诊的29例Paget病患者76处皮损,对其临床资料、PD特征及RCM特征进行回顾性分析。结果 29例患者中男18例,女11例;其中乳房Paget病9例,乳房外Paget病20例。76处皮损PD表现为乳红色背景及红褐色背景,乳白色无结构区,亮白色条纹和血管结构,部分皮损见浅棕色至蓝灰色点状色素沉着;RCM表现为表皮细胞结构紊乱,失去正常蜂窝状结构,表皮内空泡样细胞及Paget细胞,基底层见Paget细胞合并成大的肿瘤细胞巢,真皮浅层见血管扩张、迂曲及不等量炎细胞、树突状细胞,部分皮损真皮浅层见噬色素细胞。乳房Paget病与乳房外Paget病患者间皮损PD表现、RCM表现均无明显差异(均P>0.05)。结论 Paget病患者皮损在PD及RCM下具有一定的特征性,有可能为本病的无创性辅助诊断提供依据。