高分化滑膜肉瘤截肢1例

临床资料 患者男，1968年6月生。诉自出生后逐渐显露右上臂缓慢肿胀，约至1991年左右，右手背起黑褐色肿物一个，1．8cm×1．5cm×1．4cm，表面粗糙，1992年组织病理示：瘤细胞呈类圆形上皮样，形成境界不清的巢状，边缘处逐渐移行于梭形瘤细胞，细胞巢间有裂隙，胞核大小不一，有核分裂。病理诊断：高分化滑膜肉瘤。1993年11月曾来我科就诊，当时见患者右上臂明显粗肿伴色素沉着，右手背肿物触之软，周围轻触痛，右上肢长约72cm，比左侧长约4cm，周长约为对侧2倍余；查血常规无异常；     

高分化滑膜肉瘤截肢1例

临床资料 患者男,1968年6月生.诉自出生后逐渐显露右上臂缓慢肿胀,约至1991年左右,右手背起黑褐色肿物一个,1.8 cm×1.5 cm×1.4 cm,表面粗糙,1992年组织病理示:瘤细胞呈类圆形上皮样,形成境界不清的巢状,边缘处逐渐移行于梭形瘤细胞,细胞巢间有裂隙,胞核大小不一,有核分裂.病理诊断:高分化滑膜肉瘤.     

水疱型钙化上皮瘤一例

临床资料 患者,女,16岁。主因右上臂结节伴触痛1年,水疱3个月,于2012年6月就诊我科。患者于2011年夏季发现右上臂外侧一绿豆大暗褐色皮下肿物,质硬,轻度触痛,未予重视及诊治。后皮损逐渐增大,3个月前皮损表面出现小水疱样改变,当地医院彩超提示＂血管瘤＂可能。行局部穿刺,未抽吸出内容物,后肿物增长较快,水疱增大明显,伴触痛,遂就诊我科。患者平素体健,     

毛母质瘤三例临床报告

1临床资料例 1：患者为女性,48岁,发现右肩部肿物5年,体查见右肩背部有一肿物,大小约1．5cm×1cm×1cm,质硬,与周围有界限,局部未见红肿。在局麻下行肿物切除术,术中见肿物包膜完整表面不平为灰白色,     

血管平滑肌瘤

正患者女,39岁。主诉:右足踝外侧结节2年。现病史:患者2年前无明显诱因右足踝外侧出现一绿豆大小结节,缓慢增大至豌豆大小,除碰撞时有疼痛感外,无明显自觉症状。为明确诊断、进一步治疗来本院就诊。既往史及家族史:患者既往体健,发病前否认局部外伤史,否认系统性疾病。家族中无类似病史者。体检:系统检查未见明显异常。皮肤专科检查:右足踝外侧见一1 cm×0.8 cm皮     

皮肤奇异型平滑肌瘤1例

患者女, 74岁, 因右侧大腿肿物3年, 增大1年就诊。患者于3年前在右侧大腿发现鸽子蛋大小的肿物, 无明显疼痛、麻木等不适。肿物逐渐增大, 于1年前增至"苹果"大小, 自感坠胀不适, 遂就诊。门诊以右大腿上段内侧纤维肉瘤收入病房。既往体健, 无家族遗传病史。体检:各系统无异常。皮肤科检查:右大腿上段内侧可见一约13 cm × 8 cm椭圆形包块, 表面无红肿、破溃, 皮肤感觉及血运良好, 余未见异常。彩色超声检查示右侧大腿内侧探及11.2 cm × 10.3 cm的低回声, 界限清, 形态尚规则, 内部回声不均匀, 间以少量无回声。彩色多普勒超声可见红蓝血流信号, 频谱多普勒超声测得动脉血流频谱。核磁共振成像示右侧大腿内侧肌间隙类圆形长T1长T2信号肿块影(图1), 信号不均匀, 中心见环形长T1短T2信号影及斑片状稍短T1长T2信号区, DWI周围呈高信号, 中心呈低信号, 边界清晰, 邻近肌肉组织受压。右侧大腿软组织穿刺活检提示奇异细胞性平滑肌瘤, 瘤细胞怪异, 但增殖活性极低, 不排除子宫起源, 所见病变微小。活检标本肉眼观为一类圆形肿物, 体积9 cm × 9 cm × 7 ...     

血管平滑肌瘤

<正>患者女,39岁。主诉:右足踝外侧结节2年。现病史:患者2年前无明显诱因右足踝外侧出现一绿豆大小结节,缓慢增大至豌豆大小,除碰撞时有疼痛感外,无明显自觉症状。为明确诊断、进一步治疗来本院就诊。既往史及家族史:患者既往体健,发病前否认局部外伤史,否认系统性疾病。家族中无类似病史者。体检:系统检查未见明显异常。皮肤专科检查:右足踝外侧见一1 cm×0.8 cm皮     

水疱型毛母质瘤1例

患者,男,12岁。右侧颈部及右上臂囊性肿物2年。皮损组织病理示:表皮正常,真皮内见镜影细胞及嗜碱性粒细胞浸润,可见多处钙化区,其周围被纤维组织包绕。诊断:水疱型毛母质瘤。     

水疱型毛母质瘤1例

报告水疱型毛母质瘤1例。患者男,26岁,右肘部屈侧皮肤肿物7年。皮肤科检查：右肘部屈侧可见一约3.0 cm×3.0 cm×1.0 cm大小类圆形松弛的淡红色水疱,隆起皮面,边界清楚,无破溃与渗液,触之有波动感,水疱基底部可扪及一约1.5 cm×1.0 cm×0.3 cm大小的质硬结节,活动度差,形状欠规则,触压痛不明显。皮损组织病理：表皮正常,肿瘤位于真皮内,肿瘤细胞团块周围可见扩张淋巴管,其中充满淋巴液,肿瘤团块由基底样细胞及影子细胞构成。诊断为水疱型毛母质瘤。予手术完整切除,创面愈合良好。目前随访未复发。     

甲下浅表性肢端纤维粘液瘤1例

报告甲下浅表性肢端纤维粘液瘤1例。患者女,74岁,因右足拇趾甲下肿物2个月就诊。皮肤科检查：右足拇趾甲床部位见一大小约3.0 cm×2.0 cm×1.0 cm的红色肿物,质韧,压痛(+),甲板缺如。体表肿物超声：拇趾探及范围约21 mm×20 mm低回声包块,内回声不均,呈囊实混合性。右足DR:拇趾软组织肿胀,骨质未见明显异常。皮损组织病理示：表皮角化过度、角化不全,部分棘层增厚,真皮浅层水肿,小血管增多,见梭形细胞及星状增生,纤维组织增多,血管周围少量淋巴细胞浸润。阿辛蓝染色(+)。免疫组化：CD34局灶性阳性、Vimentin弥漫性阳性,S-100、Desmin、Actin、CD31、HHV-8均阴性。诊断：甲下浅表性肢端纤维粘液瘤。予手术切除肿物,术后甲床愈合良好,随访未见复发。     

深部良性纤维组织细胞瘤一例

深部"良性"纤维组织细胞瘤是一种罕见的纤维组织细胞肿瘤,好发于四肢,本文报道1例.患者,女,56岁,左前臂无痛性皮下肿物4年,组织病理示境界清楚的单发性圆形皮下肿物,约1.8 cm×1.3 cm×0.6 cm,周围有纤维性假包膜,肿瘤细胞丰富,呈梭形或类圆形,编织状致密排列,细胞无明显异型性.免疫组化:CD34(+),...     

皮内痣伴结缔组织增生性结节一例

患者男,28岁,因左侧胸部单发褐色肿物4年、多发小丘疹1年就诊。皮肤科检查：胸部左侧一1.2 cm × 1.1 cm × 1.0 cm褐色类圆形肿物,质韧,其右侧数个直径3 ~ 5 mm褐色丘疹,左侧腋下淋巴结未触及肿大。手术完整切除肿物后行组织病理检查：肿物和小丘疹内均可见真皮浅层痣细胞聚集成巢,考虑皮内痣;最大肿物...     

Unusual clinical features of cutaneous tuberculosis in an immune compromised patient

We report a case of an unusual form of cutaneous tuberculosis in an 82-year-old woman. She visited our hospital because of an intractable ulcer on the fifth finger of her right hand. While examining the ulcer surrounding half of her right fifth finger and covered with necrotic tissue, we also perceived a nodule with crust on the forearm, multiple subcutaneous nodules on the right forearm and upper arm, and a hen's-egg-sized agglomerative nodule on the axilla. All the lesions were located on her right arm. Skin biopsy specimens showed granulomatous tissue with necrosis in the lesions. Mycobacterium tuberculosis was identified by culture of a biopsied specimen, so the diagnosis was confirmed. Further examination revealed that she also had pulmonary tuberculosis. Cutaneous tuberculoses are classified morphologically with reference to host immune status, but no satisfactory classification exists. The present case can't be classified into any of the types which have been proposed so far. She is elderly and suffers from liver cirrhosis, hepatocellular carcinoma and myelodysplastic syndrome. The resulting acquired immunosuppression may have caused a unique form of cutaneous tuberculosis.     

色素性神经纤维瘤六例

6例色素性神经纤维瘤中男3例,女3例,年龄8～55岁.6例患者的皮损均表现为褐色斑片或斑块,3例皮损位于左颈部及躯干、四肢,1例皮损位于右腋窝及左上臂,1例皮损位于左前臂伸侧,1例皮损位于腰臀部,皮损2 cm×3 cm至30 cm×40 cm.3例合并Ⅰ型神经纤维瘤病.皮损组织病理主要表现为表皮轻度角化过度,基底层色素增加,真皮和皮下脂肪组织内可见肿瘤细胞呈弥漫性分布,肿瘤组织无包膜,主要由大量的梭形细胞构成.肿瘤组织中散在或簇集状分布黑素细胞,胞质内可见黑素颗粒.免疫组化显示S100(+)和波形蛋白(+).6例患者均未治疗.色素性神经纤维瘤少见,临床和组织病理上,需与Becker痣、先天性黑素细胞痣、色素性隆突性皮肤纤维肉瘤等鉴别.     

Subcutaneous nodules as initial metastatic sites in osteosarcoma

A 54-year-oid woman presented with two nonsymptomatic subcutaneous nodules. Approximately 3 months previously, after sustaining a fall, her X-rays revealed a pathologic fracture and a highly destructive appearing lesion. She underwent amputation of the right leg up to the middle of the femoral bone. Her history was negative for any pre-existing bone condition and her famiiy history was negative for malignant diseases. The pathology report macroscopically showed a neoplastic tumor with a maximal diameter of 12 cm which literally occupied almost all of the knee arthrosis and extended into the femoral condylus. Microscopic examination of the specimen showed a high grade malignant sarcoma comprising mainly spindle cells with a large percentage of necrosis. The exact histologic typing was uncertain, but was probably fibroblastic-type osteosarcoma (Fig. 1). On admission, her physical examination was significant for the presence of two subcutaneous nodules. One nodule was located on the abdominal wall in the lower left area (approximately 1×1 cm) and the other on the apex area of the scalp (approximately 1.5x1.5 cm). These lesions were not ulcerated and there was no change in skin pigmentation. The patient mentioned that they appeared a couple of months ago. She also complained of recent dim vision in the left eye. Laboratory findings included a positive fine needle aspiration (FNA) of both nodules showing metastatic infiltration of the skin and subcutaneous tissue by osteosarcoma (Fig. 2), as well as a positive computed tomography (CT) scan of the orbita showing a metastatic tumor retro-ocularly to the left which pressed against the optic nerve and was in contact with the lateral rectus. It is noteworthy to point out that, in this patient, both chest roentgenogram and CT of the chest were negative. Bone scan, liver ultrasound, and CT of the upper and lower abdomen were also negative. All other laboratory findings were within normal limits. The decision was made that the patient was to undergo chemotherapy consisting of two cycies of Adriamycin (ADR) and Piatamine (CDDP), 21 days apart, followed by one cycle of BCD (Bleomycin, Cyclophosphamide, and Dactinomycin) after 21 days. This regimen was to be repeated once for a total of six cycles, each 21 days apart. One day prior to the commencement of chemotherapy, a third subcutaneous nodule presented on the right side of the back in the scapular area. This also had a positive FNA showing metastatic osteosarcoma. On admission of the patient for the second cycle of chemotherapy (ADR and CDDP), a fourth nodule was discovered on the upper third of the left thigh, and on admission for the third cycle (BCD), a fifth nodule was found on the left arm (brachium area). The patient's-chest roentgenogram continued to be negative. A little over ½ months after initiating chemotherapy, on entering the fourth cycle (ADR and CDDP), it was observed that two of the five nodules (on the left arm and in the left lower abdominal area) had disappeared. There was also a decrease in the size of the remaining three. Furthermore, the patient mentioned improvement with regard to her vision. At the time of admission for the fifth cycle of chemotherapy (ADR and CDDP), all nodules, except that on the apex area of the scalp, had disappeared. The remaining nodule was stable in size and, on admission for the sixth cycle (BCD), had decreased in size. One month following the sixth cycle of chemotherapy, the patient was admitted for follow-up. All five subcutaneous nodules (Fig. 3) had clinically completely disappeared. Furthermore, the patient mentioned complete restoration of her vision. The laboratory tests (bone scan, liver ultrasound, orbital CT, CT of the upper and lower abdomen, and thoracic CT) were all negative. At present the patient is in remission with regard to her disease and in general good health.     

A case of hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber's disease) with dystrophic calcinosis cutis and retinal lesions

A 65-year-old Japanese female developed a nodule on the distal interphalangealjoint of her right thumb. She also had multiple telangiectasias on her face, oral mucosa, tongue, nasal mucosa and upper extremities. A lip biopsy showed irregularly dilated capillaries and venules lined by flat endothelial cells. The nodule in the right thumb was resected. Histopathology revealed calcium deposits in the dermis. This case was diagnosed as dystrophic calcinosis cutis within hereditary hemorrhagic telangiectasia. Ophthalmologic examination showed bilateral retinal vascular lesions with dilated and tortuous retinal venules.     

面部鳞癌合并巨大皮角1例

患者女,82岁。右侧面颊部赘生物1年余,明显增大4个月。皮肤科检查见右侧颊部一角化性赘生物,顶端呈牛角样,突出皮面约7cm,褐黑色,质地硬如骨,基底部约6cm×5cm大小肿块,圆形,界清,红肿,轻压痛,无破溃及分泌物渗出。结合病理及临床诊断:面部鳞癌合并巨大皮角。治疗采取扩大切除植皮术。     

Syringocystadenocarcinoma papilliferum with transition to areas of squamous differentiation: a case report and review of the literature

Syringocystadenocarcinoma papilliferum (SCACP) is an exceedingly rare cutaneous adnexal neoplasm, which is typically located in the head and neck, and perianal area. Very few cases have been reported in the literature. Here, we report a case of SCACP with evident transition to squamous differentiation. A 75-year-old white woman presented with 1-year history of a solitary tender nodule in the left upper arm. Physical examination revealed a single, 1.5 × 1.1-cm, erythematous ulcerated nodule within a background of red patch. Biopsy showed an adnexal carcinoma connected to the epidermis and composed of cystic papillary projections admixed with solid basaloid areas with marked cytologic atypia. The basaloid tumor cells appeared to blend with the squamous component that demonstrated ductal formation, which was highlighted by carcinoembryonic antigen. Tumor cells were reactive for both cytokeratins 5/6 and 7. This case represents SCACP arising from syringocystadenoma papilliferum in the upper arm, with distinct transition to areas of squamous differentiation.     

深在性红斑狼疮1例

患者女,37岁。右上臂斑块1年。皮肤科情况:右上臂前侧和后侧各见约1.5×2.5cm,1.5×4.0cm大小的淡红色浸润性斑块,表皮萎缩,质地较硬,活动度差,无压痛。皮损组织病理示:角化过度,表皮萎缩,基底细胞空泡化变性,真皮及皮下脂肪组织小血管扩张充血,小血管周围伴大量灶状淋巴细胞浸润,皮下脂肪小叶内大量淋巴细胞浸润。直接免疫荧光(LBT):表皮基底膜带C3,IgM呈线状沉积。诊断:深在性红斑狼疮。硫酸羟氯喹0.2g口服,2次/d,白芍总苷0.6g口服,3次/d,卤米松软膏、多磺酸黏多糖软膏外用。3周后皮损变软,面积变小。     

色素性基底细胞癌

报告1例色素性基底细胞癌。患者女,68岁。右侧腋下黑色条状斑块10余年。皮肤科检查:右侧腋下约3.0 cm×0.2 cm大黑色斑块,边界尚清,其上散在分布数个米粒大黑色丘疹,斑块中部可见糜烂、渗液,渗液周边可见炎症性红斑,无触痛。皮损组织病理检查:表皮层局灶瘤细胞巢,表皮至真皮层可见一肿块,由嗜碱性基底样细胞组成,可见细胞异形性及有丝分裂象,在肿块周边细胞呈栅栏状排列,可见收缩间隙。诊断:色素性基底细胞癌。