席纹状胶原瘤1例

患者男,20岁,左侧鼻翼发疹7年,渐增大。皮肤科情况:左侧鼻翼有一枚直径约0.9 cm×0.9 cm大小皮色结节,表面光滑,质地坚韧。皮损组织病理示:肿瘤占据真皮全层,边界尚清,无包膜。瘤体主要由席纹状或旋涡状排列的胶原纤维束组成,结构致密,散布星状或梭形纤维母细胞。诊断:席纹状胶原瘤。     

Pacinian collagenoma

An unusual histological variant of collagenoma is described. A 36-year-old woman presented with a lump in the left hypothenar eminence. Histological examination revealed a well-delineated lesion composed of paucicellular collagen fibres arranged in concentric lamellations giving rise to an onion skin appearance. The overlying epidermis was thin and the lateral borders were demarcated by an epidermal collarette. Inflammation and xanthoma cells were absent and occasional capillaries were present. The lesion was positive for collagen stains, reticulin and CD34. This lesion represents an uncommon histological form of collagenoma or fibroma. It can be distinguished from histological look-alikes on the basis of the characteristic morphology and immunophenotype.     

Eccrine angiomatous hamartoma: a rare skin lesion with diverse histological features

Eccrine angiomatous hamartoma (EAH) is an exceedingly rare benign tumor-like lesion prevalent in childhood which may produce pain and marked sweating. The histological features include proliferation of eccrine sweat glands and angiomatous capillary channels. We report an 8-year-old girl who had a single lesion on her left lower leg. Physical examination revealed a slightly elevated, 4×7 cm erythematous plaque on the lateral aspect of left leg. Sweating in the lesion was evoked by physical work or emotional stress. There was no pain or tenderness associated with the lesion. The patient had no history of trauma to the site. These lesions were clinically angiomatous, and we obtained the diagnosis by histopathological examination. Histopathological examination of the lesion showed increased numbers of eccrine glands, as well as dilated vascular channels in the deep dermis and subcutaneous tissue. These findings are consistent with EAH.     

额部隆突性皮肤纤维肉瘤一例

患者男,56岁,因左前额部肿块1年余入院.患者20年前左前额部因黄豆大小肿块,曾行切除术.1年前肿块复发并增大,无明显自觉症状来我院就诊.皮肤科检查:左前额部见3 cm×2 cm×1 cm大小的肿块,呈淡红色半球形隆起于皮面,表面皮肤光滑,紧张,质地较硬,与皮肤粘连,但与深筋膜无明显粘连,无触压痛.肿块周围可见明显凹陷区.皮损组织病理:真皮中下层及脂肪内可见大量梭形细胞增生,细胞轻度异形,呈编织状排列.免疫组化染色:CD34(+),波形蛋白(+),CK(-),S-100(-),上皮膜抗原(-).诊断为隆突性皮肤纤维肉瘤.切除肿瘤并行游离全厚皮片移植,术后皮片生长良好,效果满意.     

须癣毛癣菌致皮肤、眼部深在感染1例

患者女性,63岁,因左面部上下眼睑肿胀伴低热10天入院。体检：左上下眼睑、左颧上部明显红肿有压痛,中央有小片黑色坏死,用抗生素治疗无效,红肿、坏死性黑痂扩大至直径6cm,皮损组织涂片真菌检查发现大量分隔菌丝,培养为须癣毛癣菌,诊断皮肤深部真菌感染,服伊曲康唑0.2,每日2次,52天基本痊愈。     

多方向分化附属器肿瘤伴斑痣一例北大核心CSCD

患者女,41岁。患者于不到1岁时无明显诱因左侧头顶部出现淡黄色圆形斑片,随年龄增长逐渐增大呈斑块状。2年前局部出现乳头状损害,表面发红、潮湿。约同一时间左颞部出现黑色肿物,逐渐增大并中心破溃,均无自觉症状。患者约1岁时在左颌面、颈项、躯干、上肢淡褐色斑基础上出现黑褐色斑疹,渐增多、扩大,累及同侧手背,并出现丘疹。皮肤科检查：左侧头部皮肤淡黄色斑块基础上分别见约3 cm × 2 cm、2 cm × 1 cm新生物,色鲜红,表面如菜花状,境界清楚,触之较硬,表面糜烂,其间散在大小不等的黑色及淡红色丘疹。左侧颞部一约1.5 cm × 1.5 cm大环形黑色肿物,中心溃疡形成。左侧面颊、下颌、颈项、前胸、肩背、上肢、手背淡褐色斑片,边界清,其上可见黑褐色斑疹及丘疹,触之韧。取多处皮损同时行组织病理检查,头部菜花状皮损诊断为乳头状汗管囊腺瘤,黄色斑块状皮损诊断为乳头状汗管囊腺瘤合并皮脂腺瘤,颞部黑色增生性皮损诊断为毛母细胞瘤并基底细胞上皮瘤,下颌黑素丘疹样皮损及下颌褐色斑丘疹样皮损均诊断为斑痣。结合患者临床表现,诊断：多方向分化附属器肿瘤（乳头状汗管囊腺瘤、乳头状汗管囊腺瘤和皮脂腺瘤、毛母细胞瘤并基底细胞癌）,斑痣。     

疣状甲周纤维瘤1例

患者女,29岁。左足拇趾的甲根部肿块7年。手术切除术物组织病理示:表皮角化过度,棘层肥厚,真皮胶原纤维和血管增生。诊断:甲周纤维瘤。     

卵巢纤维瘤和纤维卵泡膜细胞瘤的 CT 鉴别诊断分析

目的：分析卵巢纤维瘤和纤维卵泡膜细胞瘤的CT鉴别诊断,为CT诊断水平的提高提供临床依据。方法：选取我院2009年4月至2011年4月收治的33例经病理组织学检查确诊的卵巢纤维瘤及纤维卵泡膜细胞瘤患者,其中卵巢纤维瘤18例,纤维卵泡膜细胞瘤15例,对比两组患者临床特征及CT检查结果。结果：病理组织学检查可以发现,两种肿瘤多集中在患者左下腹部,边缘锐利,包膜清晰,卵巢纤维瘤肿瘤直径较纤维卵泡膜细胞瘤大（P＜0.05）,且实性较多,纤维卵泡膜细胞瘤实性、囊性各半;两组CT平扫均显示附件区边缘锐利,肿物密度与子宫肌层相似;增强扫描其强化幅度均＜20 HU,与子宫肌层对比明显,但两组CT表现无明显差异;CT检查对卵巢纤维瘤、纤维卵泡膜细胞瘤诊断的一致性仅为83.3％、73.3％,误诊率达到21.2％（7/33）。结论：卵巢纤维瘤和纤维卵泡膜细胞瘤的病理组织、CT表现均无明显差异,仅免疫组化分析可进行鉴别诊断,而CT增强检查可将卵巢纤维瘤、纤维卵泡膜细胞瘤与子宫、子宫阔韧带肌瘤有效区分,是指导临床治疗方案选择的可靠方式。     

原发性附睾胚胎型横纹肌肉瘤1例并文献复习

目的:探讨附睾横纹肌肉瘤的临床表现、病理和诊治方法。方法:回顾分析1例原发性附睾横纹肌肉瘤患者资料并复习相关文献。患者23岁,因偶然发现左阴囊肿物3周入院。查体左附睾尾部约3cm×3cm×1.5cm大小肿物,质硬,表面不规则,无压痛。MRI左附睾肿瘤可能性大。术中冰冻活检明确肿瘤后予以行左侧睾丸附睾根治性切除。10d后行腹腔镜腹膜后淋巴结清扫术,术后予以化疗。结果:左侧睾丸附睾根治性切除术后病理:镜下见肿瘤细胞呈小圆形,核异型性明显,部分胞浆可见明显横纹。免疫组化结果:VIM(+)、MyoD1(+)、Myogenin(+)、Ki67(30%)、Desmin(+),诊断:左附睾横纹肌肉瘤。腹膜后淋巴结清扫未见淋巴转移。现予以化疗,未见复发及转移。结论:附睾胚胎型横纹肌肉瘤极罕见,临床表现不具特异性,确诊主要靠病理,预后较差,特别是10岁以上患者,是一种恶性程度高的肿瘤。     

Verrucous hemangioma

A 13-year-old female presented complaining of swelling of the skin and purplish red papules and nodules on her left leg. These lesions had been present from early childhood and had slowly enlarged, increased in number, and become more verrucous. At the age of 8 years, one of the nodules had been excised by laser, but recurrence was noted within a few months. There was occasional pain and bleeding from the lesion. Physical examination revealed a group of several well-circumscribed, hyperkeratotic, blue-red, vascular plaques arranged linearly along the inside aspect of her left lower extremity, ranging in size from 0.5 to 4.0 cm in diameter (Fig. 1). Smaller, discrete satellite nodules with a similar appearance were noted in the vicinity. Histopathologic examination showed hyperproliferation and hyperkeratosis of the epidermis. The superficial dermis showed multiple, thin-walled, dilated blood-filled spaces (Fig. 2). Similar spaces were present in the lower dermis and subcutaneous tissue. A diagnosis of verrucous hemangioma was made.     

左腋下放疗后隆突性皮肤纤维肉瘤妊娠期迅速增大一例

患者女,30岁。5年前因左乳腺癌行保乳手术并接受放射治疗,在左腋下出现放射性皮炎。2年后,在放射性皮炎部位出现3个黄豆大小的鲜红色结节,逐渐增大,行手术切除3周后复发。妊娠后肿块迅速增大、隆起,终止妊娠后,肿块增大趋势得到明显遏制。皮肤科检查：左腋下方见18 cm × 14 cm类似椭圆形暗红色或鲜红色斑块,斑块表面光滑,中央为 10 cm × 9 cm × 5 cm大的鲜红色半球形实质性隆起,表面糜烂,结痂。组织病理：真皮中下层致密、单一的梭形细胞排列成漩涡状、席纹状。部分细胞核有异形性,少见核分裂象。少数区域瘤细胞排列成“青鱼骨”状。免疫组化染色：波形蛋白（+++）,肌动蛋白（+）,CD34阴性。诊断：放疗后隆突性皮肤纤维肉瘤（纤维肉瘤型）。     

关节病性银屑病并发葡萄膜炎

报告1例关节病性银屑病并发葡萄膜炎。患者女，54岁。因全身反复起红斑、鳞屑9年，关节损害6年，伴左眼失明1年入院。体格检查：双侧瞳孔不等大，左侧瞳孔不规则，对光反射消失。全身见大小不等、上覆鳞屑的红斑。近端指（趾）间关节畸形伴活动障碍。诊断为关节病性银屑病、左眼陈旧性葡萄膜炎。     

一例合并枕部动静脉畸形和脊柱侧弯的神经纤维瘤病NF1基因突变分析

【摘要】 患者女，15岁。因全身多发咖啡斑15年、脊柱侧弯1年余就诊。1年前因枕部动静脉畸形手术切除肿物。皮肤科检查：全身散在多个大小不等咖啡斑，最大约3 cm × 4 cm，腋窝、腹股沟雀斑。全外显子测序显示，患者NF1基因第26号外显子发生碱基T杂合缺失（c.3328delT）移码突变。患者父母及弟弟均未发现该突变。诊断：神经纤维瘤病Ⅰ型合并枕部动静脉畸形和脊柱侧弯。     

瘢痕性结节病一例

患者女,31岁。因左上唇及左额部外伤瘢痕4年余,局部斑块3个月就诊。皮肤科检查：左上唇、额部皮肤分别见2em×3．5cm和1．5cm×1．5cm的斑块,色淡红,边界清楚,质硬。皮损组织病理检查：真皮内可见大小不一的细胞团块,由上皮样细胞及少许多核巨细胞构成,无明显干酪样坏死。PAS、PAM及抗酸染色阴性,各系统实验室检查未见异常。诊断：瘢痕性结节病。予激光磨削术,口服甲泼尼龙、匹多莫德和阿奇霉素综合治疗,取得良好疗效。随访1年,治疗区局部平整,且恢复正常肤色。     

痣样基底细胞癌综合征

报告1例痣样基底细胞癌综合征.患者女,45岁.左足背无痛性红斑4个月余.皮肤科检查:左足背一3 cm×4 cm红色斑块,表面糜烂、结痴.左耳后一黄豆大暗红色丘疹,质地软.左胴窝一直径0.5 cm的淡红色斑片.双掌、跖部可见密集针尖大点状凹陷.皮损组织病理检查示基底细胞癌.诊断:痣样基底细胞癌综合征.     

Subungual pleomorphic fibroma

BACKGROUND: Pleomorphic fibroma is a benign fibroblastic tumor characterized by pleomorphic, hyperchromatic cells or giant multinucleated cells embedded in a collagenous stroma. These cytologic features may lead to an incorrect diagnosis of malignancy. Most cases reported in the literature are located on trunk or extremities; the presentation as a subungual mass is rare. METHODS: We report an unusual case of a subungual pleomorphic fibroma in 66-year-old woman. Clinical information was obtained. Histologic examination and immunohistochemical studies were performed. RESULTS: A 66-year-old woman presented with a longstanding (40 years), subungual mass that deformed the nail of the left middle finger. Microscopic examination revealed a paucicellular tumor composed of hyperchromatic spindled, pleomorphic, floret-like giant cells embedded in haphazardly arranged collagen bundles in the dermis. No mitotic figures were seen. The tumor cells were vimentin-positive but did not stain with antibodies to S-100, cytokeratin, smooth muscle actin, factor XIIIa or CD34 negative. The diagnosis of a pleomorphic fibroma was made. Follow-up shows no evidence of tumor, 36 months after excision. CONCLUSION: Pleomorphic fibroma of the subungual region is an unusual cutaneous tumor with histologic features that may cause confusion with true sarcomas. This is only the second case reported of a subungual pleomorphic fibroma. Pleomorphic fibroma should be considered in the differential diagnosis of pleomorphic subungual tumors.     

Pedunculated basal cell epithelioma which is not Pinkus tumor

A 33-year-old female with pedunculated basal cell epithelioma was reported. She had noticed a cutaneous tumor on the scalp for two years before admission. It developed gradually and clinically resembled fibroma or pigmented nevus. Total resection was performed, and its histopathology revealed the solid or cystic type of basal cell epithelioma.     

乳头状汗管囊腺癌

报告1例乳头状汗管囊腺癌.患者男,76岁.下腹部丘疹缓慢增大30余年,红肿、破溃1个月余.皮肤科检查:下腹部一约2 cm×2 cm肿块,类圆形,鲜红色,表面湿润,有较多血性黏液样渗出物,周围红肿,触诊质地稍硬.皮损组织病理检查:肿块表浅部为与表皮相连并开口于表皮的乳头状结构,乳头状结构衬以2层上皮样细胞,内层为胞质稀少、核呈卵圆形且深染的小细胞,外层为胞质丰富、嗜酸性、核大、空泡状的高柱状细胞,可见顶浆分泌;间质中有大量浆细胞.肿块深部为与表浅部相连续、大小不一的肿瘤细胞团块,肿瘤细胞胞质丰富、嗜酸性、核大、空泡状.肿瘤内可见核大、深染的异形细胞和病理性核分裂象.免疫组化染色:肿瘤细胞强阳性表达泛细胞角蛋白(pan-CK)和上皮膜抗原(EMA),部分表达巨囊病性液体蛋白-15(GCDFP-15),而不表达癌胚抗原(CEA)和S-100蛋白.诊断:乳头状汗管囊腺癌.     

Cutaneous metastatic adenocarcinoma arising from a malignant sacrococcygeal teratoma in an adult

We present a patient with cutaneous metastasis caused by an adenocarcinoma arising from a malignant teratoma. A 37-year-old woman seen for the complaint of swelling in the genital region also complained of a draining mass in her gluteal region present since birth. Physical examination showed marked edema in the labia majora, multiple hyperkeratotic papules in the left labium majus, and erythema, induration, and swelling in the left femoral and inguinal regions. A soft tumor that exhibited sinus tracts was palpated in the left gluteus. Excision of the gluteal tumor revealed a teratoma. Vulvar skin biopsy confirmed a mucinous adenocarcinoma which had derived from this teratoma. A tumor that arises from pluripotent germ cells, teratoma rarely shows malignant transformation. The patient presented is a rare example of a cutaneous metastasis originating from a congenital sacrococcygeal teratoma in an adult.     

A Case of Perifollicular Fibroma

Perifollicular fibroma (PFF) is a very rare proliferative lesion of the perifollicular sheath. A flesh-colored, dome-shaped papulonodule is usually located on the face or the neck. These papulonodules may be single or multiple. Histologically, the lesion consists of a concentric arrangement of cellular fibrous tissue around a normal hair follicle. We describe here an unusual case of PFF in a 41-year-old female who had an asymptomatic small skin colored papule on the scalp, and this is an uncommon location for PFF.