皮肤白血病的临床病理

为了解各种白血病的皮肤表现及皮损分布是否有所不同;皮肤损害能否出现在系统性白血病之前;一旦诊断皮肤白血病可存活多长时间及是否预示预后不佳;只靠皮肤活检能否确定白血病之类型等一系列重要问题,作者对42名皮肤白血病患者进行了临床病理学研究。其中急性淋巴细胞白血病(ALL)3人,慢性淋巴细胞白血病(CLL)16人,急性粒细胞白血病(AGL)12人,慢性粒细胞性白血病(CGL)3人,急性单核细胞性白血病(AML)5人,急性髓单核细胞白血病(AMML)3人。研究结果表现:各型白血病均可见丘疹、斑疹、斑块、结节、瘀斑、紫癜及溃疡,以丘疹和结节为     

嗜酸性肉芽肿性多血管炎一例

患者,女,29岁。头面、手足散在血疱样丘疹、结节3天。皮肤科检查：面部、手足散在绿豆至花生大丘疹、结节,质地稍硬,浸润明显,表面可见紫癜样改变,部分皮损破溃结痂。结合临床症状、实验室及组织病理检查,诊断为嗜酸性肉芽肿性多血管炎。     

系统疾病的皮肤表现

20 0 0 34 12　有皮肤损害的急性粒细胞白血病 1例 /杨敏 (北京医院皮肤科 )…∥临床皮肤科杂志 .- 2 0 0 0 ,2 9( 1) .- 51～ 52女 ,30岁 ,躯干四肢反复出现丘疹、紫癜、结节伴瘙痒 2年 ,按湿疹治疗可缓解。经皮肤活检、骨髓检查及细胞免疫分型确诊为急性粒细胞性白血病 M2型。作者提醒如遇多形性皮损 ,反复不愈 ,用一种皮肤病不能完全解释的情况 ,应及时做皮肤病理检查及全面检查。图 3　 (刘斌 )2 0 0 0 34 13　自拟止痒汤治疗糖尿病诱发皮肤瘙痒症82例 /孙学东 (北京隆福医院 )∥北京中医 .- 2 0 0 0 ,( 3) .- 2 2以滋阴活血立法 ,自拟…     

以皮肤损害为首发表现的慢性粒单核细胞白血病转为急性单核细胞白血病1例

患者男,64岁。2009年3月前因胸痛伴发热、血常规异常4周余就诊,根据临床表现及实验室检查确诊为慢性粒单核细胞白血病(CMML),经化疗后好转出院。出院后1月余躯干、四肢出现红色丘疹、结节、浸润性斑块,组织病理为皮肤白血病。骨髓检查、免疫分型证实为急性单核细胞白血病(AMLM5)。     

急性髓细胞性白血病(M4型)

报告1例急性髓细胞性皮肤白血病(M4型).患者女,48岁.全身出现丘疹、红色结节14d,伴剧烈瘙痒.体格检查:全身泛发大小不等的红色丘疹、结节,质韧,无压痛.皮损组织病理检查:真皮内弥漫淋巴样细胞浸润,有明显异形及较多核分裂象.免疫组化组织病理检查:CD68阳性(灶性),MPO阳性(少量).骨髓穿刺:白血病细胞大量增生,免疫标记:CD68、CD11b、MPO及HLA-DR均阳性.诊断:急性髓细胞性白血病(M4型).患者经过2次DA(伊达比星、阿糖胞苷)方案化疗后,再次行骨髓穿刺示缓解,但皮损仍有复发.     

皮肤镜观察发疹性毳毛囊肿1例

<正>1 病历摘要患者男,23岁。躯干丘疹及皮下结节2年余。患者2年前无明显诱因胸部、腹部及背部出现数个绿豆大白色至淡黄色丘疹及皮下结节,逐渐增多,无明显自觉症状,未予特殊治疗。于2016年6月13日就诊于我院门诊。既往史,个人史及家族史均无特殊。体格检查:一般情况良好,各系统检查均正常。皮肤科检查:胸部、腹部及背部多发白色和淡黄色丘疹及皮下结节,直径2~5 mm,孤立不融合(图1A),质地稍硬,无压痛。     

一例有皮肤血管炎的布鲁氏菌病

布鲁氏菌病皮损不常见,它们包括斑疹,斑丘疹、丘疹,猩红热样疹,疱疹,银屑病样损害,脓疱疮样损害,紫癜,结节性红斑和皮下结节。本文报告一例布鲁氏菌病有斑疹结节和紫癜性损害,皮肤活检示肉芽肿性血管炎。患者女性、29岁,生活在农村,每天接触奶牛和猪,入院前10天感冒未治疗。主诉发热、寒战、头痛、夜汗、关节痛。入院前2～3天小腿出现红斑,体检腋下体温39.2℃,小腿有斑疹、结节和红斑。踝关节肿胀且活动受限。实验室检查Hb10.3,ESR200mm/h,SGPT50mU/ml(正常5～35mU/ml),     

细菌性皮肤病

20 0 12 917　 12例坏疽性脓皮病临床和实验室分析 /兰长贵 (四川省医院皮肤科 )…∥临床皮肤科杂志 .-2 0 0 1,30 (2 ) .- 87发病年龄 3.5～ 77岁 ,病程 4天～ 1年。表现为畏寒、发热、疼痛、压痛、恶臭、痒。皮损局限 8例 ,泛发全身 4例。受累部位依次为下肢、臀部、上肢、躯干、面部。初发皮损 :结节 8例 ,丘疹及水疱 3例 ,红斑、丘疹及水疱 1例。 12例中伴发白血病 2例 ,糖尿病、红斑狼疮、寻常型天疱疮、紫癜性多形红斑、慢性活动肝炎和肾结石各 1例。给皮质类固醇激素或免疫抑制剂与局部治疗相结合 ,同时对症处理。痊愈 5例 ,明显好转…     

黏液水肿性苔藓2例

报告2例黏液水肿性苔藓。例1.女,16岁。全身起丘疹、结节2个月,以手部结节损害为特征。例2．女,40岁。四肢、躯干丘疹3年,伴面部斑块1年,以眉间隆起的纵向斑块为特征。此2例患者的丘疹、结节组织病理检查均示真皮胶原纤维疏松,成纤维细胞增生,胶原纤维束间阿新蓝染色阳性。     

嗜酸性粒细胞增多性血管淋巴样增生1例

患者女,45 岁.因枕部出现红色丘疹和结节,伴瘙痒2 年,于2008 年12 月来我院门诊就诊.患者2 年前无明显诱因枕部出现绿豆大红色丘疹,伴阵发性瘙痒,抓破后有少许渗血,表面有血痂.2 年来丘疹渐渐增多、增大.既往史:2008 年12 月曾行甲状腺瘤手术.体格检查:系统检查未见异常.皮肤科检查:枕部见散在紫红色半球形丘疹和结节,直径0.2 ～ 1 cm,质地较硬,以左枕部较多(图1).近卫浅表淋巴结未扪及增大.     

急性髓细胞性白血病M2型所致皮肤白血病一例

报道1 例急性髓细胞性皮肤白血病.患者男,38岁,因确诊急性粒细胞性白血病1年,躯干部皮疹1个月入院.皮肤科检查:躯干、右额部皮肤散在数十个直径约1～2 cm大小的红色结节及斑块,略高出皮面,触之有明显浸润感,无压痛.骨髓检查及免疫学证实为急性髓细胞性白血病M2型,患病1年后躯干及前额皮肤出现斑块及结节,皮肤组织病理及免疫组化证实为皮肤白血病.白血病短期内出现皮肤、肺、脾、肾、胸腰骶椎多发性浸润,则提示病情急性进展及预后不良.     

皮肤白血病1例

患者男性，５７岁，病期１个月，患者先出现乏力、发热、面色苍白，半月后于颈部、双上肢发现皮疹，无自觉症状。右前臂结节组织病理报告为皮肤白血病，经骨髓检查及免疫单抗检测确诊为急性粒细胞性白血病Ｍ２型。化疗后１７天，皮疹完全消退。１个月后，皮疹又再次出现。     

Clinicopathologic correlations in leukemia cutis

This clinicopathologic study involved 42 cases of leukemia cutis: 3 of acute lymphocytic leukemia (ALL), 16 of chronic lymphocytic leukemia (CLL), 12 of acute granulocytic leukemia (AGL), 3 of chronic granulocytic leukemia (CGL), 5 of acute monocytic leukemia (AML), and 3 of acute myelomonocytic leukemia (AMML). The clinical appearance of leukemia cutis included papules, macules, plaques, nodules, ecchymoses, palpable purpura, and ulcerative lesions, and these were seen in all types of leukemias. Gingival hypertrophy was seen only in AML or AMML, and erythroderma and bullous lesions of leukemic infiltration were observed only in CLL. Cutaneous leukemic lesions may be concomitant with or preceding the diagnosis of systemic leukemia. Therefore, skin biopsy may be helpful in detecting the leukemia and may facilitate the work-up. Leukemia cutis probably is a dissemination of systemic leukemia to the skin, and the demonstration of leukemia in skin is associated with a very poor prognosis.     

Disseminated linear calcinosis cutis associated with the Koebner phenomenon in an infant with congenital acute monocytic leukaemia

We present a unique case of an infant with acute monocytic leukaemia who presented at birth with multiple rubbery, erythematous to violaceous subcutaneous nodules secondary to leukaemia cutis. As these infiltrates regressed with chemotherapy, numerous white to yellow linear confluent papules appeared in a scratch-like pattern. These lesions were widely disseminated but were concentrated across her face, trunk and extremities with relative sparing of the napkin area and back. We propose that these lesions represent a form of dystrophic calcinosis cutis that occurred secondary to koebnerization in an infant with congenital leukaemia cutis.     

Leukemia cutis presenting as localized cutaneous hyperpigmentation

The usual clinical presentations of leukemia cutis include solitary infiltrated erythematous or violaceous plaques or nodules and multiple localized or generalized papules. On the other hand, cutaneous hyperpigmentation is a frequent finding in patients with malignancies, most of the cases because of chemotherapy or other drugs that the patient is taking. We present a case of cutaneous hyperpigmentation as the presenting sign of leukemia cutis. A 61-year-old male presented with cutaneous hyperpigmentation, which had appeared during the last chemotherapy cycle for treatment for biphenotypic leukemia. Cutaneous lesions consisted of bluish to brownish irregular well-defined discoloration of the skin involving the upper part of the trunk and the temporal regions of the forehead. The patient was asymptomatic and the skin was not infiltrated at all. However, histopathologic study showed nodular infiltrates involving the full-thickness of the dermis and destroying pre-existing adnexa. This infiltrate was composed of atypical basophilic cells with large hyperchromatic nuclei and scant cytoplasm. Immunohistochemical studies showed intense immunoexpression for CD43, CD68, CD45RO and myeloperoxidase within these cells. A diagnosis of biphenotypic leukemia cutis was established. In our review of the literature we have not found any report of cutaneous hyperpigmentation as the presenting manifestation of leukemia cutis.     

Cutaneous macroglobulinosis

A patient with Waldenstr?m's macroglobulinemia had firm, translucent papules and nodules on the extremities. Clinically, the skin lesions were suggestive of amyloidosis cutis. Histologically, a homogeneous eosinophilic material was observed in the upper dermis and encasing the hair follicles. Special histochemical stains, electron microscopy, and immunofluorescence microscopy identified the material as IgM.     

Leucemia cutánea aleucémica: presentación de un caso

—The term aleukemic leukemia cutis describes the invasion of the skin by leukemic cells in the absence of peripheral blood and/or bone marrow involvement. Although the pathogenic mechanisms of this disease are still unknown, it is widely recognized its poor prognosis. Most of the reported patients completely developed the hematologic disease (the majority acute granulocytic or monocytic leukemias) in 10-14 months after diagnosis of aleukemic leukemia cutis, and they had a median survival of 22 months.We report on a case of a 77-year-old man with aleukemic leukemia cutis who presented with numerous erythematous to violaceous papulonodular lesions, mainly located on the trunk and head, lack of peripheal blood involvement and very early alterations in the bone marrow aspirate. Inmunohistochemical stains of skin and bone marrow biopsies revealed the infiltration of both tissues by blast cells of monocyte-histiocytic lineage. Our patient presented spontaneous resolution of skin lesions and his hematological disease showed no progression during 9 months after diagnosis, although he did not undergo any treatment.We emphasize the low incidence of association between myelodysplastic syndromes and aleukemic leukemia cutis as well as the surprising spontaneous remission of cutaneous lesions in our patient.     

Multiple capillary hemangiomas: a distinctive lesion of multicentric Castleman's disease and POEMS syndrome

A diagnosed case of Castleman's disease, proven by biopsy from enlarged inguinal lymph nodes, presented with multiple, asymptomatic, erythematous papules and nodules prevalent since nine years over the trunk and extremities. The lesions had been gradually increasing in number and size. The patient had had plasmacytoma of the lower thoracic vertebra 12 years ago, for which he was adequately treated with chemotherapy and local radiotherapy. Dermatological examination revealed erythematous papules and nodules on the face, trunk, and extremities that were diagnostic of capillary hemangiomas. Histopathology of the erythematous, soft papule was suggestive of capillary hemangioma. Contrast-enhanced computerized tomography of the abdomen and pelvis showed multiple retroperitoneal nodes suggestive of Castleman's disease along with multiple osteolytic lesions in the pelvic girdle and vertebrae. The patient was treated with injection rituximab and is currently under follow-up. We report this case to highlight a rare association between Castleman's disease and POEMS syndrome.     

以瘙痒性丘疹为首发症状的急性HIV感染2例

2例均为39岁的男性患者。例1全身泛发丘疹、结节,伴剧烈瘙痒3月,皮疹反复发作,进行性增多,治疗抵抗。例2面部、躯干及四肢泛发丘疹、结节和斑块,伴剧烈瘙痒2年,皮疹逐渐增多,部分丘疹顶部坏死,伴有少许糜烂、渗液及萎缩性瘢痕。2例患者血清HIV抗体初筛试验(ELISA法)及确诊试验(免疫印迹法)均(+)。诊断:急性HIV感染。