上皮样组织细胞瘤1例

报告1例腘窝上皮样组织细胞瘤。患者男,68岁,左腘窝内侧黑色赘生物10余年,渐增大。皮肤科检查:左腘窝内上方见一花生米大小黑色息肉状赘生物,边缘规则,色素均匀,表面光滑。皮损组织病理检查显示:表皮增生,表皮突向下不规则延长,基底层色素增多,肿瘤细胞累及真皮全层,由大量上皮样细胞、少量多核巨细胞及噬含铁血黄素细胞构成,境界清楚,并伴有血管增生。诊断:上皮样组织细胞瘤。     

皮肤纤维黄瘤1例

1　病历摘要患者 ,男 ,65岁 ,无明显诱因在左耳前面部皮肤起一褐色结节 3个多月 ,无明显疼痛及瘙痒 ,易出血 ,于 2 0 0 3年 1 1月 6日来我院就诊。体格检查 :全身浅表淋巴结不大 ,左耳靠近耳门处见一约1 .0cm× 2 0cm暗褐色结节 ,表皮粗糙 ,结痂 ,周边有轻度红肿 (图 1 ) ,界限清楚。临床初步诊断 ;( 1 )寻常疣 ?( 2 )皮肤钙化上皮瘤 ?组织病理检查 :表皮乳头瘤样增生 ,基底细胞液化 ,真皮浅、中层大片纤维样组织细胞浸润 ,胞浆丰富 ,泡沫状 ,胞核大小不等 ,染色深浅不一 ;部分细胞呈梭形 ,束状排列 ,为纤维样细胞 ;不典型核分裂多见 ,并见…     

臀部疣状皮肤结核误诊1例

患儿女,10岁,右臀部环状斑块8余年,曾多次误诊为股癣。皮损组织病理示:表皮角化不全,毛囊角栓,表皮假上皮瘤样增生;真皮浅中层弥漫炎细胞浸润,以淋巴细胞为主;真皮内可见上皮样细胞结节,浸润的细胞有淋巴细胞、多核巨细胞及组织细胞等。抗酸染色(-),PPD试验(3+)。诊断:疣状皮肤结核。     

网状组织细胞瘤1例

患者女,48岁,左侧颞部红色丘疹、结节1年,无自觉症状.系统检查无异常.皮肤科情况:左侧颞部数枚直径0.3～0.8 cm的红色丘疹、结节,表面光滑,界限清楚.皮损组织病理示:表皮轻度萎缩变薄,真皮内全层弥漫细胞浸润,以组织细胞和毛玻璃样多核巨细胞浸润为主,伴散在淋巴细胞.免疫组织化学检查示:CD68、CD163阳性,C...     

下肢巨大疣状皮肤结核1例

患者女,45岁。左下肢丘疹、结节及斑块15年。皮肤组织病理示:表皮假上皮瘤样增生,真皮内见大量上皮样细胞、淋巴细胞、组织细胞及少量多核巨细胞聚集。抗酸染色(-)、PAS染色(-),PPD试验(3+),T细胞斑点试验(+)。诊断:疣状皮肤结核。     

皮脂腺痣并发小汗腺汗孔癌1例

患者男,39岁。左侧头皮、面部丘疹、结节、斑块39年,部分菜花样隆起1年。皮损组织病理检查:面部前额斑块病理片显示表皮角化过度,乳头瘤样增生,真皮层皮脂腺明显增生。菜花样增生物病理片示真皮可见一个或多个上皮肿瘤细胞团,呈巢索状;肿瘤细胞团内见多角形、核位于细胞中央的的鳞状细胞样瘤细胞和含丰富的糖原且细胞膜清楚的浅染瘤细胞,核分裂相多,有病理性核分裂;瘤细胞浸润真皮及皮下,可见局灶有导管分化。免疫组化提示肿瘤结节混合性CK(细胞角蛋白)阳性,肿瘤内导管结构EMA(上皮膜抗原)强阳性,PAS染色可见胞浆内糖原染色阳性。根据临床资料、组织病理及免疫组化诊断为皮脂腺痣并发小汗腺汗孔癌。     

角化棘皮瘤21例临床及病理分析

报告２１例角化棘皮瘤。临床表观均归性，开始为一小的丘疹，迅速增大为半球状隆起于皮面的结节或肿块，中央呈火山口样凹陷，其内充满角质。组织病理变化：早期损害表皮凹陷如火山口样，充满角质物。底部表皮增生，有些病便含有不典型细胞、核丝分裂及角珠。充分发挥的损害，火山口样凹陷继续扩大，两侧表皮如拱璧状。２０例的瘤底部较平坦，界限清楚，但另１例瘤的底部个别上皮细胞侵入横纹肌速之中，真皮内可见致密的嗜中性白细胞     

皮肤镜表现为落日征的Spitz痣1例

 患儿,女,1 岁。左眉弓上方内侧结节半个月。皮肤科查体：左眉弓上方内侧有一个半球形的红色结节,大小约 0.8 cm×0.6 cm,表面破溃、浆液性渗出,边界清楚。皮肤镜检查示红色均质背景,周边有黄白色鳞屑,呈现“落日征”。组织病理表现为表皮角化过度并角化不全,表皮假上皮瘤样增生,局部表皮高度水肿,水疱形成,表面可见浆痂。局部表皮内及真皮全层大量上皮样细胞增生,局部围绕附属器排列,细胞形态尚温和,偶见核裂。免疫组化：HMB-45(部分弱+),Melan-A(-),S-100 （+）,Ki-67 （3%+）,CD163(-),CD68(-)。诊断：Spitz 痣。完整切除皮损,术后6个月随访,未见复发及转移。     

角化棘皮瘤的血管内播散——一种值得警惕的良性现象

患者男,63岁。前额发生一火山口样损害10周,组织活检标本经连续切片,HE及镜检所见:肿瘤,中央为层状角质物,偶见角化不全及炎细胞碎片,外周为厚度不同的鳞状上皮,损害周边部隆起的正常表皮呈唇突样包绕皮损。瘤体向下延伸至真皮中部小肝腺螺旋管水平。基底部的某些区域可见轻度的细胞非典型性     

Fonsecaea monophora所致着色芽生菌病

报告1例云贵高原地区由Fonsecaea monophora所致着色芽生菌病。患者男,38岁,农民。左小腿异物刺伤后皮肤出现丘疹、溃疡、增生伴疼痒8年。皮肤科检查:左小腿踝部至膝关节之间见大片界限清楚的红褐色斑块,边缘隆起,表面凹凸不平,呈肉芽肿样或疣状增生,并有溃疡、瘢痕形成或黄色厚痂覆盖,痂皮下有脓性或血性分泌物渗出,味腥臭。皮损组织病理:表皮假上皮瘤样增生,可见慢性肉芽肿样改变,真皮内大量中性粒细胞、淋巴细胞、浆细胞和组织细胞混合浸润,形成微脓肿,PAS染色其内可见成簇棕色厚壁孢子。取真菌培养菌落聚合酶链反应(PCR)扩增及r DNA ITS区测序鉴定为Fonsecaea monophora。诊断:Fonsecaea monophora所致着色芽生菌病。     

Epithelioid cell histiocytoma with underlying artery damage

Although epithelioid cell histiocytoma is considered a variant of fibrous histiocytoma (dermatofibroma), the histogenesis of this condition remains controversial. A recent investigation suggested the possibility that epithelioid cell histiocytoma is an angioformative fibrous histiocytoma. We report a case of epithelioid cell histiocytoma underlying a damaged artery. This epithelioid cell histiocytoma with a central area of hemorrhage was associated with a medium-sized artery in the reticular dermis running vertically up to the lesion. Both the artery in the reticular dermis and its centrally branched artery in the subcutaneous tissue showed mural injury and intraluminal epithelioid endothelial proliferation. Immunohistochemically, the labeling rate for each of the antibodies studied in the epithlioid cells was as follows: 40% for Factor XIIIa, 5% for CD34, 20% for factor VIII-related antigen, and 10% for alpha-smooth muscle cell actin. This case may support the view that epithelioid cell histiocytoma is a vascular and angioformative fibrous histiocytoma.     

Lymphoepithelioma-like carcinoma arising in the scar from a previously excised basal cell carcinoma

We report a case of a primary lymphoepithelioma-like carcinoma of the skin (LELCS) associated with scar from a previous excision of basal cell carcinoma. The patient was a 68-year-old female with a 3.0 mm skin-colored pearly papule on her forehead that developed over 2–3 months. The patient had a history of a basal cell carcinoma in the same location, which was completely excised 1 year earlier. A biopsy and subsequent excision of the tumor were performed. The tumor consisted of small islands of large pleomorphic mitotically active epithelioid cells surrounded by a very dense lymphoplasmacytic infiltrate. The tumor was associated with dermal scar. There was no connection of tumor with the unremarkable epidermis. Immunohistochemical examination showed that the epithelioid tumor cells were positive for pan-cytokeratin and epithelial membrane antigen, supporting the morphologic impression of LELCS. The lesion was negative for Epstein-Barr virus. Retrospective review of the original excision specimen confirmed the diagnosis of an ordinary basal cell carcinoma. Forty-five cases of LELCS have been reported to date. We report the first case of LELCS to arise in the scar from an excision of a cutaneous malignancy     

黑素瘤并发晕痣样色素减退斑

报告1例黑素瘤并发晕痣样色素减退斑.患者女,55岁.因左臀部黑色丘疹30余年,出现结节并逐渐增大和色素减退斑2年,破溃、结痂10个月就诊.皮肤科检查:左臀部-2 cm× 3 cm ×0.6 cm暗红色结节,表面破溃、结痂;结节周围绕以1-2 cm宽、边界清楚的色素脱失晕.皮损组织病理检查示真皮中上部境界清楚的肿瘤团块,由多数梭形细胞和部分上皮样细胞组成,免疫组化染色示S-100(+),HMB45(+).诊断为黑素瘤并发晕痣样色素减退斑.     

Intradermal Spitz nevus differentiated from reticulohistiocytic granuloma by immunoreactivity to S-100 protein

A firm, dark reddish, smooth surfaced nodule on the forearm of a 16-year-old boy was diagnosed as a Spitz nevus with the aid of a strong positive reactivity to S-100 protein. Histological examination revealed an intradermal epithelioid cell tumor with prominent multinucleated giant cells, suggesting the diagnosis of reticulohistiocytic granuloma. However, immunoperoxidase staining of the tumor cells showed strong positive reactivity to S-100 protein and vimentin; it was negative for lysozyme and alpha-1 antitrypsin. Although a few melanosomes in the tumor cells seen in electron microscopic examination provided crucial proof for the diagnosis of Spitz nevus, the positive reactivity to S-100 protein in ordinary formalin-fixed, paraffin-embedded tissues proved to be very useful in the differentiation of Spitz nevus from tumors of histiocytic origin, especially those of the mononuclear phagocytic system.     

上皮样血管肉瘤

报告1例上皮样血管肉瘤.患者男,61岁.头顶部出现褐红色斑片1年,额部、双眼睑弥漫分布黄褐色斑片,局部皮肤肿胀半年.曾行外科治疗,疗后局部皮肤萎缩,头发稀少.经皮损组织病理及免疫组化染色证实为上皮样血管肉瘤.     

Primary cutaneous Langerhans cell sarcoma without Birbeck granules: indeterminate cell sarcoma?

An 88-year-old white male presented with a rapidly growing skin nodule on the scalp. Clinically, the nodule did not appear unusual for an ordinary cutaneous neoplasm on sun-exposed skin of an elderly white male. Histopathological examination showed sheet-like epithelioid tumor cell growth with a vaguely nested pattern and frank malignant features, resembling malignant melanoma. However, the tumor cells possessed irregularly convoluted nuclei with nuclear groves, frequent multinucleation and fine vesicular cytoplasm, features highly suggestive of histiocytes. Immunohistochemistry studies showed that the tumor cells were diffusely positive for S-100 protein and CD1a and negative for HMB-45, Melan-A, cytokeratin and CD30. The provisional diagnosis of Langerhans cell sarcoma was thus favored. To confirm this diagnosis, electron microscopic examination was performed. Although classic features of histiocytes were readily identifiable, no Birbeck granules could be found upon a thorough search on repeated sections. These results are indicative of the indeterminate cell nature of the tumor. We propose a diagnosis of primary cutaneous indeterminate cell sarcoma for this unusual histiocytic neoplasm. Current classification of histiocytic neoplasms and differential diagnosis are reviewed.     

Multiple cutaneous fibrous histiocytomas in association with systemic lupus erythematosus

Cutaneous fibrous histiocytomas are usually regarded as superficial lesions and commonly known as dermatofibromas; however, unusual cases histologically showing fibrohistiocytic proliferation extending into the deeper dermis or subcutaneous tissues are occasionally experienced. Some authors propose this type as benign fibrous histiocytoma of the skin, distinct from dermatofibroma. We describe herein a case of systemic lupus erythematosus (SLE) who developed multiple nodules on the face, trunk and extremities. The nodule on the forehead did not present a typical clinical appearance of dermatofibroma, and histopathological examination showed fibrohistiocytic proliferation with a storiform pattern extending into the deep dermis and subcutaneous tissues. By contrast, histology of the nodule on the abdomen showed fibrohistiocytic proliferation confined to the dermis and compatible with dermatofibroma. Although multiple dermatofibromas are occasionally seen in patients with SLE, benign fibrous histiocytoma of the skin showing deeper invasion than dermatofibroma is rarely associated with SLE.     

Epithelioid Cell Histiocytoma with Granular Cells

Epithelioid cell histiocytoma (ECH) is regarded as a variant of fibrous histiocytoma. It is not readily recognized as fibrous histiocytoma because of its unconventional histologic features and its resemblance to Spitz nevus. The ECH reported herein was from a 50‐year‐old man who presented with an asymptomatic, 1.5 cm, polypoid mass of unknown duration on his posterior shoulder. Histologic examination revealed epidermal collarette and dermal sheets of epithelioid cells with granular cytoplasm. Both fine and coarse granules were noted in the cytoplasm. They were PAS positive and diastase resistant. Many dilated vessels were also noted in the lesion. A panel of immunostains including S100, vimentin, CD68, and factor 13A was done. The lesional cells were reactive with vimentin, CD68, and factor 13A, and non‐reactive with S100. These results favored exclusion of Spitz nevus and granular cell tumor, and supported the histologic impression of ECH. Both fine and coarse cytoplasmic granules were reactive with CD68. The latter finding supports that the cytoplasmic granules in this ECH represent lysosomes as in granular cell tumors.     

转移性上皮样肉瘤

报告1例转移性上皮样肉瘤。患者女,22岁,因右踝部结节10年,溃疡3个月余,发热伴右腹股沟区包块,疼痛1个月就诊,溃疡边缘皮肤组织病理检查示皮下大片状坏死,周边可见异形上皮样细胞增生;免疫组化染色结果示AEI/AE3（＋）,CD68（＋）,EMA（＋）,波形蛋白（＋＋）诊断为上皮样肉瘤,右腹股沟肿瘤组织病理检查示大片状坏死,可见肉瘤细胞,免疫组化染色结果示肌球蛋白（＋）,余与皮损检查结果相同。诊断为转移性上皮样肉瘤。     

Cutaneous balloon cell dermatofibroma (fibrous histiocytoma)

Dermatofibroma (DF) or cutaneous fibrous histiocytoma is a common benign skin tumor that exhibits multiple, distinct histologic variants. Although clear cell DF has been described in the literature, balloon cell degeneration causing a clear cell DF phenotype has been not been reported to date. Herein, we describe the clinicopathologic findings of balloon cell DF arising on the heel of a 43-year-old man. Clinically, it presented as enlarging tan-white, ulcerated, firm 1.5 cm nodule, clinically suspected to be pyogenic granuloma. Excisional biopsy revealed a circumscribed fibrous tumor populated by mostly clear and spindle cells. A zonal arrangement separated the varied tumor cells where the most superficial, polypoid area showed large, clear polygonal balloon cells; the mid-dermal zone demonstrated a transition between balloon cells, epithelioid cells, and spindle cells; and the deep dermal zone had storiform arrangement of spindle cells, with the fascicles separated by coarse collagen bundles. A CD10+ > CD68+ > Factor XIIIa+ immunophenotype was identified with negative immunolabeling for S-100 protein, HMB-45, cytokeratin AE1/AE3, desmin, smooth muscle actin, lysozyme, and leukocyte common antigen (LCA). Ultrastructurally, the clear tumor cells were filled with multiple, empty, nonmembrane bound vacuoles of varying size. No recurrence has been described after complete excision and 7 months of follow up. DF with balloon cell change, likely secondary to persistent irritation, should be added to the differential diagnosis of cutaneous primary and metastatic neoplasms showing balloon cell degeneration such as balloon cell melanocytic nevi and renal cell carcinoma, respectively.