巨大毛囊皮脂腺囊性错构瘤

报告1例巨大毛囊皮脂腺囊性错构瘤。患者男,15岁。右臀部丘疹,结节15年。体格检查示右臀部多个大小不一的丘疹及结节、部分融合成硬斑块。组织病理检查示毛囊扩张畸形,其上端为毛囊漏斗部扩张,形成囊性结构,下端为增生的皮脂腺,周围胶原增生硬化,且在真皮浅层及中部可见散在成熟的脂肪组织。诊断：巨大毛囊皮脂腺囊性错构瘤。     

播散性复发性漏斗部毛囊炎

报告1例播散性复发性漏斗部毛囊炎。患者女,26岁。颈背部及上肢丘疹伴瘙痒1年余。皮肤科检查:颈背部及上肢密集均匀分布以毛囊口为中心的肤色粟粒大丘疹,大小一致。皮损组织病理检查:表皮轻度角化过度,基底层色素增加,真皮浅层小血管周围淋巴单核样细胞浸润,小血管略增生,毛囊漏斗部见淋巴细胞浸润,海绵水肿。诊断:播散性复发性漏斗部毛囊炎。口服维生素A,配合外用维A酸,治疗效果良好。     

毛囊皮脂腺囊性错构瘤

<正>患者女,43岁。主诉:右枕后结节20年余,渐增大。现病史:患者20多年前右枕后无明显诱因出现一小米粒大、肤色丘疹,无自觉症状,多年来未予诊治,皮疹渐增大呈蘑菇状,表面较平滑,偶有黏稠伴异味分泌物排出。既往史:既往体健,家族成员中无类似疾病患者。体格检查:一般情况好,各系统检查无异常。实验室及辅助检查:血、尿常规和肝、肾功能均正常。皮肤科检查:右枕后见一枚蚕豆大、带细蒂结节,质地中等,表面较平滑,无红肿、破溃、血痂,可见小凹陷和毛发贯穿(图1),挤压无分泌物排出,周围无红肿、浸润。皮损组织病理学检查:真皮内较多的毛囊皮脂腺囊性结构,皮脂腺小叶大量增生呈放射状排列,毛囊漏斗部扩大、畸形,毛囊周     

类脂蛋白沉积症

患者女,21岁,全身丘疹、水疱、口腔溃疡伴声音嘶哑20余年.皮肤专科检查见面颈、躯干上部、双肘关节伸侧皮肤增厚,其上见肤色丘疹、斑块以及散在水疱、糜烂、浅表溃疡.皮肤镜检查示:睑缘串珠状丘疹.组织病理检查:真皮浅层血管壁、毛囊皮脂腺周围透明样物质沉积,PAS染色阳性.临床与病理符合类脂蛋白沉积症.     

毛囊丘疹型二期梅毒疹1例

毛囊丘疹型二期梅毒疹１例付兵初浙江省人民医院皮肤科（邮政编码３１００１４）患者女，４２岁，农民。头、颈、双下肢等处暗红色毛囊丘疹１月余。入院前１月先后在头皮散发少数暗红色丘疹，渐及颈项、右腋下及双下肢。自觉微痒及轻度触痛。双手、足掌出现暗红色斑疹，轻...     

小汗腺螺旋腺瘤

<正>患者男,40岁。主诉:右下颌丘疹1年。现病史:患者1年前无明显诱因右下颌出现一肤色丘疹,逐渐增大,于2015年9月28日来我科就诊。既往史、家族史、个人史:无特殊。体格检查:一般情况好,系统检查无异常。皮肤科检查:右下颌可见一约绿豆大肤色丘疹,表面光滑(图1),质软,无明显压痛。皮损组织病理检查:表皮轻度萎缩,真皮内可见界限清楚的嗜碱性细胞团块,周围有纤维结缔组织鞘,可见收缩间隙(图2A),瘤     

前额纤维化性脱发二例

例1女,44岁,额颞部发际线后移4年,面部多发性肤色小丘疹2年.皮肤科检查:额颞部发际线后移,局部皮肤光滑菲薄,可见残存的细小毛发;眉毛、腋毛和阴毛部分脱落;额颞部、双下颌角处可见弥漫性分布许多粟粒大小的肤色小丘疹.皮肤镜下可见毛囊开口数减少,毛发直径不一,瘢痕性白斑和毛囊周围红斑.例2女,55岁,额颞部毛发稀少2年.皮肤科检查:双侧额颞部发际线后移,眉毛、腋毛和阴毛部分脱落.2例患者的组织病理检查均可见毛囊周围以淋巴细胞为主的浸润,基底细胞液化变性,毛囊周围有板层状纤维化.2例患者的临床和组织病理表现均符合前额纤维化性脱发的诊断.     

毛囊粘蛋白病1例

报告1例以毛囊性丘疹为表现的毛囊粘蛋白病。患者男,46岁,颈、背、双上肢密集帽针头大小毛囊性丘疹半年,无疼痛、瘙痒,渐增多,部分浸润增厚。皮肤组织病理检查示:毛囊上皮细胞轻度水肿,真皮毛细血管及毛囊周围淋巴细胞、组织细胞浸润,阿新蓝染色见毛囊上皮细胞内及毛囊周围粘蛋白沉积。经美卓乐,甲状腺素治疗两个月后,皮疹消退,目前该患者仍在随访当中。     

痤疮样痣1例

临床资料 患者女,29岁.因右侧颈后毛囊性丘疹20余年,突然增大半年,于2008年3月来我院就诊.自幼年右颈后出现正常肤色的丘疹,群集分布,每个丘疹中央毛囊口扩大并有黑色、坚硬的角栓.     

顶泌汗腺性痒疹1例

正1临床资料患者女,27岁,双侧腋窝皮疹伴痒3年。3年前患者双侧腋窝出现数个肤色、毛囊性丘疹,偶有痒感,未进行任何治疗,后出现间歇性瘙痒,皮疹数量逐渐增加。1个月前,皮疹增多明显,瘙痒加剧,尤以高温、神经紧张、出汗或月经来潮前明显。患者既往体健,无相关疾病家族史。皮肤科情况:双侧腋窝可见多发的、圆顶的、肤色毛囊性丘疹,直径1 mm,表面光滑,孤立分布,未见融合,双侧腋窝毛发稀疏,周围皮肤正常(图1)。腋窝皮疹组织病理示:表皮     

Acne keloidalis. Transverse microscopy, immunohistochemistry, and electron microscopy

The earliest stages of acne keloidalis are not well characterized. In the present study, transverse sections of the early lesions revealed follicular units in several stages of inflammation. These follicles surrounded the central follicular units that gave rise to the clinically evident papule. Despite a spectrum of inflammatory changes, the most marked inflammation consistently occurred in the deep infundibular and isthmian levels of the hair follicles. Two follicles, presumably in the earliest stage, exhibited primarily an acute folliculitis and perifolliculitis, with destruction of the follicular wall and the release of hair. Central follicles showed predominantly acute neutrophilic or chronic lymphocytic inflammation at the upper isthmian levels and granulomatous inflammation at the deeper isthmian levels. Other follicles showed scar at the isthmian levels trapping hair fragments in the inferior portion of the follicle, with granulomatous inflammation and scarring. Sebaceous glands were absent in all stages of folliculitis in seven of eight follicular units.     

Hair Follicle Nevi and Accessory Tragi: Variable Quantity of Adipose Tissue in Connective Tissue Framework

Abstract: Controversy exists about the histologic differences between hair follicle nevi and accessory tragi. We examined 10 congenital lesions histologicaiiy, possible diagnoses of which were hair follicle nevi or accessory tragi. Two specimens out of the 10 had tiny, mature hair follicles surrounded by thick fibrous root sheaths, a few fat cells, and no cartilage. The subcutaneous fat cells of their bases were segmented by a connective tissue framework. They had histologic features of hair follicle nevi. One specimen had cartilage and abundant fat cells with a connective tissue framework in the nodule, as well as a conglomeration of numerous well-differentiated hair follicles. It possessed both elements of a hair follicle nevus and an accessory tragus. Seven specimens had abundant subcutaneous fat and showed a prominent connective tissue framework. These were typical accessory tragi. The present study suggests that the number of fat cells in the nodule or papule differs between these two conditions. All the lesions studied revealed a connective tissue framework in the subcutaneous fat. Histologic features of both hair follicle nevi and accessory tragi can coexist in a single lesion. Hair follicle nevi may represent incomplete accessory tragi with scant fat cells.     

Nestin expression in stromal cells of trichoblastoma and basal cell carcinoma

Background Both trichoblastoma and basal cell carcinoma (BCC) are considered to be a benign and malignant neoplasm of follicular germinative cells respectively. A recent investigation revealed that the mesenchymal cells in the perifollicular sheath and evolving follicular papilla of embryonic hair germs and those cells in hair follicles in early anagen express nestin. Objective The aim of the present study was to investigate whether trichoblastoma and BCC recapitulate the epithelial–mesenchymal interactions in embryonic hair germs or early anagen hair follicles by expressing nestin in stromal cells. Methods Immunohistochemical staining was performed with antibody against nestin for 15 trichoblastomas including large/small nodular, retiform and trichoepithelioma types, while adding the superficial type associated with nevus sebaceous and for 20 BCCs including superficial, nodular, nodulo‐infiltrative, and infiltrative/micronodular types. Results In all 15 trichoblastomas, the stromal cells expressed nestin with variable positive reactions, except for superficial trichoblastomas within nevus sebaceous lesions, in which stromal cells were constantly positive for nestin. In all 20 BCCs, the stromal cells were basically negative for nestin. Conclusions The development of trichoblastomas incompletely recapitulates the epithelial–mesenchymal interactions in embryonic hair germs or early anagen hair follicles, whereas BCCs fundamentally have lost this ability. Among the various types of trichoblastomas, the superficial type associated with nevus sebaceous was found to have the most similar character to either embryonic hair germs or early anagen hair follicles.     

Warty Dyskeratoma Involving Two Adjoining Follicles

Warty dyskeratoma (WD) is a rare epidermal tumor that frequently arises as a papule or nodule on the head or neck of middle-aged or older persons. Histologically, it shows a cup-shaped keratin-filled invagination of an acanthotic epidermis, suprabasilar clefting with villi projecting into the clefts and acantholytic dyskeratotic cells are also present. The changes almost always involve a single hair follicle. We describe a distinctive case of WD that showed involvement of two adjoining follicles within a solitary lesion.     

Ber-EP4 antigen is a marker for a cell population related to the secondary hair germ

Ber-EP4 is an antibody to a cell membrane glycoprotein of unknown function. In the skin, Ber-EP4 immunoreactivity has been reported to be localized in structures composed of basaloid epithelial cells, i.e. fetal epithelial germ cells, basal cell carcinoma, and trichoepithelioma as well as eccrine or apocrine ducts. In this study, we further characterized the follicular expression of Ber-EP4 immunoreactivity at different stages of the hair cycle of human terminal hair follicles. In addition, to clarify the location of Ber-EP4(+) cells, we compared the Ber-EP4 immunoreactivity with the expression of keratin 15 and keratin 19. Positive staining by Ber-EP4 was found in the lower part of the epithelial strand of late catagen hair follicles, in the secondary hair germ of telogen hair follicles, and in the matrix of early anagen hair follicles but not in any parts of mature anagen hair follicles. In contrast, the follicular expression of keratin 15 detected by using LHK15 antibody was restricted to two distinct parts of anagen hair follicles, i.e. the outer root sheath above the hair bulb and that of the isthmus including the bulge area, and to the outer root sheath of late catagen and telogen hair follicles. The follicular expressions of keratin 19 and that of keratin 15 were apparently superimposed, whereas keratin 15 expression was more extended. The immunoreactivity of LHK15 antibody and antikeratin 19 antibody against the secondary hair germ of telogen follicles was negative or dim. Our results suggest that Ber-EP4 reacts with the secondary hair germ and possibly a cell population related to the secondary hair germ but not with the presumptive stem cell population as revealed immunohistochemically either by the keratin 15 or keratin 19 expression.     

Solitary Basaloid Follicular Hamartoma

We present a case of solitary basaloid follicular hamartoma of 8 years' duration on the nose of a 55-year-old Japanese man. Clinical examination revealed a solitary, asymptomatic, smooth-surfaced, black papule. Histologically, the lesion showed multifocal proliferation of basaloid cells forming islands, branching cords and anastomosing strands that were continuous with the basal layer of the epidermis. Individual hair follicles were replaced by these undifferentiated basaloid proliferating cells. Some abortive hair folliclelike structures composed of follicular bulbs and contiguous rudimentary dermal papillae were observed. This solitary papular type of basaloid follicular hamartoma is quite rare; our case is clearly distinguished from other neoplasms with hair follicle differentiation as well as from infundibulocystic basal cell carcinoma, which have been the most problematic differential diagnoses in the recent dermatopathologic literature.     

The immunohistochemical expression of CD34 in human hair follicles: a comparative study with the bulge marker CK15

BACKGROUND: Anti-CD34 antibodies label the bulge region of mouse hair follicles. However, in human hair follicles, CD34 immunoreactivity is found in the outer root sheath below the bulge zone. The immunohistochemical staining of CD34 in catagen and telogen follicles has not been evaluated. AIMS: To characterize the expression of CD34 immunoreactivity at different stages of the hair cycle in human terminal hair follicles, and to compare the immunostaining pattern of CD34 with that of CK15, used here as a marker of the bulge region. METHOD: Serial vertical sections of human hair follicles in anagen, catagen and telogen phases were immunostained with anti-CD34 (QBEnd 10) and anti-CK15 (LHK15 and C8/144B) antibodies. Double-labelling immunofluorescence was also performed. RESULTS: The catagen and telogen follicles studied did not show CD34 immunoreactivity in the outer root sheath. The location of CD34 and CK15 immunoreactivity in anagen follicles reveals a different staining pattern: CD34-positive cells are located in the outer root sheath below the attachment zone of the arrector pili muscle, whereas CK15-positive cells are located in the outer root sheath above the attachment zone of the arrector pili muscle. CONCLUSIONS: Only anagen human hair follicles show CD34 immunoreactivity. CD34 and CK15 recognize different types of cells or cells at different stages of differentiation.     

Hair follicle stem cell marker nestin expression in regenerating hair follicles of patients with alopecia areata

Cells that are nestin positive and keratin 15 (K15) negative are located in the hair follicle pluripotent stem cell (hfPS) area (hfPSA). The hfPSA is located within the root of the sebaceous glands, in a region just above the hair follicle bulge area. In the current study, we investigated the expression pattern of the stem cell marker nestin in the hair follicle cycling of patients with alopecia areata. In the normal human scalp, the majority of hair follicles are in the anagen phase of development. While it is often difficult to identify nestin expression in late anagen phases, nestin-expressing cells are easily identified in proliferating cells located in the hfPSA of the growing early and middle anagen phase hair follicles. In patients exhibiting alopecia areata, the middle anagen hair follicles with growing cells were found to be nestin positive and K15 negative. In contrast, the hair follicles undergoing degradation in alopecia areata patients demonstrated lymphocytic infiltration within the nestin- and K15-negative dermal papilla cells. Both the nestin-positive hfPSA and K15-positive hair follicle bulge areas were not damaged in all phases. In addition, the regenerating early anagen hair follicles demonstrated nestin-positive and K15-negative cells within the dermal papilla and in the area surrounding the hair bulb. These results suggest that the nestin-positive cells play an important role not only in the hfPSA, but also in the dermal papilla in the regenerating hair follicle.     

Fibrofolliculoma/trichodiscoma and fibrous papule (perifollicular fibroma/angiofibroma): a revaluation of the histopathological and immunohistochemical features

Background: The multiple facial lesions of fibrofolliculoma (FF)/trichodiscoma (TD) and those of fibrous papule (FP; perifollicular fibroma/angiofibroma, AF) are characteristic of Birt-Hogg-Dubé (BHD) syndrome and tuberous sclerosis, respectively. However, there was a recently reported case of BHD syndrome with multiple facial FP lesions and a case of tuberous sclerosis, in which one FF lesion was included among the multiple facial FPs.
Methods: The histopathological and immunohistochemical features of FF/TD and FP lesions were revaluated to study the relationship between the two. This investigation evaluated 20 FF/TD lesions including two cases of BHD syndrome and 35 FP lesions including three cases of tuberous sclerosis.
Results: There are common histopathological features in the two lesions, such as the follicular and perifollicular elements, an angiofibromatous element and stellate fibrocytes. The similar immunohistochemical features between the two lesions included the expression patterns of CD34, factor XIIIa, nestin and c-kit in the stromal cells as well as abnormal CK15 expression in the hair follicles.
Conclusions: Both FF/TD and FP are hamartomas composed of perifollicular or interfollicular connective tissue and a hair follicular epithelial component, which may be caused by an abnormal functioning of the hair follicle bulge cells.     

Apoptosis in murine hair follicles during catagen regression

Catagen hair follicle involution has been reported to involve apoptosis, although the precise mechanism has not been satisfactorily resolved. Previous studies have involved solely morphological or electron microscopical methods. We report here studies on murine hair follicles during the first postnatal hair cycle conducted using the terminal deoxy-nucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) method. Electrophoresis of DNA isolated from the hair follicles of the same animals was carried out in order to confirm the systematic fragmentation of DNA that typifies apoptosis. On day 10, when all the follicles were growing, there was no evidence of staining with TUNEL in the hair bulbs. Electrophoresis similarly did not show characteristic DNA ladders. By day 15, a few positive cells were observed in the hair bulbs and the numbers had increased by day 17 when many positive cells were seen, especially in the lower portions of the follicles. Electrophoresis demonstrated DNA ladders on days 15, 16 and 17, although the DNA ladder on day 15 was less prominent than that on day 17. These studies confirmed that apoptosis, as identified by techniques that measure DNA fragmentation, occurs in the lower regions of hair follicles towards the end of catagen. Received: 19 March 1997