Th17和Treg细胞与蕈样肉芽肿相关性研究

目的 探讨调节性T（Treg）细胞和Th17细胞在蕈样肉芽肿不同分期中的变化。 方法 流式细胞仪检测28例蕈样肉芽肿、13例大斑块型副银屑病、17例扁平苔藓患者及10例健康对照外周血Treg细胞和Th17细胞百分率,同时应用免疫组化法检测40例蕈样肉芽肿、13例副银屑病、17例扁平苔藓及10例健康对照蜡块组织中叉头状转录因子P3（FOXP3）和白细胞介素17（IL-17）的表达。 结果 蕈样肉芽肿、副银屑病、扁平苔藓患者外周血Treg细胞百分率分别为（8.09 ± 1.68）%,（6.53 ± 1.67）%,（2.84 ± 1.16）%较健康对照［（1.01 ± 0.35）%］升高,差异均有统计学意义。蕈样肉芽肿、副银屑病患者外周血Treg细胞百分率亦高于扁平苔藓（均P < 0.05）;蕈样肉芽肿与副银屑病患者差异无统计学意义（P > 0.05）。外周血Th17细胞百分率在蕈样肉芽肿较副银屑病、扁平苔藓患者比健康人升高［（3.22 ± 0.82）%比（2.46 ± 0.79）%,（1.38 ± 0.47）%和（0.59 ± 0.30）%,均P < 0.05］。FOXP3阳性率在蕈样肉芽肿、副银屑病及扁平苔藓均高于正常皮肤组织［（14.94 ± 4.46）%,（11.95 ± 4.72）%,（6.32 ± 2.81）%比（3.43 ± 1.79）%,均P < 0.05］,蕈样肉芽肿及副银屑病比扁平苔藓高（均P < 0.05）,蕈样肉芽肿比副银屑病差异无统计学意义（P > 0.05）。IL-17阳性率在蕈样肉芽肿、副银屑病、扁平苔藓和正常组织中分别为（15.89 ± 4.27）%,（12.02 ± 3.34）%,（4.84 ± 1.93）%和（2.62 ± 0.89）%,其中,蕈样肉芽肿均高于副银屑病、扁平苔藓组织及正常组织（均P < 0.05）。蕈样肉芽肿、副银屑病外周血Th17/Treg细胞比率比扁平苔藓、健康对照低（0.41 ± 0.11,0.39 ± 0.12比0.50 ± 0.06,0.57 ± 0.19（均P < 0.05）。早期蕈样肉芽肿Th17细胞与Treg细胞呈正相关（r = 0.423,P < 0.05）,肿瘤期蕈样肉芽肿Th17细胞有所下降,而Treg细胞继续升高,但蕈样肉芽肿各期差异无统计学意义,且二者在肿瘤期无相关性。 结论 Treg和Th17细胞失衡可能参与了蕈样肉芽肿的发生与发展。     

肉芽肿性蕈样肉芽肿

1病例资料 例1,男,72岁,因躯干和四肢出现淡红色或淡灰白色斑片3年,于1994年8月10日就诊就于我科。1991年初患者躯干和四肢陆续出现淡红色或淡灰白色斑片,表面有少量鳞屑,不痒。既往体健,无外伤和传染病史。     

肉芽肿性蕈样肉芽肿

患者女,57岁.皮肤出现红斑4年,结节半年.皮损组织病理检查示:表皮轻度萎缩,Pautrier微脓肿形成,真皮大片状单一核细胞和组织细胞为主浸润,呈肉芽肿样改变.免疫组织化学染色显示LCA(+),CD2(+),CD3(+),CD4(+),CD8部分阳性,CD45Ro(+),CD68部分阳性,CD20(-).诊断为肉芽肿性蕈样肉芽肿.     

肉芽肿性蕈样肉芽肿

报告1例肉芽肿性蕈样肉芽肿。患者男,41岁。因全身起红斑、丘疹、结节6年,左侧眉毛脱落2个月就诊。皮损组织病理检查:表皮大致正常,真皮内可见大量淋巴细胞、组织细胞、多核巨细胞浸润,部分淋巴细胞核有异形。免疫组化染色示:淋巴细胞CD3、CD5、CD4阳性,组织细胞及多核巨细胞CD68阳性。结合临床和组织病理表现,诊断为肉芽肿性蕈样肉芽肿。     

肉芽肿性蕈样肉芽肿

报告1例肉芽肿性蕈样肉芽肿。患者女,49岁。因躯干及四肢红斑、斑块1.5年,间断发热半个月就诊。皮损组织病理:表皮萎缩变薄,真皮内片状密集分布淋巴细胞、组织细胞及多核巨细胞,部分淋巴细胞核异形,真皮内可见肉芽肿病变。免疫组化:淋巴细胞CD3、CD4、CD5阳性,CD8散在阳性,组织细胞CD68阳性,T细胞样受体(TCR)基因克隆重排:TCRγ重排+。诊断:肉芽肿性蕈样肉芽肿。     

儿童肉芽肿性蕈样肉芽肿

报告1例儿童肉芽肿性蕈样肉芽肿.患儿男,14岁.自6岁起头皮开始出现脓疱,并逐渐脱发,形成浸润性红斑,近年来耳前及左胸部亦出现类似红斑.皮损组织病理检查见典型的表皮内Pautrier微脓肿、异形淋巴细胞浸润及真皮内肉芽肿改变.高倍镜下可见异形淋巴细胞.免疫组化染色显示CD3、CD45RO阳性.诊断:肉芽肿性蕈样肉芽肿.推荐外用糖皮质激素,补骨脂素长波紫外线(PUVA),维A酸及α-干扰素治疗.     

肉芽肿性蕈样肉芽肿一例

患者男,42岁.因全身皮肤红斑鳞屑10年,结节、肿瘤8年于2004年8月就诊.10年前患者无明显诱因背部出现一鱼鳞病样斑片,无自觉症状.1个月后,胸背部皮肤出现片状淡红斑,微痒,并逐渐扩展至头面部、颈、四肢,呈弥漫性,红斑上有细小糠状鳞屑.在当地医院多次按湿疹治疗无明显好转.     

肉芽肿性蕈样肉芽肿1例

1 病历摘要 患者男,69岁.因全身皮肤出现红斑、斑块、破溃及愈合后色素沉着16年,于2011年6月来我所就诊.16年前无明显原因患者双下肢出现暗红斑,同时膝关节内侧出现暗红色结节、溃疡,约3个月余自行愈合,留有色素沉着,后皮损缓慢蔓延至全身,无自觉症状.曾诊断"肉样瘤",未进行系统治疗.近1年来左额部及右肩背部出现暗红斑块,并破溃结痂,未愈合,自觉疼痛.     

蕈样肉芽肿

1 临床资料 患者男,70岁.因全身红斑、斑块,伴瘙痒7年,加重3个月就诊.7年前无明显诱因患者双髋及胸部出现许多红斑,伴剧烈瘙痒,以夜间为甚.皮损逐渐增多,累及躯干、四肢,在当地医院诊断为湿疹,予以中药口服及糖皮质激素外用,皮损可部分缓解,但不能完全消退.3个月前无明显诱因皮损突然增大、增多,泛发全身,自觉剧烈瘙痒,遂就诊于我科.患者自发病以来无发热,精神及食欲好,两便正常,体重无明显改变.2年前因胃溃疡在外院行胃大部切除术.     

肉芽肿性蕈样肉芽肿一例

肉芽肿性蕈样肉芽肿(granulomatous mycosis fungoides,GMF)是蕈样肉芽肿(MF)的一种特殊的病理类型,其肉芽肿形成的病因学、发病机制及临床意义尚不清楚．预后也有争议。该病临床罕见．现遇一例报道如下。     

Small malignant melanoma in patients with mycosis fungoides

An increased risk for a second malignancy has been reported in patients with mycosis fungoides. We describe two subjects with mycosis fungoides who developed small malignant melanoma after topical application of nitrogen mustard.     

异维A酸联合放疗治疗9例蕈样肉芽肿

应用异维A酸 0 75mg/(kg·d) ,结合浅层放射治疗 9例蕈样肉芽肿患者 ,其中 6例为斑块期 ,3例为肿瘤期。每例患者照射总剂量为 16GY。治疗 2个月后 8例患者 90 %的皮损痊愈 ,结节损害由平均 11个减为 1个。此联合疗法与单独口服异维A酸或放射治疗相比 ,可缩短疗程、减少剂量 ,且副作用小。     

Follicular mycosis fungoides: presentation of a case and review of the literature

Follicular mycosis fungoides is a rare variant of mycosis fungoides (MF). Structural-wise there are several acneiform lesions made up of comedones, cysts and hyperkeratosis. The main histological finding is atypical lymphocytic infiltration around follicular structures, without epidermotropism. The association with follicular mucinosis is widely discussed in the literature. We report a case of follicular (MF) and review the cases published to date.     

Evaluation of cardiovascular disease risk factors in patients with mycosis fungoides

BACKGROUND

Mycosis fungoides, the most common subtype of cutaneous T-cell lymphoma, is more common in patients aged 45-55.

OBJECTIVE

Cardiovascular risk factors have been investigated in several skin diseases. However, the relation between cardiovascular diseases and mycosis fungoides remains unclear. Therefore, the aim of this study was to assess cardiovascular risk factors in patients with mycosis fungoides.

METHODS

32 patients with mycosis fungoides and 26 healthy controls were enrolled in the study. Glucose, total cholesterol, high-density lipoprotein cholesterol, triglyceride, homocystein, high sensitivity C-reactive protein, low-density lipoprotein – cholesterol, were measured in the sera of patients.

RESULTS

Patients had significantly higher high-sensitivity C-reactive protein, homocysteine, low-density lipoprotein - cholesterol, total cholesterol (p= 0.032) (p< 0.001) (p= 0.001) (p< 0.001). There was a positive correlation between the levels of homo-cysteine and total cholesterol (p= 0.001, r = +0.431). Additionally, a significantly positive correlation was found between the levels of high-sensitivity C-reactive protein and low-density lipoprotein - cholesterol (p= 0.014, r = +0.320) in patient group.

CONCLUSIONS

Patients with mycosis fungoides had significantly higher levels of total-cholesterol, low-density lipoprotein -cholesterol, homocysteine and high-sensitivity C-reactive protein than healthy subjects. The present study has demonstrated an increased rate of cardiovascular risk in patients with mycosis fungoides. Even though the etiology of these associations is elusive, dermatologists should be sensitized to investigate metabolic derangements in patients with mycosis fungoides, in order to lessen mortality and comorbidity with a multidisciplinary approach.     

Further similarities between Sézary syndrome and mycosis fungoides

Summary Sézary syndrome and mycosis fungoides, both malignant Non-Hodgkin lymphomas, although characterized as specific entities, show a close relationship. This is based on striking similarities not only with respect to morphological, cytophotometrical, cytogenetical and immunological findings, but also with respect to a typical common reaction pattern to photochemotherapy.     

窄谱中波紫外线治疗早期蕈样肉芽肿的疗效观察

目的 探讨窄谱中波紫外线(NB-UVB)治疗早期蕈样肉芽肿(MF)的安全性及有效性.方法 19例患者中,男9例,女10例;年龄20～71岁,平均42.6岁,经组织病理检查证实为MF早期,临床分期ⅠA～ⅠB17例,ⅡA2例.每周NB-UVB照射2～3次,随访1～18个月.结果 13例完全缓解,5例部分缓解,1例无缓解.平均照射次数25.9次,平均累积照射剂量25.6J/cm².主要不良反应为红斑、瘙痒和色素沉着,患者均能耐受.结论 NB-UVB照射对早期MF疗效确切,不良反应较少.     

早期蕈样肉芽肿微小RNA表达谱的研究

目的：筛选与早期蕈样肉芽肿（MF）相关的微小RNA（miRNA ）。方法用高通量miRNA PCR芯片检测6例早期MF与6例湿疹和扁平苔藓皮损中miRNA的表达差异。针对差异表达的miRNA,进行13例早期MF、13例湿疹和扁平苔藓皮损组织及Myla细胞株的实时荧光定量PCR（RT?qPCR）验证。结果芯片结果示,相对于对照组,早期MF hsa?miR?378a?5p、hsa?miR?107、hsa?miR?302c?3p显著高表达,差异有统计学意义（P<0.05）。皮损组织的RT?qPCR验证结果与芯片结果一致。与正常人外周血T淋巴细胞相比,Myla细胞株中hsa?miR?378a?5p、hsa?miR?107显著上调,与芯片结果一致;未见hsa?miR?302c?3p的差异性表达。结论与炎症性皮肤病相比,早期MF存在差异表达的miRNA表达谱。     

Mycosis fungoides and S&eacute;zary syndrome: Role of chemokines and chemokine receptors

Mycosis fungoides is the most common form of cutaneous T-cell lymphoma (CTCL), and is characterized by a clonal expansion of malignant CD4⁺ T lymphocytes with skin-homing properties. Clinically and pathologically, mycosis fungoides can be categorized into patch, plaque and tumor stages. The clinical course of mycosis fungoides is usually chronic and indolent, but a proportion of patients may develop progressive disease with peripheral blood, lymph node and visceral organ involvement. Sézary syndrome is an aggressive leukemic form of CTCL characterized by a clonal population of malignant T cells in the peripheral blood. Various forms of skin-directed and systemic treatments are available for mycosis fungoides and Sézary syndrome. However, current treatments are generally not curative, and can only control the disease. Currently, the etiology and pathogenesis of mycosis fungoides and Sézary syndrome are not well defined. Proposed mechanisms include chronic antigenic stimulation by infectious agents, expression of specific adhesion molecules, altered cytokine production, mutations of oncogenes and tumor suppressor genes, and avoidance of apoptosis. In recent years, a number of chemokine receptors and their corresponding chemokine ligands have been found to contribute to the migration and survival of lymphoma cells in mycosis fungoides and Sézary syndrome, including CC chemokine receptor 4 (CCR4), CCR10, C-X-C chemokine receptor type 4 (CXCR4), CCR7, CCR3 and CXCR3. Since chemokines and chemokine receptors have been found to play important roles in the pathophysiology of mycosis fungoides and Sézary syndrome, they may be potentially useful targets for the development of new treatments for these diseases in the future.