深部穿通性痣

<正>患者男,24岁。主诉:因右手背黑褐色肿物10年,于2013年2月来我院就诊。现病史:患者自10年前无明显原因右手背出现一黑褐色米粒大肿物,无明显自觉症状,并逐渐缓慢增大至黄豆大。患者曾2次于外院诊断为蓝痣,并建议手术切除。既往史及家族史:患者既往体健,家族中无类似疾病患者。体格检查:系统检查均正常。皮肤科检查:右手背一黄豆大黑褐色丘疹,表面光滑,边界清晰(图1),其他部位未见类似皮损。     

深部穿通性痣一例

31岁女性患者,左臀部蓝黑色结节10余年。皮损组织病理示:真皮中下部可见楔形肿瘤团块,深部锥形损害沿血管、神经、毛囊和汗腺向下穿透深达真皮深部;肿瘤团块由梭形及上皮样细胞组成,内有大量色素颗粒,肿瘤细胞无明显异形性。诊断:深部穿通性痣。     

反应性穿通性胶原病1例

患者女,21岁。下肢红斑、丘疹伴瘙痒1个月,无系统疾病。皮肤科检查:双下肢红斑、丘疹,中心有脐凹,内含角质栓。皮损组织病理示:表皮缺如,下方为坏死胶原纤维穿通表皮。诊断:反应性穿通性胶原病。     

获得性穿通性足部溃疡

报告1例获得性穿通性足部溃疡。患者女，66岁，长期嗜酒。双足反复出现水疱及穿通性溃疡，左足内翻畸形，双小腿中段以下浅感觉减退，病程长达44年。足部X线检查发现趾骨骨质吸收和致残性关节病。     

反应性穿通性胶原病1例

患者女,21岁。下肢红斑、丘疹伴瘙痒1个月,无系统疾病。皮肤科检查：双下肢红斑、丘疹．中心有脐凹,内含角质栓。皮损组织病理示：表皮缺如,下方为坏死胶原纤维穿通表皮。诊断：反应性穿通性胶原病。     

获得性反应性穿通性胶原病3例

获得性反应性穿通性胶原病属于穿通性疾病中的穿通性胶原病,其临床表现为中心出现脐凹的丘疹,覆以不易剥脱的痂皮,组织病理学可见表皮局部缺损,痂皮内可见变性的胶原纤维,真皮乳头可见胶原束穿出。本文报道3例获得性反应性穿通性胶原病并对其临床诊断、病理学改变及鉴别诊断进行归纳。     

获得性反应性穿通性胶原病一例

患者男,55岁,躯干、四肢泛发红丘疹伴痒4个月。就诊前4个月,患者因患糖尿病用艾塞那肽（exenatide）治疗后,躯干四肢出现广泛的红丘疹,逐渐增多,伴瘙痒,停药后皮疹未明显好转,遂到中国医学科学院皮肤病医院就诊。既往糖尿病史10年。否认家族中类似病史。体检：一般情况可,各系统检查未见明显异常。皮肤科检查：躯干、四肢见广泛针尖至绿豆大红色、红褐色丘疹,表面环状脱屑,部分丘疹中央见角栓或脐凹,可见Koebner现象（图1）……     

反应性穿通胶原病1例

患者女性,52岁,表现为四肢散在有脐凹的角化性丘疹,有的中央有角栓。组织病理示胶原束以垂直方向穿通表皮。     

播散性Spitz痣3例

Spitz痣又称梭形和上皮样细胞痣(spindle cell and epithelioid cell nevus),是一种后天发生的良性黑素细胞增生性疾病,在组织病理上容易与黑素瘤混淆.本病多发生于儿童和青少年的颜面部和四肢,通常表现为后天发生的单发丘疹.多发性Spitz痣较为罕见,根据其临床皮损形态和分布的不同又分为簇发性Spitz痣和播散性Spitz痣.现将笔者诊断的3例播散性Spitz痣临床及组织病理特点报告如下.     

匐行性穿通性弹力纤维病1例

患者男 ,15岁。面颊部出现丘疹 ,呈环状排列 ,匐行性向外扩展 ,无明显自觉症状。组织病理具有典型的匐行性穿通性弹力纤维病的特征     

Deep penetrating (plexiform spindle cell) nevus

This report describes 41 patients with lesions similar to those previously termed "deep penetrating" or "plexiform spindle cell" nevus (DPN). DPN occurs primarily during the first four decades, is somewhat more common in females, and has a predilection for the face, trunk, and proximal extremities. It is usually less than 1 cm in diameter and often shows variegation in color, including shades of brown, blue, and black, that create clinical concern regarding malignant melanoma. None of the present tumors nor those from the literature recurred following excision. Microscopically, DPN usually has a wedge shape, invariably involves reticular dermis, and may penetrate subcutis. Involvement of neurovascular structures and adnexae and spread between fibers of the reticular dermis create a fascicular-plexiform architecture. The melanocytes are fusiform or epithelioid, lightly to moderately pigmented, and exhibit mild to focally prominent nuclear atypia. Sparse to abundant melanophages are characteristic. Mitotic figures are few and present in only a small minority of lesions. The present study of a consecutive series also indicates that DPN is a frequent participant in combined nevus, as it was associated with ordinary nevus in two-thirds of the lesions.     

Pure apocrine nevus: a report of 4 cases

Apocrine nevus is a rare tumor composed of increased mature apocrine glands and ductal structures within a fibrous stroma, located predominantly in the reticular dermis. They have been reported in association with apocrine carcinoma, extramammary Paget disease, and syringocystadenoma papilliferum; less commonly a pure apocrine nevus is identified, unassociated with another apocrine proliferation. Clinically apocrine nevi may appear as solitary or multiple nodules or plaques on the scalp, presternal skin, though they are seen most commonly in the axillae. We describe 4 cases of pure apocrine nevus, all of which appeared clinically as painless or mildly tender skin-colored axillary masses, 2 of which were bilateral. In each case, the lesions appeared in adulthood, and patients denied knowledge of congenital or childhood presence. Patients denied pruritis, discharge, bleeding, or antecedent trauma. Grossly, the specimens consisted of subcutaneous, multicystic ill-defined nodules. Biopsy showed prominent apocrine glands composed of irregularly columnar luminal cells with eosinophilic cytoplasm arranged in a somewhat organoid pattern filling the reticular dermis and extending into the subcutaneous adipose tissue. The glandular luminal cells displayed decapitation secretion. There was a paucity of pilosebaceous units. In one case, the overlying epidermis was papillomatous. The deepest portion of one specimen had lactational change simulating a lactational adenoma. No atypia was seen in either the glandular structures or the stroma. The adjacent sebaceous and eccrine structures were normal. The histologic features and immunohistochemical profile in relation to other apocrine lesions will be reviewed.     

Malignant blue nevus: a report of eight cases.

Malignant blue nevus is uncommon compared to its benign counterpart and is regarded as a rare form of malignant melanoma. We report the clinical and histological findings in eight cases. Histologically, all eight specimens showed no epidermal involvement and had contained within or were adjacent to portions of blue nevus or cellular blue nevus. Proliferation of bundles of bipolar spindle shaped cells with marked cellular atypia, mitotic figures, foci of necrosis, and inflammatory cell infiltrate were noted. Two of the cases were studied by DNA flow cytometry and the populations of tumor cells were found to be diploid. Two cases have died secondary to metastasis. Although malignant blue nevi may not behave as aggressively as nodular malignant melanoma, they have definite potential to do so and therefore should be removed by wide surgical excision.     

Reed nevus (pigmented spindle-cell nevus): a report of three cases with distinct dermoscopic patterns

Reed nevus or pigmented spindle-cell nevus may mimic cutaneous melanoma; however, its dermoscopic and histopathological characteristics are different. This case report describes three patients with distinct clinical, dermoscopic and histopathological presentations, which were correlated to enable a differential diagnosis to be made between melanoma and Spitz nevus.     

Meyerson痣一例

<正>临床资料患者,男,65岁。因左小腿外侧丘疹60年余,伴瘙痒3个月余于2018年4月9日就诊于我科。患者自诉幼时左小腿外侧出现一绿豆大黑色丘疹,一直未见明显增大,无破溃、渗出、结痂,无瘙痒、疼痛,未给予相应处理。2年前患者无明显诱因躯干、四肢出现红斑、丘疹,部分皮疹融合成片,但左小腿外侧丘疹及其周围未见皮疹,随于当地医院就     

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。     

Meyerson痣一例

报道Meyerson痣一例。患者,女,78岁。右上臂肿块70年,伴红斑瘙痒3个月,皮损组织病理示：轻度角化过度,棘层肥厚,皮突延长,真皮内痣细胞和痣细胞巢,部分呈毛玻璃样,部分增生活跃,有较多淋巴细胞和嗜酸粒细胞为主的炎细胞浸润,有成熟现象,外围血管增生和炎性细胞浸润。诊断：Meyerson痣。