大汗腺囊瘤

报告1例大汗腺囊瘤。患者女,20岁。左眼外眦处出现一米粒大肤色匠疹,渐增大1年,不痒不痛,皮损组织病理榆查：真皮内可见多个扩大的囊腔,囊壁由单层和双层扁平或柱状细胞组成,内层细胞可见断头分泌,外层为扁平或立力。形肌上皮细胞。部分囊壁上皮向囊腔内呈乳头状突起,囊内为少量嗜伊红物质。     

误诊为阴囊湿疹的扁平湿疣1例

报告1例误诊为阴囊湿疹的扁平湿疣。患者男,75岁,因"阴囊扁平丘疹无痛痒2月"就诊。体检:阴囊可见密集紫红色扁平丘疹,部分融合,表面糜烂,肛周可见多个黄豆至花生米大小暗红色、浅红色境界清楚的扁平丘疹。组织病理:鳞状上皮增生伴浅表糜烂,真皮浅层血管扩张,真皮大量单一核细胞为主的炎性细胞浸润。实验室检查TPPA阳性,TRUST 1∶128阳性,HIV阴性。结合临床表现、血清学检查以及皮肤病理活检,诊断为二期梅毒、扁平湿疣。     

原发性皮肤腺样囊性癌

报告1例原发性皮肤腺样囊性癌。患者男,70岁。左大腿伸侧结节伴溃疡2年余。皮肤科检查：左大腿伸侧见一蚕豆大暗红色结节,中央破溃、结痂。皮损组织病理检查：真皮内可见呈巢状排列的筛状、腺管状生长肿瘤,瘤细胞呈单一形态的基底样细胞。筛状结构中可见大小不一的微囊,囊腔内可见酸性黏蛋白,腔壁衬以扁平的上皮细胞。诊断：原发性皮肤腺样囊性癌。     

乳房外Paget’s病伴多发转移

患者男,71岁。阴囊右侧皮肤肿物1年余,阴囊水肿1个月。皮肤科检查：阴囊右侧可见5 cm×4 cm乳头瘤样增生性肿块,界限清楚,中央潮红、糜烂,伴白色分泌物,部分区域上覆秽黄色厚痂及米粒至绿豆大薄壁水疱,触之易出血,基底及周围有浸润感,质硬,阴阜可见散在米粒大浸润性暗红色丘疹,阴囊及阴茎明显水肿。皮损组织病理：表皮内Paget细胞团,真皮内可见浸润的肿瘤细胞,免疫组化示细胞角蛋白（CK）7及巨囊性病液体蛋白（GCDFP）-15阳性,CK20阴性。辅助检查：PET-CT示左颈部淋巴结、双肺门、纵膈、腹膜后、盆腔及左髂骨转移可能。诊断：乳房外Paget’s病伴多发转移。治疗：至成形科行右侧阴囊病变扩大切除、左侧腹股沟淋巴结部分清扫术,目前正在术后放疗中。     

易误诊的二期梅毒一例

患者,男,34岁。左鼻孔、阴囊起无痛性丘疹、结节2个月。皮肤科检查：左鼻孔见一枚黄豆大丘疹,阴囊根部可见一蚕豆大结节。临床诊断为肿瘤,予手术切除。术前血液常规检查示：TPPA≥1∶2560;TRUST:1∶4;TPAB-ELISA:阳性。阴囊结节活检病理示表皮突增生延长,表皮内可见角化物,真皮浅层可见包含大量浆细胞的炎细胞浸润巢,诊断为二期梅毒。     

乳房外Paget病3例

3例乳房外Paget病患者,均为男性,年龄范围69~84岁,病程1~2年不等,发病部位均为阴囊部。组织病理检查显示:表皮及毛囊上皮可见单个或成巢的Paget细胞,细胞大,胞浆丰富淡染。符合乳房外Paget病的诊断。     

银屑病合并乳房外Paget病1例

患者男,61岁。有银屑病史30年。阴囊上部、阴茎及阴阜可见不规则浸润性红斑,界限清楚,表面糜烂、渗出、结痂。组织病理检查示:表皮内分散和成团的Paget细胞,细胞大,圆形或椭圆形,胞浆丰富淡染呈空泡状,无细胞间桥,核大深染,核周有空晕。诊断为银屑病合并乳房外Paget病。     

阴茎大汗腺汗囊瘤1例

报告阴茎大汗腺汗囊瘤1例.患者男,23岁.阴茎部出现一米粒大小肤色丘疹渐增大1月余.皮损组织病理学检查示表皮大致正常,真皮内可见一扩大的囊腔,囊壁由1～2层细胞构成,细胞核呈圆形或椭圆形,位于细胞底部,可见明显的顶浆分泌现象,未见囊内容物.诊断:阴茎大汗腺汗囊瘤.予手术完整切除皮损,切缘干净规整,对皮缝合后表面无渗液....     

表皮松解性棘皮瘤一例

患者男,46岁.因阴囊扁平丘疹伴瘙痒2年余,且逐渐增多,于2012年6月10日来我科就诊.曾在外院就诊,诊为股癣,间断治疗未见好转.一周前在外院就诊,拟诊为尖锐湿疣,为明确诊断到我院就诊.患者既往体健. 体检:各系统检查无异常.皮肤科检查:患者阴囊散在12个0.2～0.6 cm大小扁平丘疹,丘疹孤立不融合,顶端扁平,淡褐色或肤色,部分丘疹顶端有少量鳞屑(图1).实验室检查:梅毒血清学检查TPHA阴性,阴囊两侧大的皮损组织病理检查:表皮角化过度,棘层肥厚,表皮上部颗粒变性,透明角质颗粒粗大,颗粒层到棘层上部细胞核周空泡化,真皮浅层血管扩张,血管周围淋巴细胞浸润.     

综合疗法治愈急性泛发性扁平苔藓1例

患者男 ,19岁 ,汽车司机。主诊 :颈双侧、身躯、外生殖器出皮疹瘙痒二月。二月前不明原因的先于双前臂屈侧出数个米粒大紫红或褐红扁平丘疹 ,自觉瘙痒 ,约经数日向上臂及胸腹部蔓延 ,部份密集融合成片。近一月来因工作繁忙 ,睡眠欠佳 ,皮疹突然增多 ,波及全身。平时一般身健 ,无急慢性传染性疾病。家族成员中无类似皮肤病。体查　系统检查无异常发现。皮肤科情况 :颈双侧、胸、腹、背、腰及四肢屈侧为主 ,阴茎包皮、阴囊皮肤可见粟粒至绿豆大小扁平丘疹 ,呈圆形、椭圆形或多角形 ,境界清楚 ,色紫红或暗红 ,散在孤立或密集融合成小片或线条状…     

阴囊多发性表皮囊肿一例

患者,男,19岁。半年前阴囊无明显诱因出现数个丘疹、结节,不断增多、增大。组织病理示:表皮大致正常, 真皮内可见数个大小不一的囊肿,囊壁由内向外分别为颗粒层、棘层和基底层,与表皮结构相似,囊内充满角质样物质。诊断:阴囊多发性表皮囊肿。嘱患者泌尿外科就诊手术切除皮损。     

Idiopathic calcinosis of the scrotum: Histopathologic observations of fifty-one nodules

A 29-year-old man had a 2-year history of multiple, asymptomatic, firm, subcutaneous nodules on the scrotal skin, which sometimes discharged a chalky material. Fifty-one nodules were observed in the histopathologic examination, which revealed, in addition to the typical findings of idiopathic calcinosis of the scrotum, various forms of intact cysts: epidermal (some calcified), pilar (calcified), hybrid (calcified), and indeterminate cysts with diffusely calcified keratinous content and attenuated walls. A mixture of calcified keratinous material and inflammatory infiltrates was detected, with or without remnants of the cyst wall. These findings suggest that idiopathic calcinosis of the scrotum derives from the dystrophic calcification of cysts.     

Cutaneous manifestations and massive genital involvement in Hennekam syndrome

We describe a 16-year-old boy with intestinal lymphangiectasia, lymphedema of the limbs and genitalia, mild mental retardation, and facial anomalies (Hennekam syndrome) and cutaneous lesions. Severe edema in the genital area created a gigantic mass that included the scrotum and penis. Numerous grouped red-violaceous pseudo-vesicular lesions and plaques, as well as verrucous brown papules, were present on the penis and scrotum. The prepuce was hypertrophic, with severe phimosis. Histologic analysis revealed dilated lymphatic vessels lined by a discontinuous layer of flat endothelial cells in the papillary dermis and extending down to the reticular dermis. Dilated blood vessels were also present but no cellular abnormalities were identified. A diagnosis of superficial cutaneous lymphatic malformations was made. To the best of our knowledge, this is the first detailed cutaneous histologic investigation in a patient with Hennekam syndrome. We assume that the onset of cutaneous lesions in our patient was likely triggered by a generalized worsening of his lymphedema.     

阴囊特发性皮肤钙沉着症伴发白癜风1例

患者男,33岁。爬树摩擦后阴囊出现硬结节21年,局部伴白斑6年。硬结节组织病理示:真皮及皮下纤维结缔组织中有多灶性钙沉着颗粒,团块及玻璃样变,HE染色深蓝,颗粒周围可见巨噬细胞和淋巴细胞浸润,符合皮肤钙沉着症,白斑组织病理示白癜风。既往体健,系统检查未见异常。考虑爬树时摩擦、挤压阴囊等不良刺激可能为该例皮肤钙沉着症的诱发因素。白癜风伴发于阴囊特发性皮肤钙沉着症,其相关性有待进一步探讨研究。予手术切除全部结节及白斑,1周后伤口一期愈合。术后2个月时局部除线状切痕外未见异常。     

Eccrine hidrocystoma: two cases of Robinson and Smith types.

Two cases of eccrine hidrocystoma, one of which is a "classic" Robinson type and the other a Smith type, were reported. The walls of both cysts consisted mainly of two layers of flat or low cuboidal epithelial cells with eosinophilic cytoplasm. Immunostaining for S-100 protein was negative in the cells of the cyst wall of the Robinson type and only weakly positive in the inner luminal layer of the Smith type. Electron microscopically, the Smith type showed double-layered cuboidal lining and cell membrane interdigitations as junctions of neighboring cells without any characteristics of the secretory segment of sweat glands, indicating substantial similarity to those of the intradermal portion of the eccrine sweat duct.     

Pigmented epidermal cysts.

There are few reports documenting the presence of melanin or melanocytes in epidermal cysts. One hundred and twenty five epidermal cysts from Indian patients were analyzed for the presence of melanin pigment and their sites were noted. A Masson's Fontana stain and immunohistochemistry for S-100 protein and HMB 45 was performed for localization of melanin and melanocytes within the epidermal cysts. Seventy-nine (63%) of the epidermal cysts showed presence of melanin pigment or melanocytes to a variable extent. Melanin was not present in epidermal cysts occurring along lines of fusion of skin folds during embryonogenesis (e.g., ventral midline, inner canthus, nose, upper lip and in the distal most parts like leg and foot and also scrotum). Ten of the 79 epidermal cysts showed extensive accumulation of melanin pigment and infiltration with melanophages in the cyst wall. Four of these patients gave history of trauma and the follow-up was uneventful in two of them. Pigmentation of epidermal cysts thus follows a definite anatomic pattern and is dependent on the natural skin color. Large amount of pigment accumulation within epidermal cysts occurs after cyst rupture and is not associated with hemochromatosis as was believed in the past.     

阴囊Paget病与湿疹皮损反射式共聚焦显微镜图像对比分析

目的 分析比较阴囊Paget病与湿疹皮损在反射式共聚焦显微镜(RCM)下的影像特征.方法 对5例临床怀疑为阴囊Paget病和5例阴囊湿疹男性患者的皮损进行RCM扫描,再取该处皮损行组织病理检查,对比分析两者RCM图像与组织病理表现.结果 5例Paget病患者,RCM图像可见表皮结构紊乱,正常的蜂窝状结构消失,棘层内可见单个或成巢分布的Paget样细胞.5例阴囊湿疹患者RCM扫描显示棘细胞间水肿,可见网状变性的水疱,偶见脓疱形成.结论 阴囊Paget病RCM影像特征与阴囊湿疹明显不同,应用RCM筛查有利于Paget病的早期诊断.     

Tuberculosis verrucosa cutis of the scrotum

A 13-year-old boy had asymptomatic slowly progressive warty growth on the scrotum for 4 years. Examination revealed a 4 cm x 2 cm keratotic, nontender, indurated plaque on the right side of the scrotum. Histopathological examination of the lesion showed epithelioid cell granuloma with giant cells and lymphocytes in the dermis. Mantoux test was 15 mm x 20 mm. A diagnosis of tuberculosis verrucosa cutis of the scrotum was made. Six months of therapy with INH 150 mg and rifampicin 300 mg daily resulted in complete clearance of the lesion.