217 麻风病足底溃疡发生鳞状细胞癌一例报告

足底溃疡为麻风病常见并发症。麻木、外伤、受压、感染及畸形为其常见的病因,足底溃疡的恶变甚为罕见,文献报告不多。本文报告1例男性,45岁,左足跟发生足底溃疡一年。麻风病史已15年,临床诊断为瘤型麻风。足底溃疡开始时很小,后渐增大,就诊时为3×3cm。溃疡形态不规则,边缘隆起,外翻且硬。按一般溃疡治疗无效。淋巴结未受累。取自溃疡边缘的活检,组织病理学诊断为分化     

石膏绷带固定治疗麻风溃疡

住院病人5例,男3例,女2例;溃疡均在5年以上,其中小腿下段大溃疡3例,均为18×10cm左右;足底溃疡2例,1例为单纯性溃疡,约3.0×2.0cm,另一例复杂性溃疡合并足外翻。用半靴型石膏快速固定成足底托和足背托,一     

腐植酸钠治疗麻风足底溃疡21例疗效观察

麻风足底溃疡是麻风并发症之一,国内外报导麻风足底溃疡发病率在10％～60％。足底溃疡发生后,轻者引起疼痛,行走困难;并由于重力发生改变,局部麻木使溃疡加重或愈合后易于复发。重者因营养障碍,造成骨质吸收而致足部畸形;以致患者丧失劳动力。更严重者,发生继发感染,引起骨髓炎,危及生命。自1976年以来,已有试用腐植酸钠治疗麻风足底溃疡的报导。我们为了进一步探索腐植酸钠治疗足底溃疡的疗效,于1976年8月、78年6月先后采取不同方法用腐植酸钠治疗麻风足底溃疡21例,现报导如下:     

两例麻风溃疡癌变的报告

例1,男,65岁,1958年诊断为T型麻风。1967年两足发生溃疡,骨吸收,足呈杵状,残端露骨。1984年两小腿骨肿胀、疼痛,残端肉芽呈疣样高起,约20cm,作菜花状,质脆易出血。腹股沟淋巴结肿大,诊断为溃疡癌变,治疗无效死亡。例2,男,70岁,T型麻风。1965年已有足底溃疡,有死骨脱出。1989年元月左足底溃疡出现3×2cm的肉芽疣样增生,质脆易出血。腹股沟淋巴结肿大。以后疣样肉芽外翻呈菜花样,分泌物恶臭。诊断为鳞癌Ⅱ级。     

麻风足底溃疡的癌变

苍山县于1955～1986年共发现麻风足底溃疡癌变者3例。为了解此类癌变的发生率,对全县31年间的1046例麻风进行了调查,结果有5年以上的足底溃疡者66例(6.3％),癌变3例占病人总数的0.28％,占有5年以上溃疡者的4.5％。例l,男,42岁。1955年诊断为T型麻风。1960年右足第五跖骨小头处及跟骨结节处各有1×1及2×2cm的单纯性深溃疡,左足底跟骨结节处有2×3cm的同样的溃疡。1979年6月,右跟骨结节处溃疡扩大至5×5cm,深达跟骨,边缘呈菜花样,渗液多而恶臭。取溃疡边缘组织,病理     

发生于麻风神经营养性溃疡的鳞状上皮癌一例报告

本文报导一79岁女患者.1979年10月因左足底溃疡并发肿瘤而入院.其麻风病于1930年经病理确诊,砜类药物治疗至1952年,病情静止.自1940年有复发性足底溃疡,能愈合,但自1976年以来,两足跖溃疡虽经局部处理及抗菌素治疗,未再完全愈合.入院前9个月,左跖溃疡向外增生甚大,x线片示广泛脱钙.有持续性疼痛,门诊治疗无效而入院.检查见右跖部有一直径0.5cm之浅溃疡.左跖     

皮肤利什曼病

报告1例皮肤利什曼病。患者男,44岁。左上肢及左腹部红斑、丘疹及溃疡伴疼痛10个月。皮肤科检查:左腹部一直径约12 cm斑片,中央可见直径5~6 cm溃疡,表面覆黄色较厚痂壳,可见大量浆液性渗出;左前臂一5 cm×8 cm斑片,中央一手掌大溃疡,表面覆有黑褐色及黄色痂壳,未见明显渗出。皮损组织病理检查:表皮大致正常,真皮浅层可见大量组织细胞浸润,细胞内可见大量利什曼小体样结构。诊断:皮肤利什曼病。     

足底基底细胞癌1例

报告1例足底基底细胞癌.患者男,70岁,右足底皮肤黑色斑片2年.皮肤专科检查:右足底见一 2 cm×3 cm大小的黑色斑片,边界尚清,皮损表面可见一表浅性溃疡,病灶无红肿、渗液,无流血、流脓,无触痛及压痛.皮肤镜检查可见黄白色结构伴少许蓝灰色结构,见个别不典型溃疡伴少许点状血管.皮损组织病理检查可见真皮浅层的基底样细胞...     

足底溃疡性扁平苔藓1例

患者 ,男 ,10岁 ,以右侧足底部溃疡伴疼痛 3月 ,加重半月 ,于 1998年 10月 16日收住我院外科。患者半年前右侧足底部出现皲裂、脱屑及轻度糜烂 ,伴有轻微疼痛。 3个月前 ,糜烂面形成溃疡 ,疼痛加重。半月前溃疡面变大加深 ,疼痛增剧 ,日夜呻吟 ,无法着地行走 ,同时左侧足底对称部位也出现糜烂。曾用过螺旋霉素、皮炎平及高锰酸钾洗液等药。我院外科诊断为“足部溃疡继发感染” ,予头孢曲松钠静滴 1周 ,同时予止痛药及创面换药 ,无效 ,遂转到皮肤科病房。患者以往体质一般 ,家族中无特殊皮肤病史。体检　系统检查无异常 ,浅表淋巴结未触及。…     

综合疗法治疗麻风足底溃疡的疗效观察

麻风足底溃疡是麻风防治工作中常见而又辣手的难题,我们从1994年3月至1997年4月,对12例病人,26处溃疡采用中药、西药外用并教会病员自我保护和自我护理,提供防护鞋和必要手术综合治疗方法,收到了较好疗效。现总结如下。临床资料门例患者均为住院病人,其中男性9例,女性3例,年龄27－68岁,病程最短1个月,最长32年。足底溃疡22处,小腿4处（其中有一患者联下约有20cmx10cm溃疡皮损）,单纯性溃疡15处,平均面积为3．45cm’;较深在世溃疡8处,平均面积为5．scm‘;复杂性溃疡（X线显示骨质破坏明显）3处。治疗药物中药：肉桂、黄连、…     

盘状红斑狼疮继发口唇鳞状细胞癌1例

报告1例盘状红斑狼疮继发口唇鳞状细胞癌。患者女,62岁。面部、右侧手背盘状红斑30年,上唇菜花状增生物1年,迅速增大3月。皮肤组织病理检查:盘状红斑处皮损示角化过度,棘层萎缩,表皮突变平,基底细胞液化变性,真皮层有淋巴细胞灶性浸润。菜花状增生物皮损示:真皮内广泛分布由表皮细胞形成的癌细胞巢,癌巢内表皮细胞轻度异形性改变,可见病理性核分裂,有大量角化珠形成。癌细胞团周围少许炎症细胞浸润。诊断盘状红斑狼疮继发口唇鳞状细胞癌。     

弥漫性大B细胞淋巴瘤皮肤受累一例

患者,女,76岁,全身皮下多发结节伴右下肢皮肤溃烂2个月。皮损病理活检示（腹壁肿物）：非霍奇金淋巴结,B细胞型,免疫表型符合DLBCL,生发中心来源。免疫组化：CD20弥漫连片（+）,CD3散在（+）,CD10（+）,CD21显示FDC网消失,Ki67（80%）。胸腹部增强CT示胃窦十二指肠占位性病变,胃镜检查取胃窦部病变活检示：（胃窦小弯、大弯）非霍奇金B细胞淋巴瘤,考虑DLBCL或其他高侵袭性类型;免疫组化：粘膜腺体间弥漫的淋巴样细胞侵润性生长,CD20连片阳性,Ki67（90%）。我院血液科诊断为非霍奇金淋巴瘤（弥漫大B细胞型）IV期IPI,评分5分 继发皮肤受累。患者家属拒绝治疗,患者出院1周后死亡。     

巨大寻常疣继发原位鳞状细胞癌1例

 报告1例巨大寻常疣继发原位鳞状细胞癌。患者男，54岁，右膝关节斑块10年，破溃结痂2年。皮肤科检查：右膝关节内侧见一范围约5 cm×6 cm角化性斑块，表面乳头状突起，可见厚层痂壳，边界清楚，无破溃、渗出，有臭味，局部轻压痛。皮损组织病理示：表皮角化过度伴角化不全，棘层肥厚，表皮突向下延长，真皮乳头瘤样增生，乳头状突起之间的凹陷处可见明显的颗粒细胞，表皮上部可见挖空细胞；部分表皮全层细胞排列紊乱，大小形态不一，可见异形细胞和角化不良细胞，基底细胞层完整。真皮浅层可见混合炎性细胞浸润。诊断：巨大寻常疣继发原位鳞状细胞癌。予手术完整切除联合植皮治疗，术后半年电话随访，术区恢复良好，无新发皮损。     

面部鳞癌合并巨大皮角1例

患者女,82岁。右侧面颊部赘生物1年余,明显增大4个月。皮肤科检查见右侧颊部一角化性赘生物,顶端呈牛角样,突出皮面约7cm,褐黑色,质地硬如骨,基底部约6cm×5cm大小肿块,圆形,界清,红肿,轻压痛,无破溃及分泌物渗出。结合病理及临床诊断:面部鳞癌合并巨大皮角。治疗采取扩大切除植皮术。     

局限型淋巴瘤样丘疹病一例

患者，女，48岁。右下肢散在红色结节、破溃反复发作3年。组织病理示：异型单一核细胞散在或簇状分布，淋巴细胞、炎性细胞大致呈楔形生长。免疫组化染色结果示CD30(+)、CD4(+)。诊断：局限型淋巴瘤样丘疹病A型。     

Langerhans' cell histiocytosis with multisystem involvement in an adult

A 32-year-old Chinese woman presented for further investigation with a 6-year history of polyuria and polydipsia, a 4-year history of vulva ulceration and a 2-year history of gingival swelling. A biopsy of the vulva lesion showed diffuse infiltration of medium-sized cells with lobulated, grooved, vesicular nuclei. Occasional mitoses were present. The infiltrate of the cells showed reactivity with antibody to S-100 protein and CD1a, confirming the diagnosis of Langerhans' cell histiocytosis (LCH). Cephalic magnetic resonance imaging scanning revealed that an 8 x 7 x 8 mm3 large mass was located at the pituitary stalk. An X-ray film of the jaw showed sharply demarcated rarefaction of the right posterior portion of the mandible. In women with diabetes insipidus and genital ulcer, LCH should be considered in the differential diagnosis.     

滤泡树突状细胞肉瘤相关的副肿瘤天疱疮

报告1例滤泡树突状细胞肉瘤相关的副肿瘤天疱疮。患者男,16岁。因口腔、外阴溃疡伴发热2个月余,全身糜烂20d入院。临床表现为口腔、生殖器溃疡,全身水疱、糜烂及结痂,皮损组织病理改变符合副肿瘤天疱疮。腹部CT示右肾上腺占位性病变,手术切除并经组织病理证实为滤泡树突状细胞肉瘤。经大剂量静脉注射用人免疫球蛋白及口服、静脉滴注糖皮质激素和免疫抑制剂治疗后,采用手术切除肿瘤,术后7周躯干皮损基本愈合,遗留黏膜损害及肢端皮损。     

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 leiomyosarcoma, trichoblastoma, and syringocystadenoma papilliferum arising from nevus sebaceus

A 54-year-old man presented with a recurrent swelling on the right occipital region of the scalp. Two months earlier, the patient had undergone an initial local excision of the lesion which had enlarged progressively over the previous 2 years on a hairless patch which had been present since birth. On examination, a 5 x 4-cm, pinkish, firm, ulcerated swelling was seen on the right occipital region with a scar running over it. The lesion was not fixed to the underlying bone and there was no regional lymphadenopathy. X-Ray of the skull was normal and no evidence of metastatic disease was identified. Wide local excision of the tumor was performed and it was sent for histopathologic examination. Specimens and slides of the earlier surgery performed elsewhere were also studied. The specimen of the initial surgery consisted of skin-covered tissue with an exophytic firm growth measuring 6 x 5 x 4 cm. The skin surface was rough with areas of ulceration. No necrosis was noted grossly. Microscopically, three distinct lesions were seen. One was a well-circumscribed tumor located in the superficial dermis with lobules of basaloid cell aggregates with peripheral palisading and with no epidermal connection. The lobules were surrounded by cellular fibrous tissue (Fig. 1). Unlike basal cell carcinoma, however, no cleft between the cellular aggregates and stroma was noted. Foci of pigmentation were seen within cellular lobules and these features were consistent with a diagnosis of tricho-blastoma. The second tumor was seen adjacent to the first, and consisted of duct-like structures and cystic spaces with papillary projections. These were lined by double-layered epithelium with stromal infiltration by plasma cells, which are features of syringocystadenoma papilliferum (Fig. 2). The third lesion was a spindle cell sarcoma which formed the major part of the lesion, diffusely infiltrating the dermis and subcutaneous tissue, elevating and ulcerating the overlying skin. The tumor consisted of interlacing fascicles of spindle cells with oval to elongated nuclei having finely dispersed chromatin and inconspicuous nucleoli. The tumor cells were seen encircling the sweat glands, without destroying them (Fig. 3). Nuclear pleomorphism was minimal, with a mitotic rate of 9-10 per high-power field. A small area of epidermal hyperplasia with acanthosis and papillomatosis overlying malformed highly placed sebaceous glands was the only evidence of a pre-existing nevus sebaceus. The status of the surgical margins was not clearly discernible. The wide excision specimen of the recurrent swelling consisted of a skin-covered nodule with ulceration, measuring 3 x 4 x 3 cm, with a gray-white whorled cut surface. No necrosis was noted grossly. Multiple sections showed only spindle cell sarcoma infiltrating the skin and subcutaneous tissue, morphologically similar to the earlier tumor, with ulceration of the overlying skin. The surgical margins were free from tumor. Immunohistochemical stains on the spindle cell sarcoma showed positive staining for smooth muscle actin (SMA) (Fig. 4), vimentin, epithelial membrane antigen (EMA), and S100. The tumor cells were negative for cytokeratin (CK), HMB45, desmin, glial fibrillary acidic protein (GFAP), CD34, and CD68. Correlating the histomorphology and immunohistochemical findings, a diagnosis of cutaneous leiomyosarcoma with tricho-blastoma and syringocystadenoma papilliferum arising on nevus sebaceus was made. The patient received postoperative radiotherapy and is disease free 8 months after diagnosis.     

上皮样肉瘤1例

报告1例皮肤上皮样肉瘤,患者男,42岁,右胫前皮肤硬肿块伴疼痛12年,破溃2年,双侧腹股沟淋巴结肿大5年,皮损及淋巴结组织病理检查示上皮样细胞殿堂增生呈团块状或条索状分布,细胞民形性明显,见核丝分裂像.免疫组化检查波形蛋白( ),AE1( ).