发疹性毳毛囊肿1例

报告1例发疹性毳毛囊肿，患者女，32岁，因前额和两侧颞部起许多蓝灰色有脐窝的丘疹10余年就诊，曾误诊为汗管瘤和异物肉芽肿，组织病理为典型的发疹性毳毛囊肿。     

皮肤化生性滑膜囊肿1例

报道1例皮肤化生性滑膜囊肿。患儿男,14岁,因额部囊性肿物6月余就诊。皮损组织病理示真皮内囊腔样结构,囊腔内见宽带状绒毛状突起,囊壁由类似增生性滑膜的多种细胞结构组成,部分区域覆盖纤维蛋白样透明结缔组织,而部分区域高度细胞化,排列着多层上皮样细胞和梭形细胞。免疫组化示上皮样细胞及梭形细胞弥漫表达波形蛋白和组织细胞标记C...     

Cystic trichoblastoma (so-called trichoblastic infundibular cyst): a report of three new cases

Three cases of so-called trichoblastic infundibular cyst are reported. The lesions showed a configuration similar to infundibular cysts, including basophilic orthokeratotic corneocytes arranged in basket-weave pattern and intermingled with eosinophilic sebum. The cyst wall was mainly composed of stratified squamous epithelium showing infundibular keratinization throughout a granular layer. However, in some areas, epithelial cords, buds and reticulated proliferations of follicular germinative cells surrounded by a densely cellular stroma emanated radially from the cyst wall. In one case, in addition to the presence of follicular germinative cells, there were also aggregations of matrical cells with evidences of inner sheath and matrical differentiation. In our opinion, these findings support a neoplastic rather than a cystic nature for this lesion. We discuss the histopathologic differential diagnosis with other follicular cystic lesions showing similar keratinization.     

A case of trichilemmal cyst on the leg

A 46-year-old man had a dome-shaped tumor on his left leg without any involvement. Clinically, we considered epidermal cyst; however, histological features of the skin biopsy matched those of trichilemmal cyst     

In situ carcinoma in a hybrid cyst: a case report

Follicular hybrid cysts including two or more components of the epithelial skin adnexa are very rare. The epithelial lining of hybrid cysts varies, and either contains epidermis, and trichilemmal squamous epithelium, or other epithelia of the skin adnexa. Hybrid cysts may also be associated with neoplasia, such as in situ carcinoma, Bowen's disease and squamous cell carcinoma. A 37‐year‐old female was complaining of a cyst on her scalp. The unilocular cystic lesion was lined with markedly atypical squamous cells with trichilemmal differentiation. Marked nuclear and cytological atypia, pleomorphism, numerous mitotic figures and atypical mitosis was detected in the squamous epithelium. The epithelium of the cyst was also composed of ductal structures lined with cuboidal epithelium. Immunohistochemical staining was positive for cytokeratin 7 (CK7) in both squamous and glandular epithelium. Luminal staining was shown by carcinoembryonic antigen (CEA), although gross cystic disease fluid protein‐15 (GCDFP‐15) was negative in the glandular epithelium. In addition, p16 tumor suppressor gene was strongly positive in both the squamous and glandular epithelium. Overall, the unique cystic lesion reported contained pilar squamous epithelium with in situ carcinoma and eccrine ductal structures, which was interpreted as a hybrid cyst composed of in situ trichilemmal carcinoma and a ductal eccrine component.     

经典皮肤纤毛囊肿一例

患者,女,17岁。左股内侧囊肿渐增大1个月。组织病理示：表皮正常,皮肤组织真皮层及皮下组织内见一囊肿,与表皮不相连,囊肿壁可见较多乳头状突起,囊壁覆以假复层纤毛柱状上皮。免疫组化染色示：上皮膜抗原（EMA）、CK 7、CK8/CK18、CK19、ER、PR、E-Cca均为阳性, S-100个别阳性,大囊肿病液体蛋白15（GCDFP-15）、癌胚抗原（CEA）、平滑肌肌动蛋白（SMA）均为阴性。诊断：皮肤纤毛囊肿。     

传染性软疣伴发表皮囊肿1例

报告1例传染性软疣伴发表皮囊肿。患者男，71岁。鼻尖部出现一黄豆大红色丘疹4个月，无自觉症状。皮损组织病理检查显示真皮内见一囊肿，囊壁细胞内见嗜酸性圆形或椭圆形病毒包涵体，囊腔内的角质物网眼内亦见病毒包涵体。组织病理诊断为传染性软疣发表皮囊肿。     

A case of cutaneous bronchogenic cyst over the left scapula.

Bronchogenic cyst is noted shortly after birth or in early childhood and usually presents as a swelling or draining sinus in the presternal area. Its origin and pathogenesis can be explained as a developmental anomaly of the tracheobronchial buds from the primitive foregut. The patient was a 4-year-old boy with a child-fist-sized soft mass over his left scapula, which had been detected at birth and had been gradually growing. Grossly, it appeared to be a simple cyst with clear mucoid fluid. Histopathological study demonstrated a unilocular cyst composed of ciliated pseudostratified columnar epithelia, interspersed goblet cells, smooth muscles, and mucous glands on the cyst wall, which are features compatible with cutaneous bronchogenic cyst.     

Hybrid cyst: case reports and review of 15 cases in Japan

Hybrid cyst is a rare cystic lesion that includes more than two components of the pilosebaceous units. To clarify the clinical and pathological features of hybrid cysts, we report two cases and review 15 cases of hybrid cyst in Japan. On the whole, the age range was 12-73 years with a 2.95:1 female predominance and predilection for the scalp and face (46.7%). Most of the tumours presented as a solitary lesion and the size range was 2-45 mm. The most frequent histological type was the combination of infundibular and trichilemmal cysts (60.0%). Studying the clinicopathological features of hybrid cysts helps us in understanding the pathogenesis of diseases arising from pilosebaceous units.     

线状苔藓伴皮肤钙沉着症并表皮囊肿一例

患者女,14岁。11年前右下肢内侧出现一线状排列的淡红色扁平丘疹,上覆少许鳞屑,逐渐向两端扩展,未予治疗。5年前原发皮损处开始出现坚实的皮下结节。就诊前10d局部皮损出现溃破,并有红肿痛,异物排出,一直未予处理。皮肤科检查：右下肢内侧及腹部可见线状排列萎缩性暗红斑,其下可触及深在结节状物质,活动度尚可,有粘连,触之硬,压之疼痛。局部隆起于皮面,溃破处有块状、质硬、白色物质排出。组织病理检查：右大腿内侧皮损：表皮角化过度伴灶性角化不全,灶性基底细胞液化变性,真皮浅层较多的淋巴细胞浸润,真皮浅中层见深蓝色的无定形物质。右小腿内侧皮损：表皮灶性角化不全,灶性基底细胞液化变性,真皮乳头及真皮中深部血管及附属器周围淋巴细胞呈片状及团块状浸润,真皮深部及皮下脂肪层可见块状及细碎状的深蓝色钙沉积。右股（大腿）内侧皮损表现为线状苔藓伴皮肤钙沉积症,右小腿内侧皮损表现为线状苔藓伴皮肤钙沉着症并表皮囊肿。结合临床与病史,诊断为线状苔藓伴皮肤钙沉着症并表皮囊肿。治疗：先后分2次予以手术全部切除。     

Hyaluronidase allergy: A rare cause of periorbital inflammation

Hyaluronidase is a bovine or ovine testicular protein that is used as an adjunct to co-administered medicaments and fluids to enhance their dispersion and absorption through the degradation of hyaluronan. While it is a known potential allergen, there are few reports of hyaluronidase hypersensitivity. A 56-year-old lady presented 8 hours post glaucoma surgery with ipsilateral lacriminorrhoea, periorbital erythema, oedema, proptosis, pruritis and conjunctival chemosis. Right ocular motility was restricted and visual acuity was reduced. The reaction settled with oral corticosteroids and antihistamines. Hyaluronidase allergy was confirmed on skin prick testing. Hyaluronidase allergy is rare. In the few cases reported, reactions occurred at various doses and were acute (intraoperative), early (within hours), intermediate (within days) or delayed (within weeks). Anaphylaxis has also been described. Primary sensitization appears to be a prerequisite for most reactions. The variability in onset of symptoms and the response to skin testing would suggest that type I and type IV hypersensitivity may both contribute to this response. In this case, the timing fitted with a late phase type 1 reaction. This case shows that despite being less common than haemorrhage for acute reactions and infection for delayed reactions, allergy can account for orbital inflammation following ophthalmic surgery.     

CLL/SLL with initial presentation as a longstanding cutaneous plaque: a rare case

While chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is the most common leukemia in the western world, it uncommonly initially presents as a cutaneous lesion. When it does, it is often found incidentally in the context of another distinct lesion. We present a case of CLL/SLL that initially presented as a solitary nodular erythematous plaque on the left flank of a healthy 60‐year‐old man without lymphadenopathy or constitutional symptoms. The lesion had been present for many years, but had recently begun to grow and become pruritic and painful. Excisional biopsy revealed a large nodular aggregate of variably sized CD20(dim), CD5(+), CD23(+), BCL‐2(+) atypical lymphocytes in the dermis without epidermotropism. The lymphocytes were negative for BCL‐1/cyclinD1, BCL‐6, and CD10, and no other background lesion was identified. This constellation of biopsy findings was consistent with CLL/SLL. This case emphasizes the potential for involvement by CLL/SLL in the cutaneous biopsies of otherwise asymptomatic patients.     

Trichilemmal cyst: report of a case in which the cyst was connected with the epidermis by an epidermal canal.

An 87-year-old Japanese woman with a trichilemmal cyst (TC) on the subnasal area is described. Histopathological examination revealed that the cyst was connected with the overlying epidermis by an epidermal canal. This has suggested that the pathogenesis of TCs could be that they originate from the isthmus or lower portion of the hair follicle.     

Cutaneous ciliated cyst of the inguinal area in a man

Cutaneous ciliated cysts are rare, predominantly occurring on the lower extremities of young women. Most of them have been regarded as müllerian remnants. Cases in men are rarely reported. We report a case of a cutaneous ciliated cyst involving the inguinal area of a 56-year-old man and briefly review the published work.     

A rare combination of sebaceoma with carcinomatous change (sebaceous carcinoma), trichoblastoma,and poroma arising from a nevus sebaceus

We report a case of a 48‐year‐old Malay female who presented with multiple tumors arising from a large nevus sebaceus on her right parieto‐temporal scalp. Histologically, the tumors corresponded to a sebaceoma with carcinomatous change, a poroma and a trichoblastoma. Immunohistochemical staining of the sebaceous tumor with p53 showed strong within the areas of carcinomatous change, while there was negative to weak staining within the sebaceoma‐like areas. A discussion on the potential secondary neoplasms from a nevus sebaceus ensues, with a review of this literature on multiple tumors from a nevus sebaceus.     

一例急性呼吸窘迫综合征患者的循证非机械通气治疗

目的为1例肺部感染引起的急性呼吸窘迫综合征患者制定非机械通气治疗方案。方法根据患者临床状况,提出液体管理、药物治疗等临床问题,通过文献检索,根据所获证据给患者制定非机械通气治疗方案。结果现有证据显示：在保证器官灌注的前提下进行限制性液体治疗、早期小剂量应用糖皮质激素、白蛋白联合速尿有助于改善患者预后。NO吸入、β-2肾上腺素受体激动剂、肺表面活性物质、抗真菌药物、粒细胞-巨噬细胞集落刺激因子目前不推荐作为ARDS的常规治疗。结合患者情况,应用证据治疗后,患者最终康复出院。结论以循证医学证据指导临床治疗,能提高ARDS疗效,降低病死率。