皮肤科医师与深度卷积神经网络诊断色素痣和脂溢性角化病皮肤镜图像比较

【摘要】 目的 比较深度卷积神经网络（CNN）与皮肤科医师对色素痣和脂溢性角化病的诊断准确率。方法 使用5 094幅色素痣和脂溢性角化病（SK）的皮肤镜图像对CNN网络ResNet?50通过迁移学习进行训练,建立CNN二分类模型,并应用该模型对30幅色素痣和30幅SK的皮肤镜图像进行自动分类。同时,95位经过皮肤镜培训的有经验的皮肤科医师结合临床皮损图片对上述CNN自动分类的60幅皮肤镜图像进行判读。比较二者的诊断准确率,并对错误分类的图像做进一步统计分析。结果 CNN自动分类模型对色素痣和SK的皮肤镜图像的分类准确率分别为100%（30/30）和76.67%（23/30）,总准确率为88.33%（53/60）;95位皮肤科医师的诊断准确率平均值分别为82.98%（25.8/30）和85.96%（24.9/30）,总准确率为84.47%（50.7/60）。CNN自动分类模型与95位皮肤科医师对色素痣和SK的诊断准确率差异无统计学意义（χ2 = 0.38,P > 0.05）。CNN错误分类的皮肤镜图像被分为3类,即特殊类型（如皮损色素含量多、角化明显）,具有典型特征但存在干扰因素,具有典型特征尚找不到错误分类的原因。结论 CNN自动分类模型在色素痣和SK皮肤镜图像的二分类任务中的表现与有经验的皮肤科医师水平相当。CNN错误分类的原因仍需皮肤科医师与人工智能专业人员共同探索。     

唇恶性淋巴瘤与假性淋巴瘤的免疫病理分析

报告７例唇恶性淋巴瘤和４例唇假性淋巴瘤。唇恶性淋 瘤原发于唇粘膜下淋巴细胞，具有样肉肿的特征，经免疫组化证实７例中有６例为小多形Ｔ细胞性，１例为淋巴浆细胞性。唇淋巴瘤及唇假性淋巴瘤都在慢性唇炎基础上发生，多见于中年人，生长缓慢，以唇粘膜肿胀为特征。文章就两者的鉴别诊断进行了讨论。     

Prognostic classification of malignant melanoma by clinical criteria

In a retrospective study of 503 well-documented cases of primary malignant melanoma (stage I) clinical criteria were analysed for their prognostic relevance. The maximum elevation (in mm) of the tumour was found to be the most important single prognostic factor. There was a close association with tumour thickness, measured histologically by the method of Breslow (correlation coefficient = 0.73). A combination of elevation and three additional clinical criteria (site, nodule- or lesion-diameter, and surface defects such as erosion, ulceration or bleeding) allowed a further improvement in prognostic accuracy. This clinical classification into low-risk and high-risk melanomas was as effective as the use of tumour thickness measured histologically, and can therefore be used for the preoperative planning of treatment.     

Desmoplastic malignant melanoma of the lip: a report of 6 cases and review of the literature

Desmoplastic malignant melanoma is a rare neoplasm consisting primarily of spindle-shaped melanoma cells embedded in a fibrous stroma, with approximately 6% of cases occurring in the lip. A literature search revealed that most reported cases occur in sun-exposed areas in older men. Few cases of desmoplastic malignant melanoma of the lip in young people (in their mid-twenties) have been described. We report 6 previously undocumented cases of labial desmoplastic malignant melanoma occurring in young individuals and review 20 cases from the literature. Physicians should consider the possibility of desmoplastic malignant melanoma in young people who present with atypical lip lesions, which on histopathologic analysis demonstrate spindle-cell hyperplasia. Although this diagnosis is rare and there have not been reports of such patients in the literature thus far, our findings should alert clinicians to the possibility of desmoplastic malignant melanoma as a diagnosis for lip lesions in young people.     

Ultrasound assessment of deep tissue on the wound bed and periwound skin: A classification system using ultrasound images

AimsGiven the utility of ultrasonography in assessing pressure injury, some ultrasonographic findings have already been used as indicators of deep tissue pressure injury. Despite reports showing that a cloud-like ultrasonographic pattern reflected the presence of deep tissue necrosis, identifying cloud-like patterns was difficult given the presence of similar findings, such as a cobblestone-like pattern. This case series reports patients with pressure injuries who presented with a cloud-like (five cases) and cobblestone-like (four cases) pattern during ultrasonography.MethodsThis study was conducted at a Japanese university hospital. Participants included patients who underwent routine examination by an interdisciplinary pressure injury team. Pressure injury severity was assessed using the DESIGN-R® scoring system and the wound size were measured using ImageJ software based on the wound photograph.ResultsAmong the five cases showing a cloud-like pattern upon ultrasonography, all exhibited an increase in the total DESIGN-R® score, while three exhibited an increase in wound size. On the other hand, all four cases showing a cobblestone-like pattern displayed no increase in the total DESIGN-R® score and a decrease in wound size.ConclusionThis study suggested that distinguishing between cloud-like and cobblestone-like ultrasonography patterns is necessary for determining the presence or absence of deep tissue pressure injury. In order to comprehensively assess pressure injuries with ultrasonography, future studies should be conducted in a large number of participants.     

儿童体表血管性病变伴随的深部血管性疾患磁共振成像表现

目的 评估磁共振成像(MRI)对儿童体表血管性病变所伴随的深部血管性疾患的临床诊断价值.方法 对2012年1月至2016年12月于上海市儿童医院皮肤科就诊的105例体表血管性病变患儿行MRI检查,分析患儿的临床和影像资料.结果 105例患儿中男42例,女63例,年龄0.5～ 168个月,平均21.6个月.MRI检查发现,25例(23.8％)患儿有肉眼无法观察到的深部血管性病变,其中多部位深部毛细血管瘤15例,颅颜面血管瘤综合征4例,动静脉畸形3例,颅内永存动脉窦2例,静脉曲张骨肥大综合征1例.结论 MRI对儿童体表血管性病变所伴随的深部血管性疾患有较高诊断价值.     

发生于恶性疾病的Sweet综合征2例报告

1981年,我们遇到发生于慢性粒细胞白血病及恶性组织细胞增生症的Sweet综合征各一例,报告如下.