天疱疮、类天疱疮及皮肌炎合并恶性肿瘤临床分析

目的：了解天疱疮、类天疱疮及皮肌炎3种自身免疫性疾病合并恶性肿瘤的情况。方法：分析92例天疱疮患者、60例类天疱疮患者、174例皮肌炎患者的临床特点以及与肿瘤发生的相关因素。结果：肿瘤发生率在类天疱疮患者为10．00％，天疱疮患者为6．52％，皮肌炎患者为12．07％。与肿瘤发生可能相关的因素包括：天疱疮患者的病程(P=0．032，OR=0．718)，皮肌炎患者的发病年龄(P=0．012，OR=1．053)以及应用甲氨喋呤(MTX)(P=10．032，OR=0．273)。结论：天疱疮、类天疱疮与恶性肿瘤的发生无肯定的相关性，而皮肌炎与恶性肿瘤相关。     

合并肿瘤的皮肌炎10例临床分析

目的：探讨皮肌炎合并恶性肿瘤的临床特点。方法：回顾性分析10例皮肌炎合并恶性肿瘤的临床特征。结果：患者年龄58～72岁，男：女=1．5：1，5例有典型皮损，3例出现异色病样改变，4例有明显的呛咳及吞咽困难，4例有肺间质的改变，皮肌炎多出现在肿瘤发生之前，手术治疗后皮肌炎症状明显好转甚至完全消失。结论：皮肌炎合并肿瘤与患者年龄，典型皮损，吞咽困难有一定相关性，与血清肌酶升高无明显关系，应积极查找恶性肿瘤。     

213例皮肌炎临床和血清肌酶特征分析

目的：探讨皮肤科门诊定期就诊的皮肌炎患者临床和血清肌酶特征及长期皮质类固醇治疗引起的副作用。方法：分析213例皮肌炎的首发症状及病程中临床表现和血清肌酶分析情况，并按年龄、性别组进行分析比较。结果：所有患者一般特征、临床表现和血清肌酶与国内外报道基本一致，首发症状为肌无力者占96．24％，成年组伴发恶性肿瘤者为23．94％。结论：儿童皮肌炎预后较好，而成人皮肌炎伴发肿瘤和肺部受累提示预后较差，皮质类固醇副作用以合并浅表真菌感染最常见。     

皮肌炎/多发性肌炎伴恶性肿瘤45例分析

目的分析皮肌炎，多发性肌炎伴发恶性肿瘤患者的临床情况。方法回顾性分析我院1991—2005年间45例皮肌炎，多发性肌炎伴发恶性肿瘤患者，分析其临床特点及肿瘤相关因素。结果313例皮肌炎，多发性肌炎患者中45例（14．38％）伴发恶性肿瘤，伴发的肿瘤主要为鼻咽癌、肺癌、乳腺癌，69％患者恶性肿瘤发现于皮肌炎的诊断之时。伴发肿瘤的高危因子包括皮肌炎的发病年龄晚（〉40岁）（P=0．0047，OR=0．186）及病程短（〈1年）（P=0．0033，OR=3．884）。结论皮肌炎，多发性肌炎常伴发恶性肿瘤，所合并肿瘤的类型广泛，但以鼻咽癌、肺癌、乳腺癌等为主。对于年龄〉40岁、病程〈1年的患者，应进行相关检查及监测以排除可能合并的恶性肿瘤。     

皮肌炎合并恶性肿瘤的临床分析

皮肌炎是一种以皮肤及横纹肌的炎症为主的全身性疾病,可合并恶性肿瘤,为探讨皮肌炎合并恶性肿瘤的临床表现。早期诊断,使本病达到及时正确的治疗,笔者收集了１９８４年９月～１９９９年８月我院皮肌炎患者的病历资料,现将其合并恶性肿瘤１８例分析报道如下：１临床资料１．１一般资料１９８４年９月～１９９９年８月,我院共收治８２例皮肌炎患者,其中合并恶性肿瘤１８例,占２１．９５％,男６例,女１２例,男：女＝１：２,年龄３６～７６岁,平均５６．０８岁,小于４０岁２例,大于４０岁１６例。１．２合并恶性肿瘤类型肺癌４例…     

皮肌炎合并恶性肿瘤82例临床分析

目的了解皮肌炎合并恶性肿瘤的几率和临床特点。方法回顾1991年1月—2011年2月中山大学附属孙逸仙纪念医院住院治疗的511例皮肌炎患者,统计和分析其合并恶性肿瘤情况。结果皮肌炎合并恶性肿瘤82例,占皮肌炎患者16.05%。以41~60岁年龄段发生率高。鼻咽癌最常见,共48例,占恶性肿瘤58.54%。肺癌11例,卵巢癌6例。先发皮肌炎后发恶性肿瘤者64例;皮肌炎与恶性肿瘤同时发生11例;先发恶性肿瘤后出现皮肌炎者7例。治疗恶性肿瘤后皮肌炎症状好转,恶性肿瘤恶化皮肌炎症状加重。结论皮肌炎合并恶性肿瘤常见于年龄40岁以上患者,广东地区皮肌炎合并的恶性肿瘤以鼻咽癌最常见,其次是肺癌和卵巢癌。     

皮肌炎合并恶性肿瘤5例临床分析

目的　探讨皮肌炎合并恶性肿瘤的临床特点。方法　回顾性分析 5例皮肌炎合并恶性肿瘤的临床特征。结果　患者年龄 5 2～ 70岁 ,平均 63 .5岁 ,4例表现为恶性红斑 ,2例并有表皮坏死。患者血清肌酶均升高 ,程度与是否合并肿瘤无明显关系。结论　皮肌炎合并肿瘤 ,与表皮坏死、年龄有一定相关性 ,血清肌酶升高与是否合并肿瘤无明显关系。恶性红斑提示预后不良。     

无肌病性皮肌炎16例临床分析

目的：探讨无肌病性皮肌炎（ADM）的命名。方法：回顾性分析符合Euwer提出的ADM诊断标准的16例患者的临床资料。结果：16例患者中2例进展为皮肌炎,1例进展为慢性皮肤型红斑狼疮（CCLE）。间质性肺炎（ILD）发生率为68．8％,恶性肿瘤发生率为25．0％。结论：提出皮肌炎样皮炎的命名,并认为它是一种复杂的综合征,可以是皮肌炎的早期表现,也可以伴有严重的肺部损害或疾病向红斑狼疮转归,皮肌炎样皮炎可并发恶性肿瘤,因此需要行全身系统检查,并加强随访。     

皮肌炎与恶性肿瘤-13例临床分析

皮肌炎合并恶性肿瘤早已为人们所认识。为了进一步了解皮肌炎和恶性肿瘤的关系 ,我们对本院1980年～ 1998年收集的 4 3例皮肌炎患者的临床资料进行了分析 ,现将结果报道如下。1　临床资料1 1　一般资料资料完整的皮肌炎住院病例 4 3例 ,其中男 2 6例 ,女 17例 ;年龄最大 74岁 ,     

合并肺间质病变或恶性肿瘤皮肌炎患者的外周血差异基因表达分析

【摘要】 目的 研究合并肺间质病变或恶性肿瘤的皮肌炎/临床无肌病性皮肌炎（DM/CADM）患者的差异表达基因及相关信号通路。方法 2017年1月至2018年1月于上海交通大学医学院附属瑞金医院皮肤科确诊的DM/CADM患者27例，按照合并症状分为3组，即合并肺间质病变组10例，合并恶性肿瘤组8例，无肺间质病变和恶性肿瘤组9例。同时收集7例健康对照。采用高通量RNA测序技术筛选上述4组受试者外周血中差异表达基因，进行基因本体论（GO）分析以及京都基因与基因组百科全书（KEGG）通路富集分析。结果 与健康对照相比，DM/CADM患者4 820条基因表达上调，137条基因表达下调；GO分析获得显著富集条目49个，其中37个（75.5%）与生物过程相关；KEGG分析差异基因富集于感染、肿瘤以及免疫相关通路。与无肺间质病变和恶性肿瘤组相比，合并肺间质病变组272条基因表达上调，158条基因下调；GO分析获得显著富集条目157个，其中114个（72.6%）与生物过程相关；KEGG分析差异基因富集于细菌感染和自身免疫/炎症通路。合并恶性肿瘤组398条基因表达上调，68条基因表达下调；GO分析获得显著富集条目117个，其中94个（80.3%）与生物过程相关；KEGG分析差异基因富集于糖基化、代谢以及肿瘤相关信号通路。结论 DM/CADM患者与健康对照组间、合并肺间质病变或恶性肿瘤的DM/CADM组与无合并症患者组间转录组基因及通路存在差异，细菌感染、细胞因子/趋化因子通路在合并ILD的DM/CADM患者中显著富集，而糖基化、蛋白代谢以及抗原提呈和自然杀伤细胞的细胞毒作用在合并恶性肿瘤的DM/CADM患者中显著富集。     

成人皮肌炎患者抗核抗体与临床特征及肿瘤风险的关系

目的 探讨成人皮肌炎患者抗核抗体与临床特征及肿瘤风险的关系.方法 回顾性分析2008年4月至2018年4月在苏州大学附属第一医院皮肤科住院的101例皮肌炎患者的临床资料,分为抗核抗体阳性组和阴性组,比较两组之间肌病、肿瘤发生风险以及其他临床特征的差异.92例患者随访2年.采用卡方检验分析比较两组的临床特征,利用多因素回...     

Significance of dual-basin drainage in patients with truncal melanoma undergoing sentinel lymph node biopsy

BACKGROUND: The number of nodal basins and the number of lymph nodes containing regional metastases are important prognostic factors in patients with truncal malignant melanoma. Because the lymphatic drainage pattern of truncal melanoma often includes more than 1 basin, we designed a study to evaluate whether: (1) patients with dual-basin drainage were at an increased risk of lymph node metastases identified by sentinel lymph node (SLN) biopsy; and (2) the histologic status of an individual basin reliably predicted the status of the other draining basin in patients with dual-basin drainage. METHODS: The records of 269 consecutive patients with melanoma, who were treated primarily with intraoperative lymphatic mapping and SLN biopsy between 1997 and 2002, were reviewed. Of these patients, 122 had primary truncal melanomas. All patients underwent preoperative lymphoscintigraphy, which established the number and location of draining nodal basins. The chi-square and Fisher's exact tests of relevant clinicopathologic factors determined which factors were predictive of the presence of a pathologically positive SLN. RESULTS: At least one SLN was identified in all patients. Dual-basin drainage was present in 39 (32%) patients, and a pathologically positive SLN was found in 12 (31%) of these patients. By chi-square and Fisher's exact tests, dual-basin drainage was not a significant independent risk factor for the presence of at least 1 pathologically positive SLN (P =.846). Tumor thickness (P <.001), Clark level (P =.003), and tumor ulceration (P =.003) were significant independent risk factors for the presence of at least 1 pathologically positive SLN. SLN pathology in one basin did not predict the histology of the other basin in 7 (18%) of 39 patients with dual-basin drainage. CONCLUSIONS: Dual-basin drainage is not independently associated with an increased risk of nodal metastases in patients with truncal melanoma. Because the histologic status of an individual basin did not reliably predict the status of the other draining basins in patients with dual-basin drainage, it is important to adequately identify and completely assess all nodal basins at risk, as defined by lymphoscintigraphy, in patients with truncal melanoma.     

Reliability of prognostic models in malignant melanoma. A 10-year follow-up study

Certain histologic and clinical features of malignant melanoma have been shown to be indicators of prognosis, both collectively and individually. Even though the predictive value of these features is well established, long-term survival is occasionally seen in individuals with multiple poor prognostic factors. To further examine this phenomenon, histologic sections from 53 patients with malignant melanoma excised between the years 1977 and 1980 in whom reliable clinical follow-up data were obtained were evaluated for the presence of features associated with a poor prognosis (thickness greater than 1.7 mm, Clark level greater than or equal to III, vertical growth phase, high mitotic index, marked cytologic atypia, minimal tumor inflammatory infiltrate, presence of regression, presence of plasma cells, male sex, age greater than or equal to 45 years, and axial anatomic location). Sixty-eight percent of the patients survived for greater than or equal to 10 years. Of these, 26% had lesions greater than or equal to 1.7 thick. Multivariate discriminant analysis of all features provide a model that was 76% accurate in predicting outcome over a 10-year period. Although the predictive value of these prognostic variables is generally reliable, there is a significant population of long-term survivors in whom prognosis could not be accurately predicted using these features.     

皮肌炎的早期诊断和内脏损伤早期识别

皮肌炎是一种临床常见的自身免疫性疾病, 常有肌肉和肺的累及, 也常合并恶性肿瘤, 肺累及常是致命性的。因此, 早期诊断及治疗, 对减少肌肉和肺的损伤、识别和诊治合并的恶性肿瘤、提高患者预后和生存率有极大帮助。皮肌炎的异质性强, 临床表现多种多样, 本文论述皮肌炎合并急性肺间质性纤维化、发生吞咽困难、合并恶性肿瘤的高风险因素, 总结出"皮疹+甲皱血管+肌炎抗体"的联合模式有助于早期诊断皮肌炎, 早期识别重要内脏损害风险和肿瘤, 早期干预, 提高患者的整体生存率。     

皮肌炎并发恶性肿瘤患者P53蛋白表达的研究

目的：探讨P53蛋白在皮肌炎并发恶性肿瘤过程中的作用。方法：应用免疫组化技术对皮肌炎患者的肿瘤组织细胞及外周血单个核细胞(PBMCs)P53蛋白的表达进行了检测。结果：1例皮肌炎并发卵巢癌患者的肿瘤细胞及PBMCs均表达P53蛋白，另1例皮肌炎并发鼻咽癌患者的肿瘤细胞、浸润单个核细胞及PBMCs均表达P53蛋白。其它15例未并发恶性肿瘤的皮肌炎患者中有1例PBMCs表达P53蛋白。20例正常对照均阴性。结论：p53基因的种系突变在皮肌炎并发恶性肿瘤中可发能发挥重要作用。     

皮肌炎合并肺间质病变

为了解皮肌炎的肺间质病变，对36例皮肌炎患者进行了分析。结果：肺间质病变者8例，占22.2%。皮肌炎合并肺间质病变患者发热、咳嗽发生率高，分别为87.5%、62.5%。抗Jo-1、RNP抗体、ANA阳性率分别为57.1%，42.9%和57.1%，均高于不合并肺间质病变者。     

成人皮肌炎伴发恶性肿瘤的相关因素分析

目的:探讨成人皮肌炎(DM)患者伴发肿瘤的相关因素。方法:回顾性分析2016年1月至2018年12月在我院皮肤科确诊为成人DM的患者,对其临床特征、实验室检查共16项指标进行统计分析。结果:共分析114例成人DM患者,其中伴发肿瘤21例(18.4%),以肺癌(6例,28.57%)最常见。单因素分析结果显示,单纯DM组和DM伴发肿瘤组年龄、性别、吞咽困难、白蛋白水平和红细胞沉降率(ESR)比较差异有统计学意义(P<0.05)。将上述单因素分析差异有统计学意义的指标纳入多因素Logistic分析结果显示,性别和ESR是影响成人DM伴发肿瘤的危险因素。结论:应考虑将男性DM患者,或者ESR≥35 mm/h纳入成人DM伴发恶性肿瘤的危险因素,加强DM早期的肿瘤筛查工作。     

Dermoscopy of solitary angiokeratomas: a morphological study

OBJECTIVES: To describe the dermoscopic structures and patterns associated with solitary angiokeratomas and to determine the sensitivity, specificity, positive predictive value, negative predictive value, and reproducibility of these dermoscopic features. DESIGN: Multicenter retrospective study. SETTING: University hospitals in Spain, Italy, Argentina, New York City, and Austria. PATIENTS: There were 256 patients total, and 32 specimens each of solitary angiokeratomas, melanocytic nevi, Spitz-Reed nevi, malignant melanomas, pigmented basal cell carcinomas, dermatofibromas, seborrheic keratoses, and other vascular lesions (19 angiomas, 7 pyogenic granulomas, 3 spider nevi, 2 lymphangiomas, and 1 venous lake) were consecutively collected from the laboratories of 8 hospitals. Diagnoses of all patients' lesions were confirmed histopathologically. INTERVENTION: Dermoscopic examination. MAIN OUTCOME MEASURES: The frequency, sensitivity, specificity, positive predictive value, negative predictive value, intraobserver agreement, and interobserver agreement of the different dermoscopic features associated with solitary angiokeratomas were calculated, and the differences were evaluated using the chi(2) or Fisher exact test. RESULTS: Six dermoscopic structures were evident in at least 50% of the solitary angiokeratomas: dark lacunae (94%), whitish veil (91%), erythema (69%), peripheral erythema (53%), red lacunae (53%), and hemorrhagic crusts (53%). Dark lacunae exhibited a sensitivity of 93.8% and a specificity of 99.1% (P<.001 for both), not being found in malignant melanomas or pigmented basal cell carcinomas. The positive predictive value was 93.8%, and the negative predictive value was 99.1%. The intraobserver agreement was perfect (kappa, 1.00), and the interobserver agreement was excellent (kappa range, 0.83-1.00) (P<.001 for both). Pattern 1, consisting of dark lacunae and whitish veil, exhibited a sensitivity of 84.4% and a specificity of 99.1% and was not found in malignant melanomas or pigmented basal cell carcinomas. The positive predictive value was 93.1%, the negative predictive value was 97.8%, the intraobserver agreement was perfect (kappa, 1.00), and the interobserver agreement was excellent (kappa range, 0.83-1.00) (P<.001 for all). Conclusion Dermoscopy is helpful in improving the diagnostic accuracy of solitary angiokeratomas and allows the observer to differentiate them from other cutaneous tumors such as malignant melanomas and pigmented basal cell carcinomas.