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。     

Protease-Activated Receptor-2 Is Associated with Terminal Differentiation of Epidermis and Eccrine Sweat Glands

Background

Protease-activated receptor 2 (PAR-2) participates in various biological activities, including the regulation of epidermal barrier homeostasis, inflammation, pain perception, and melanosome transfer in the skin.

Objective

To evaluate the basic physiological role of PAR-2 in skin.

Methods

We investigated PAR-2 expression in human epidermis, skin tumors, and cultured epidermal cells using western blot and immunohistochemical analysis. Additionally, we examined the effect of the PAR-2 agonist, SLIGRL-NH2, on cultured keratinocytes.

Results

Strong PAR-2 immunoreactivity was observed in the granular layer of normal human skin and the acrosyringium of the eccrine sweat glands. In contrast, weak PAR-2 immunoreactivity was seen in the granular layer of callused skin and in the duct and gland cells of the eccrine sweat glands. Interestingly, PAR-2 immunoreactivity was very weak or absent in the tumor cells of squamous cell carcinoma (SCC) and syringoma. PAR-2 was detected in primary keratinocytes and SV-40T-transformed human epidermal keratinocytes (SV-HEKs), an immortalized keratinocyte cell line, but not in SCC12 cells. SV-HEKs that were fully differentiated following calcium treatment displayed higher PAR-2 expression than undifferentiated SV-HEKs. Treatment of cultured SV-HEKs with PAR-2 agonist increased loricrin and filaggrin expression, a terminal differentiation marker.

Conclusion

Our data suggest that PAR-2 is associated with terminal differentiation of epidermis and eccrine sweat glands.     

汗腺癌1例

目的：报道1例发生于臀部的汗腺癌。患女性，80岁。右臀部红色斑块1年、溃疡2月。组织病理可见真皮内巢状异形细胞，个别呈腺样结构。免疫组化：CK强阳性，CEA阳性。     

Mucinous Carcinoma of the Skin: Report of a Case with DNA Cytofluorometric Study

A 62-year-old man with a mucinous carcinoma of the skin on the left cheek is described. The excised specimen showed a characteristic histopathologic picture. The findings from histochemical, immuno-histochemical, and electron microscopic examinations suggested an eccrine differentiation of the tumor cells. The removed tumor was examined using DNA cytofluorometry in order to analyze the cell kinetics and to estimate its biological behavior and prognosis. The tumor cells showed a diploid mode with a small number of polyploid cells. Only a small number of cells in the S and G₂/M phase ranges were detected. After four years, there has been no evidence of tumor recurrence nor metastasis. The results of DNA ploidy analysis were thus compatible with the nature of slow growth with a good prognosis in this case.     

以皮角为表现的肾透明细胞癌皮肤转移1例

患者男,55岁。右枕部红褐色皮角样增生物3个月,进行性增大1个月。2010年确诊为"肾癌"并行右肾摘除术。皮肤科情况:右枕部可见一长约2.0cm圆锥形红褐色增生物,顶部球状角化,外观似"跳棋状",基底部直径约0.8cm,质硬,皮损周围红肿。皮损组织病理示:顶端表面破溃结痂,肉芽组织增生,真皮浅层见结节状肿瘤组织,肿瘤由巢状、腺泡状透明细胞构成,细胞核轻度异型,细胞巢周围可见丰富的血窦及毛细血管。免疫病理示:EMA(+),CD10(+),vimentin(+),CK7(-),CK20(-)。诊断:肾透明细胞癌皮肤转移。术后患者拒绝化疗,现仍在随访观察中。     

Recurrent primary cutaneous mucinous carcinoma with neuroendocrine differentiation: case report and review of the literature

We report the case of a 60‐year‐old woman presenting with primary cutaneous mucinous carcinoma (PCMC) with neuroendocrine differentiation, revealed by neuroendocrine tumor lymph node metastasis 7 years before identification of the skin tumor. Only five cases of PCMC with neuroendocrine differentiation have been reported to date. The frequency of this neuroendocrine component may be underestimated, as it can require immunohistochemistry for identification, rather than being obvious on initial histopathologic examination. In the case presented here, the prominent neuroendocrine component displayed the morphological features of a well‐differentiated neuroendocrine tumor with expression of common neuroendocrine markers, strong expression of estrogen and progesterone receptors and low Ki67 proliferation index (5%). This case shows that not all primary cutaneous neuroendocrine carcinomas are Merkel cell carcinomas (MCCs). In addition to rare primary cutaneous carcinoid tumors, the diagnosis of PCMC with neuroendocrine differentiation must be considered, particularly when confronted by a mucinous tumor or lymph node metastases of neuroendocrine carcinoma of unknown origin. On the basis of this case, identification of a neuroendocrine component in a PCMC might be an adverse prognostic indicator of recurrence or of lymph node metastasis and should support wider excision margins of the tumor.     

原发性皮肤黄曲霉病1例

报告 1例 5 6岁女性患者右小腿溃疡 2个月 ,经真菌学及组织病理学检查证实为原发性皮肤黄曲霉病。患者无免疫缺陷及相关基础疾病 ,经口服特比萘芬 2 5 0mg ,1次 /d ,共 3 5天治疗后痊愈。本文结合所报告的病例对皮肤曲霉病的分类标准、发病机制、病原菌及其治疗作了讨论与分析。     

皮肤Merkel细胞癌1例

患者女,63岁。发现右肘皮肤暗红色肿块3月。皮损组织病理示:肿块位于真皮呈巢状分布,肿瘤细胞大小形态较一致,胞质较少,略嗜碱性,胞核圆形,伴典型的细颗粒状(尘样)染色质及多个核仁,核分裂相及核碎片易见。免疫组化示:肿瘤细胞CK20,CHG,CD56,Syn均阳性,LCA阴性。诊断:右肘皮肤Merkel细胞癌。     

膀胱移行细胞癌皮肤转移1例

患者女,83岁。外阴起皮疹1个月,破溃半月。5个月前因"膀胱移行细胞癌"行膀胱肿瘤切除术及左侧输尿管成形术。术后定期行膀胱灌注丝裂霉素化疗。2个月前再次出现肉眼血尿伴血块。1个月前无明显原因右侧大阴唇出现一约蚕豆大淡红色结节,无不适,但增长较快,半个月前结节中央破溃。家族中无类似病史。外阴皮疹组织病理示:表皮大致正常,真皮内可见异形性显著的移行细胞性肿瘤细胞团块,胞浆淡染,部分血管内可见癌栓。免疫组化示:CK7(+),HMB45(-)。诊断:膀胱移行细胞癌皮肤转移。     

Basal Cell Carcinoma with Eccrine Differentiation

We describe a light, electron microscopic, and immunohistochemical study of basal cell carcinoma with eccrine differentiation. The cytoplasm did not stain with fat stain on cryostat sections, but contained numerous gland-like structures. Immunohistochemistry on formalin fixed, paraffin embedded tissues using antibodies to human involucrin, thirteen kinds of cytokeratin, S-100 protein, and carcinoembryonic antigen (CEA) was performed. We found that tumor cells were positive for keratin, PKK1, MA-903, No 8, No 19, AE 1, AE 3, and 5+8. Tumor cells were negative for S-100 protein, CEA, and the other antigens examined. Electron microscopy demonstrated short microvilli and amorphous materials within the intracytoplasmic cavity. We concluded that this tumor is basal cell carcinoma with eccrine differentiation.     

皮肤局灶性黏蛋白病1例

患者男,53岁。颈部丘疹20年余,无自觉症状,也无甲状腺功能异常。皮损组织病理示:真皮中上部胶原纤维稀疏,其内充满均质性无定形物质。阿新蓝染色阳性。诊断:皮肤局灶性黏蛋白病。     

皮肤Rosai-Dorfman病1例

患者男,28岁。左小腿内侧暗红色结节4月。皮损组织病理示:示真皮全层及皮下组织中有大量组织细胞浸润,其间有淋巴细胞及浆细胞,并可见组织细胞内吞噬淋巴细胞及浆细胞。免疫组化结果示淡染的组织细胞S-100蛋白阳性、CD68阳性。诊断:皮肤Rosai-Dorfman病。     

Primary cutaneous mucinous carcinoma: report of two cases treated with Mohs' micrographic surgery

We present a 72-year-old woman who presented with a slowly enlarging, asymptomatic, cystic nodule on the right eyebrow, and a 66-year-old woman who had a reddish, nodular lesion on the left lower eyelid. Incisional biopsy from the two neoplasms showed dermal epithelial cell islands embedded in mucin pools. Tumour cells stained positive for cytokeratin 7, oestrogen and progesterone receptors, and negative for vimentin and S-100 protein. These findings were consistent with a diagnosis of mucinous carcinoma. Extensive work-ups excluded cutaneous metastases from primary visceral mucinous carcinomas. To ensure complete tumour removal, both patients underwent Mohs' micrographic surgery (standard fresh-frozen technique). They remain disease-free 42 and 26 months after surgical excision, respectively. Mohs' micrographic surgery appears to be a rational and effective treatment for this uncommon malignancy.     

皮肤窦性组织细胞增生症1例

报告1例皮肤窦性组织细胞增生症(CSH)。患者女,53岁,右侧下颌及左颊部可见浸润性斑块。皮损组织病理示真皮全层组织细胞团块状增生伴淋巴细胞浸润,可见组织细胞吞噬现象。免疫组化染色示:组织细胞S-100蛋白和CD68(+),CD1α标记(-)。现继续治疗中。     

皮肤转移性黑素瘤1例

患者男,53岁。左大腿肿块伴瘙痒2月余。结合病史、皮损特点、实验室检查、皮损组织病理学改变、免疫组化检查结果,确诊为皮肤转移性黑素瘤。     

A Case of Metastatic Renal Cell Carcinoma Mimicking Granuloma Pyogenicum

Renal cell carcinoma (RCC) is well known for its frequent metastasis and particularly to the lungs, liver, bones and brain, but metastasis to the skin is rare. We report here on a case of metastatic RCC in a 73-year-old man who presented with a 1.5 cm sized, moist, beefy-red and exophytic nodule on the scalp. The lesion had grown rapidly for 2 months and it clinically mimicked granuloma pyogenicum. A skin biopsy revealed a solid mass composed of clear cells with clear cytoplasm and oval hyperchromatic nuclei, and they were arranged in an alveolar pattern. As skin metastasis from renal cell carcinoma signals widespread systemic metastasis and a poor prognosis, clinicians should conduct a careful inspection of the skin of a patient with RCC and they should also have a high index of suspicion for finding a primary internal organ malignancy in the RCC patients who present with a skin lesion.     

皮肤颗粒细胞瘤1例

患者女,34岁,右侧阴唇皮疹10月。组织病理示真皮中下部可见弥漫性巢状排列的肿瘤细胞,细胞核大,核深染,免疫组化标记S-100,CD68(+)。诊断:皮肤颗粒细胞瘤。     

表现为乳房外Paget病的异时性双重原发癌1例

报告异时性双重原发癌1例。患者女,60岁。3年前经尿道膀胱肿物电切术,切除物组织病理示膀胱移行细胞癌Ⅱ级。半年前出现外阴部红斑、丘疹,逐渐扩大。以乳房外Paget病行Mohs切除术。诊断:异时性双重原发癌。     

皮肤Rosai-Dorfman病1例

患者男,28岁。左小腿内侧暗红斑、结节6月,组织细胞表达S-100(+)、CD68(+)、SMA(-)、Lyso(+),特殊染色PAS(-),诊断为皮肤Rosai-Dorfman病。皮肤Rosai-Dorfman病是临床罕见的疾病,明确病理组织学特点在鉴别诊断中有重要意义,预后较好需要随访。