棘层松解浸润性原发性乳房外Paget病

报告1例棘层松解浸润性原发性乳房外Paget病。患者男,66岁。会阴红斑溃疡10余年。皮肤科检查:阴茎、阴囊及阴阜大片红斑及溃疡,其上有大小不等的结节及大量脓性分泌物。皮损组织病理:表皮棘层明显增生肥厚,向真皮内浸润,细胞排列絮乱,异形明显,可见核分裂象及角化不良细胞,真皮内可见少量鳞状细胞团块,周围大量炎性细胞浸润。腹股沟淋巴结组织病理:淋巴结内见Paget样细胞浸润。诊断:棘层松解浸润性原发性乳房外Paget病。     

透明细胞鲍温病1例

报告1例透明细胞鲍温病。患者女,52岁。左上胸部出现一黄豆大小红斑3年,缓慢增大至1 cm×2 cm,伴瘙痒、疼痛。皮损组织病理:表皮角化过度伴角化不全,棘层肥厚,棘细胞排列紊乱,可见角化不良细胞,部分细胞具有异型性,核大深染,可见散在病理性核分裂象,棘层上部的细胞胞质淡染,在核周呈明显空泡状,基底层完整,真皮浅层见慢性炎性细胞浸润。诊断:透明细胞鲍温病。手术切除。随访1年,无复发。     

光线性角化病132例临床及组织病理分析

对132例光线性角化病进行临床及组织病理分析.男64例,女68例,平均年龄(62.26±14.10)岁,皮损发生于头面部及颈部,临床表现多为肤色或淡褐色角化性斑丘疹,上覆粘着性鳞屑,皮损周围皮肤可见萎缩、毛细血管扩张或淡黄色斑等慢性光损伤的表现.皮损绀织病理特点包括角化过度、角化不全,基底层甚至棘层不典型角质形成细胞增生,细胞排列紊乱,基底层不典型角质形成细胞呈芽蕾状伸人真皮乳头层,真皮浅层嗜碱性变,炎性细胞浸润.组织病理分型主要是肥厚型和萎缩型.     

日光角化病继发鳞癌1例

报告1例日光角化病继发鳞癌。患者男,82岁。四肢灰褐色角化性丘疹2年,右小腿皮损明显增生为痛性结节伴溃疡20天。左小腿组织病理同时具有日光角化病和鳞癌特点表皮角化过度柱和角化不全柱交替出现,颗粒层灶性增厚,棘层肥厚,棘细胞排列紊乱,胞核有间变,表皮突的芽蕾突向真皮浅层,真皮浅层见大小不等的鳞状细胞团和角珠,细胞呈异型性,可见核分裂相,真皮浅层炎细胞浸润。提示日光角化病和鳞癌关系密切。     

儿童多发性口腔尖锐湿疣

患儿女,9岁。因下唇赘生物2年,手术切除后复发并增多1个月就诊。皮肤科检查:牙龈、下唇、舌体中部可见数枚米粒至黄豆大赘生物、色淡红、表面粗糙。牙龈皮损组织病理检查示角化过度,表皮乳头瘤样增生,表皮颗粒层及棘层上部见多量凹空细胞,真皮浅层少量淋巴细胞浸润。免疫组化染色示棘层中上部的细胞核P16呈阳性。原位杂交:人乳头瘤病毒(HPV)6型阳性,诊断:口腔多发尖锐湿疣。     

趾间人乳头瘤病毒16,18阳性鲍恩样丘疹病

报告1例趾间鲍恩样丘疹病(BP)。患者男,26岁,双足趾间斑疹4个月余。皮肤科检查:双足第三、四趾间均可见青灰色斑疹,外生殖器部位未见新生物、糜烂及溃疡。皮肤镜检查:皮肤镜下可见褐色斑及鳞屑,表面可见少许小球状血管。皮损组织病理检查:表皮角化过度伴角化不全,不规则增生,表皮全层细胞排列紊乱,大小不一,可见异常核分裂象及细胞空泡化;真皮浅层有淋巴细胞及组织细胞浸润。人乳头瘤病毒(HPV)原位杂交检测:HPV16及HPV18均(+),HPV6及HPV11均(-)。结合皮损组织病理检查及HPV检测,诊断为鲍恩样丘疹病。     

伴持久性色素斑块的成人Still病一例

56岁男性患者,反复高热,胸腹部持久性色素斑块伴瘙痒7个月.皮肤科情况:胸腹部见大致对称分布的色素沉着性苔藓样斑块.皮损组织病理示:表皮角化过度伴角化不全,棘层轻度肥厚,棘层上部可见散在角化不良细胞,真皮浅层可见嗜色素细胞及色素颗粒.诊断:伴持久性色素斑块的成人Still病.     

脂溢性角化病并发日光性角化病及基底细胞癌1例

患者女,85岁。右前臂伸侧出现一花生米大暗红色结节2年。皮损组织病理示:(1)突起部分:表皮局部糜烂,真皮可见由基底细胞组成的巢状肿瘤团块,癌巢周边的基底细胞呈栅栏状排列;(2)蒂部周围:棘层下方细胞排列紊乱,有异型性,部分区域表皮全层异型,基底层非典型细胞呈芽蕾状增生,伸向真皮上部。真皮浅层胶原纤维嗜碱性变,并有较多的淋巴细胞浸润;(3)外围黑褐色斑块皮损:角化过度、棘层肥厚、基底细胞呈乳头瘤样增生,瘤边界平坦,下界与皮肤基底层相平。诊断:脂溢性角化病并发日光性角化病及基底细胞癌。     

角化性皮肤病

20100153光线性角化病132例临床及组织病理分析/廖文俊(四军大附属西京医院全军皮研所),樊平申,王雷…∥临床皮肤科杂志.-2009,38(7).-423～426对132例光线性角化病进行临床及组织病理分析。男64例,女68例,皮损发生于面部及颈部,临床表现多为肤色或褐色角化性丘疹,上覆磷屑,皮损周围皮肤可见萎缩、毛细血管扩张或淡黄色斑等慢性光损伤的表现。皮损组织病理特点为角化过度、角化不全,基底层至棘层不典型角质形成细胞增生,细胞排列紊乱,基底层不典型角质形成细胞呈芽蕾状伸入真皮乳头层,真皮浅层嗜碱性病变,炎性细胞浸润。组织病理分型主要为肥厚型和萎缩型。有关光线性角化病的性质还存在争议     

疣型外阴上皮内瘤变1例

患者女,64岁。左侧腹股沟赘生物6年。皮肤科情况:左侧腹股沟见一约4cm×3cm大小肉红色赘生物,呈菜花状隆起,边界清楚,有蒂,表面粗糙,湿润,质脆,赘生物周围有暗红色斑疹。皮损组织病理示:角化过度,伴角化不全,真皮乳头瘤样增生,表皮颗粒层及棘层上部见多量凹空细胞,棘层内见多量不典型增生的细胞,可见病理核分裂相。真皮浅层见少量淋巴细胞浸润。行HPV分型检查示:高危型HPV病毒51亚型。诊断:疣型外阴上皮内瘤变(VIN)。     

Detection of human papillomavirus (HPV) DNA in oral squamous cell carcinomas by in situ hybridization and polymerase chain reaction

Summary A series of 156 formalin-fixed, paraffin-embedded biopsies from 40 patients with surgically-treated oral squamous cell carcinomas was analysed for the presence of human papillomavirus (HPV) infection by histopathological evaluation, in situ DNA hybridization and polymerase chain reaction (PCR). Epithelial changes suggesting a HPV lesion within, or adjacent to, the carcinoma lesions were found in 16 out of 40 patients (40%). Morphological signs of a flat HPV lesion were found in four cases (10%), those of inverted type in three cases (7.5%), and those of papillary type in nine cases (22.5%). HPV DNA was demonstrated in one of the lesions by in situ hybridization with biotin-labelled DNA cocktail probe containing HPV types 6, 11, 16 and 18. With the PCR technique, samples from 11 (27.5%) of the 40 patients proved to contain HPV DNA. Of these, HPV 6 was demonstrated in one case, HPV 16 in ten cases and HPV 18 in one case. HPV DNA was exclusively detected in the biopsies showing carcinoma tissue or its adjacent precancer lesions. No viral DNA was found in the biopsies derived from the tumour-free resection margins. These results provide further evidence to support the concept of HPV involvement in the aetiology of oral squamous cell carcinomas, most probably acting synergistically with other carcinogens.     

Hidradenoma papilliferum with oxyphilic metaplasia: a clinicopathological study of 18 cases, including detection of human papillomavirus

Reported here are 18 cases of hidradenoma papilliferum with oxyphilic metaplasia. All patients were women ranging in age from 29 to 74 years. Each presented clinically with a small, solitary tumor in the anogenital region. Microscopically, in addition to classic histopathological features, in every case there was oxyphilic metaplasia of the constituent epithelial cells. This finding could be likened to apocrine metaplasia, a term used in breast pathology. Other histopathological findings observed in this series, analogous to benign breast disease, included sclerosing adenosis-like changes, atypical apocrine adenosis-like changes, changes corresponding to usual ductal epithelial hyperplasia, epitheliomatosis with a streaming growth pattern, lamprocyte-like changes, clear cell change of the myoepithelium, foamy histiocyte reaction, and stromal fibrosis. Immunohistochemistry inferred that in the majority of cases oxyphilic metaplasia resulted from more lysosomes, whereas numerous mitochondria were detected in only 3 cases. Using 2 different PCR methods we identified HPV in 4 of 15 cases of hidradenoma with oxyphilic metaplasia. In addition, HPV was detected in 3 of 16 conventional papillary hidradenomas used as a control group. The following HPV types were identified: 16, 31, 33, 53, and 56. The last type was found in 5 cases. More than one HPV type from a single lesion was seen in 5 cases. Our observations are consistent with previous publications noting similarities between tumors of the breast and sweat glands. Oxyphilic metaplasia, areas with solid growth, and changes simulating atypical apocrine adenosis are rare and poorly recognized in hidradenoma papilliferum and may cause diagnostic difficulties; in our cases several submitting pathologists suspected malignancy. A causal role for HPV in hidradenoma papilliferum cannot be confirmed from our results, as the detection rate is too low. The exact role of the HPV in etiology and pathogenesis of this neoplasm has yet to be determined.     

Apoptosis in Bowen's disease. An ultrastructural study

We performed ultrastructural studies of apoptosis (previously referred to as "malignant dyskeratosis") in a case of genital Bowen's carcinoma in which human papillomavirus (HPV) type 33 genome was identified and in two cases of cutaneous Bowen's disease with no detectable viral DNA; herein we present the sequential stages in the development of apoptotic bodies. The apoptotic process in the HPV-containing genital Bowen's disease was similar to that in the cutaneous lesions with no detectable HPV. The presence of a large number of apoptotic bodies in Bowen's disease may be responsible for the slow progression and noninvasive growth of this carcinoma in situ.     

Reactive syringofibroadenomatous hyperplasia in peristomal skin with formation of hybrid epidermal-colonic mucosa glandular structures, intraepidermal areas of sebaceous differentiation, induction of hair follicles, and features of human papillomavirus infection: a diagnostic pitfall

We report a case of reactive syringofibroadenomatous hyperplasia in peristomal skin. The patient was a 62-year-old woman who had undergone abdominoperineal resection of the rectum for rectal adenocarcinoma with subsequent colostomy 2 years earlier. Clinically, a nodule and small, whitish, warty lesions developed at the outer margin of the stoma extending onto the adjacent skin. Following a clinical suspicion of adenocarcinoma, recurrent at the colostomy site, a 5 x 4 x 3-cm excision of the peristomal skin and the affected portion of the stoma was performed and submitted for histologic examination. The biopsy revealed a peculiar composite lesion of reactive syringofibroadenomatous hyperplasia and the excised part of the stoma. Several unusual histopathological features were detected in the syringofibroadenomatous part of the lesion such as the formation of plentiful hybrid epidermal-colonic mucosa glandular structures, intraepidermal areas of sebaceous differentiation, koilocytic changes, induction of rudimentary hair follicles, and intradermal mucinous lakes. The cellular composition of the glandular structures was mainly similar to that seen in a normal colonic mucosa epithelium. They also contained occasional Paneth cells. Being located at a distance from the stoma, these accentuated colonic mucosa epithelial glands reaching the epidermis may be a diagnostic pitfall prompting the consideration of adenocarcinoma involving the stoma. The rudimentary follicles and sebaceous differentiation were probably induced by an altered stroma and/or human papillomavirus (HPV): HPV, type 36 was identified by PCR using consensus primers followed by sequencing of the PCR products.     

Human papillomavirus type 59 identified in a verrucous cyst of the flank

The verrucous cyst is a non-plantar epidermoid cyst with histopathological features of human papillomavirus (HPV) infection, including papillomatosis and hypergranulosis of the cyst lining. We report the first case of a verrucous cyst demonstrating not only the histopathological and immunohistochemical features of HPV infection, but also homology with HPV type 59 on HPV genotyping. A 28-year-old male developed a palpable mass in his right flank. Histological examination revealed an intradermal cyst lined by an acanthotic and papillomatous squamous epithelium with prominent keratohyaline granules and squamous eddies. The keratinocyte nuclei were positive for papillomavirus antigens on immunohistochemistry and HPV genotyping demonstrated a homology to HPV type 59, a high-risk genital type. Although we only experienced a single case with such a finding, we suggest that it may be necessary to subject patients with verrucous cysts to a closer follow up for better characterization of their clinical behavior.     

Papular acantholytic dyskeratosis of the anogenital area with positive direct immunofluorescence results

Acantholytic dyskeratosis is a distinct histological pattern characterized by hyperkeratotic and parakeratotic epidermis with intraepidermal clefts harbouring acantholytic and dyskeratotic keratinocytes. This histopathological pattern is uncommon in dermatoses of the anogenital region. We report a 30-year-old woman who had numerous smooth whitish papules on the labia majora, perineum and perianal region, which coalesced into plaques in some areas. Microscopically, the lesions showed prominent suprabasal and intraspinous acantholysis with dyskeratotic keratinocytes. Direct immunofluorescence examination revealed intercellular Ig G and C(3) within the epidermis. We were unable to find a similar case of papular acantholytic dyskeratosis of the anogenital area with positive direct immunofluorescence findings reported in the literature, thus in this report, the clinicopathological features of a unique case are presented.     

Multiple Bowen's disease of the fingers

We describe herein a case of multiple Bowen's disease that developed on the left hand fingers of an 80-year-old male patient who had practiced as a gynecologist. PCR-based analysis indicated that the lesion contained human papillomavirus (HPV) type 18 DNA. Topical application of bleomycin and liquid nitrogen cryotherapy were effective in treating this case. After treatment, histopathologically no atypical cells were seen throughout the epidermis.     

Herpes simplex virus-induced plasmacytic atypia

The clinical and histopathological features of cutaneous herpes simplex virus (HSV) infection have been well described. Genital herpetic infections are largely induced by HSV type 2, but 30% of cases can be caused by HSV type 1. Immunocompromised patients are known to exhibit atypical patterns of clinical presentation with variable lesion morphology and anatomic location. A subset of patients may show morphology such as nodules or verrucous lesions. Analogously, some biopsy specimens may show unusual microscopical features, such as a lack of keratinocyte cytopathology, lymphocyte infiltration or vasculopathic changes that are expected irrespective of the patient's immune status. We present the case of a patient carrying a previous diagnosis of pemphigus vulgaris, status posttreatment with methotrexate and prednisone, who developed a perineal ulcer exhibiting significant numbers of plasma cells, many of which were cytologically atypical. This morphology was suggestive of a hematopoietic malignancy. Immunoperoxidase staining for HSV decorated a focal collection of keratinocytes that lacked appreciable viral changes expected of HSV infection.     

Pagetoid dyskeratosis of the prepuce. An incidental histologic finding resembling extramammary Paget's disease

BACKGROUND: Pale cells resembling those of paget's disease have been seen as an incidental finding within the epidermis in a variety of benign papules most commonly located in intertriginous areas. This lesion, called pagetoid dyskeratosis, is considered a reactive process in which a small part of the normal population of keratinocytes is induced to proliferate. Among the inductors friction is suspected. As far as we know, these cells have not been reported in the penis. METHODS: Here we describe the location of the lesion in the foreskin and the incidence of this lesion in a group of 281 unselected patients surgically treated for phimosis. In selected cases histochemical staining and immunohistochemical studies were performed. RESULTS: Pagetoid dyskeratosis was found in 105 cases (37.4%) but only in 5 cases (1.8%) the lesion was conspicuous. The cells of pagetoid dyskeratosis show an immunohistochemical profile different from the surrounding keratinocytes characterized by premature keratinization. Pagetoid dyskeratosis cells must be distinguished from the artefactual clear cells of the epidermis, from reactive melanocytes, and from pale-cell acanthosis. In cases in which pagetoid dyskeratosis shows a florid expression there is a hazard of overdiagnosis to the patient. The main differential diagnosis includes extramammary Paget's disease, pagetoid squamous cell carcinoma in situ, epidermotropic metastasis, superficial spreading malignant melanoma, clear cell papulosis, and penile koilocytoses. CONCLUSIONS: The pathologist should be familiar with the histologic features of pagetoid dyskeratosis in the foreskin in order to avoid misdiagnosis and unnecessary treatment. Routine histologic study is usually sufficient to identify the lesion.     

Ichthyosis follicularis with alopecia and photophobia in a mother and daughter

A mother and daughter having ichthyosis follicularis with alopecia and photophobia (IFAP) are reported, with histopathological and electron microscopic findings. We have followed the clinical course of the mother for 26 years since she was 5 years old, and the daughter since birth. They have had almost all the classical and some of the minor symptoms of IFAP, including severe photophobia, extensive non-inflammatory follicular hyperkeratosis, generalized non-scarring alopecia, hyperkeratosis of the extensor aspect of the four extremities, nail deformity and recurrent cheilitis. In addition, their facial appearance greatly resembles that of previously reported patients. A consistent feature in the mother was florid keratotic inflammatory eruptions on the genital region during each of her pregnancies, which rapidly improved after the delivery. Skin biopsy of the genital lesion showed marked acanthosis with dyskeratosis and spongiotic changes. The electron microscopic examination of diseased skin showed damaged desmosomes with spongiosis. No obvious changes were found in normal appearing skin.