Granuloma multiforme

CASE 1: A 51-year-old woman presented with skin-colored annular lesions on the upper chest, neck, and dorsa of the hands of 1-year duration. The lesions initially started as small papular lesions, which gradually evolved to form large annular and polycyclic lesions. Initially, the lesions were associated with a burning sensation and pruritus. She had no other systemic complaints. Examination revealed 5-6 annular, polycyclic lesions distributed over the upper chest, neck, and dorsa of both hands, varying in size from 1 to 5 cm. All the lesions had a prominent erythematous to skin-colored, irregular, papular border which was firm in consistency (Figs 1 and 2). Central clearing and minimal atrophy were evident in larger lesions. There was no sensory loss or peripheral nerve thickening. Clinical possibilities entertained were granuloma annulare, granuloma multiforme, and annular sarcoid. Routine investigations, including hemogram, renal and liver functions, blood sugar levels, chest X-ray, and urine examination, were within normal limits. A skin biopsy taken from the edge of a lesion revealed foci of collagen degeneration surrounded by an inflammatory infiltrate composed of many histiocytes and multinucleated giant cells. In addition, there were perivascular and periadnexal lymphocytic aggregates. No acid-fast bacilli (AFB) were detected. These findings were consistent with a diagnosis of granuloma multiforme (Fig. 3). CASE 2: A 47-year-old man presented with annular skin-colored lesions associated with a mild burning sensation of 8 months' duration. On examination, 2-3 annular, arciform lesions were distributed over the upper chest and neck. The lesions ranged in size from 2 to 7 cm in diameter, were irregular in shape, and were rimmed by a well-defined raised papular border. Again, there was no sensory loss or peripheral nerve thickening. Histopathology of the skin from the edge of the lesion showed multiple areas of histiocytic granulomas with focal necrobiosis and prominent multinucleated giant cells, findings consistent with granuloma multiforme.     

Giant congenital melanocytic naevus associated with Dandy–Walker malformation, lipomatosis and hemihypertrophy of the leg

A 30-year-old woman presented with congenital hyperpigmented plaques and multiple tumoral lesions. Her left leg was hypertrophic, although the bones were normal. Dermatological examination revealed hyperpigmented macules and plaques with hair on the legs, abdominal and lumbar areas (covering > 60% of the total body surface) and multiple naevi on the face, arms, back and chest. Multiple soft masses of various sizes, some of which colocalized with hyperpigmented plaques, were seen on the trunk and legs. Malignant melanoma was excluded by histopathological examinations of multiple biopsy specimens obtained from the pigmented lesions. Histopathological examination of one of the soft masses showed that it was a lipoma. Cranial magnetic resonance imaging and computed tomography scans showed an enlarged fouth ventricule and vermis hypoplasia (Dandy–Walker malformation; DWM). Neurocutaneous melanosis is a rare combined abnormality of the skin and central nervous system. A few case reports relating to the coexistence of giant congenital melanocytic naevus, lipomatosis and hemihypertrophy have been published in the literature. We report this very rare case of giant melanocytic naevus with lipomatosis, hemihypertrophy of the leg, and DWM.     

Coexistence of Basal Cell Carcinomas and Multiple Sebaceous Gland Hyperplasias in a Cyclosporine (Ciclosporin)-Treated Renal Transplant Recipient

A 55-year-old man presented with multiple, asymptomatic, yellowish papules on his face with a 4-year history, and two non-healing tumoral lesions on his nose with a 7-month history. He was a renal transplant recipient and had been treated with cyclosporine (ciclosporin) for 9 years. A biopsy from the asymptomatic, yellowish papule on the face showed sebaceous gland hyperplasia, and biopsies from the lesions on the nose revealed basal cell carcinomas. The lesions on the nose were excised. Sebaceous gland hyperplasia and skin cancers are among the cutaneous neoplasms observed in renal transplant recipients receiving cyclosporine. To our knowledge, this is the third reported case of the coexistence of basal cell carcinomas and multiple sebaceous gland hyperplasias in a cyclosporine-treated renal transplant recipient.     

Association of juvenile xanthogranuloma with café-au-lait macules.

A 2-year-old boy was referred to the dermatology services for the evaluation of yellowish-brown raised lesions over the face of 3 months' duration. In addition, he had multiple asymptomatic hyperpigmented spots over the trunk, which his parents had noticed at the time of birth. His physical and mental milestones of development were normal. Apart from the cutaneous lesions, the child was otherwise well and there was no history of seizures. He was the only child born to nonconsanguineous parents. No family history of similar lesions was available. The boy weighed 14 kg, had a height of 88 cm, and a head circumference of 48 cm. General physical and systemic examination was normal. Cutaneous examination revealed multiple, yellowish-brown papules over the forehead, sides of the face, and shoulders. The papules measured 0.5-0.8 cm in diameter, were discrete, well defined, oval and flat topped without any surface changes (Fig. 1). Multiple café-au-lait macules varying from 0.5 to 3.0 cm in diameter were present over the trunk (Fig. 2). There was no freckling in the axillary or the inguinal regions and no neurofibromas were present. A diagnosis of juvenile xanthogranuloma was considered. Complete blood counts, urine analysis, hepatic and renal function tests, and serum lipid levels were normal. A skin biopsy from a papule over the shoulder revealed a dense infiltrate in the dermis underlying a normal epidermis. The infiltrate was well demarcated and comprised lymphocytes, eosinophils, and foamy histiocytes along with Touton giant cells and proliferating fibroblasts. This confirmed the diagnosis of juvenile xanthogranuloma. The parents were informed about the benign and self-limiting nature of the disorder and were advised to bring the child for regular follow-up.     

乳房外Paget病一例

患者男,54岁,阴囊及股部赘生物4个月.皮肤科检查:右侧腹股沟及阴囊见多个红色或皮色的结节和肿块,直径为0.5 cm×0.5 cm～8 cm×8 cm,呈疣状或圆顶状,部分表面糜烂,有少许脓性分泌物,伴恶臭.该患者在以往的皮损基础上出现新生物,伴有恶臭,根据患者的临床表现及病史考虑为鳞状细胞癌,给予进一步检查,经皮损组织病理和免疫组化的检查诊断为原发性乳房外Paget病.实验室检查HPV为阴性.

Abstract：

A 54-year-old man presented with neoplasms on the groin and scrotum for 4 months.Physical examination revealed multiple, erythematous or skin-colored, verrucous-like or dome-shaped nodules and neoplasms measuring 0.5 to 8 cm in diameter on the right groin and scrotum. Erosions were observed on the surface of some lesions with purulent secretion and stench. The neoplasms arose in previous lesions with stench. The patient was initially diagnosed with squamous cell carcinoma according to the clinical manifestation and medical history, but histopathological and immunohistochemical examination confirmed a diagnosis of primary extra-mammary Paget's disease. PCR was negative for low- or high-risk human papilloma virus types in this patient.     

面部扁平湿疣1例

患者女,48岁。面部扁平丘疹、斑块5个月,加重伴肛周丘疹1个月。皮肤科情况:面部见30余个暗红色直径1.0～2.0cm的扁平丘疹。鼻周和下颏部丘疹融合成环状斑块,表面覆黄色脓痂,浸润。其间散在分布少许豆粒大小暗红色丘疹。肛周见一扁豆大小的暗红色丘疹,上覆灰白色膜。TRUST1:32,TPPA1:1280。皮损组织病理示:表皮增生,真皮血管内皮细胞肿胀,真皮层大量淋巴细胞、浆细胞、中性粒细胞浸润。诊断:二期梅毒。予苄星青霉素240万U分两侧臀部肌注,1次/周,连续3周。3周后皮疹大部分消退。     

Linear arrangement of hypopigmented Spitz nevi on the ear after trauma

A 10‐year‐old boy had multiple papules after surgery on a primary lesion on his left ear. The papules were pink and showed a linear arrangement around the helix. Histopathological examination of two separate lesions showed proliferation of epithelioid cells in the dermis and some of them formed nests. No melanin was found in the epithelioid cells, and immunohistochemistry staining with S100, HMB45 and Melan‐A were positive in the neoplasm cells. According to the clinical and histopathological characteristics, it was diagnosed as hypopigmented Spitz nevi with linear arrangement after trauma.     

环状肉芽肿43例分析

目的 探讨局限型、泛发型环状肉芽肿诱发因素、临床、组织学改变及治疗情况。方法 回顾性分析24例局限型及19例泛发型环状肉芽肿患者临床资料。结果 两型中尤其是泛发型中部分患者病情与日晒明显相关。局限型皮损常局限于手、颈后、足背，小丘疹排列成环状，直径1～2cm，最大7cm；泛发型皮损较小，0．5～1cm，常泛发。组织学改变以栅状肉芽肿最多见，占61．9％，散在性组织细胞浸润次之，占38．1％．两者均以局限型较泛发型为多。局限型以避光、局部外用糖皮质激素、冷冻、手术切除为主．必要时口服维生素E、烟酰胺、顽固者口服小剂量氯喹可控制病情。泛发型以系统用药为主，氯喹、氨苯砜、糖皮质激素及异维A酸可取得满意疗效，但部分停药后易复发。结论日光照射可能在泛发型环状肉芽肿发病中起着一定的作用；组织学改变以栅状肉芽肿最多见；局限型以局部治疗为主，泛发型以系统治疗为主。     

儿童脑回状皮脂腺痣14例临床分析

目的 探讨脑回状皮脂腺痣的临床表现、病理特征及手术时机.方法 回顾2014年6月至2019年12月北京儿童医院皮肤科诊治的14例脑回状皮脂腺痣患儿的临床特点、组织病理学特征以及手术治疗时机.结果 14例患儿中男10例,女4例,出生即有皮损,单发且位于头面部,外观与脑回结构相似,平均直径4.79 cm.所有患儿系统检查均...     

A case of lymphangitic sporotrichosis occurring on both forearms with a published work review of cases of bilateral sporotrichosis in Japan

The patient, 56-year-old man who was working as a clerk and a farmer, presented with nodules that had appeared on the dorsa of both his hands 3 months earlier. At the first examination, there were multiple dark-red nodules scattered on the fingers, dorsa and wrists of both hands. The nodules were up to 3 cm in diameter and had crusts in the incenters. The patient was suspected to suffer from prurigo and was subsequently treated with topical steroid, but the nodules did not respond. Therefore, a skin biopsy and fungal culture were performed, and the patient was finally diagnosed as having bilateral multiple sporotrichosis. He was then successfully treated with local thermotherapy and oral potassium iodide. Bilaterally-distributed lymphangitic sporotrichosis is very rare and often difficult to diagnose. Careful attention is required to avoid misdiagnosis.     

汗孔角化性小汗腺孔和真皮导管痣

报告1例汗孔角化性小汗腺孔和真皮导管痣。患儿男,7岁。因手足和左膝关节内侧角化性丘疹和黑头粉刺样丘疹7年就诊。部分丘疹呈线状或带状排列（主要位于手足侧缘）。组织病理检查可见多个黑头粉刺样的表皮凹陷,内有角化不全柱。有些角化不全柱内可见扭曲的末端小汗腺导管穿过。角化不全柱的底部颗粒层变薄或消失,角质形成细胞空泡化,并可见角化不良细胞。角化不全柱下方的真皮内可见小汗腺导管。     

头面部血管肉瘤1例报告

报道一例血管肉瘤。患者为70岁老年男性。临床表现为头皮及面部暗红色浸润性斑块伴自发破溃出血。组织病理检查提示血管肉瘤。同时，作了免疫组化研究。     

One stone,two birds: managing multiple common warts on hands and face by local hyperthermia

A man developed with multiple warts on his hands and the inner canthus of his left eye. We applied local hyperthermia on a single target lesion on his hand at a surface temperature of 44°C for 30 minutes on Days 1, 2, 3, 17, and 18. All the lesions treated with or without heat cleared 8 weeks after the last treatment. Treatment of a target lesion resolved all other untreated lesions, a fact suggestive that local hyperthermia could induce activation of specific immunity against human papillomavirus on the lesional skin, which lead to resolution of all the warts.     

Morbihan病一例

患者，男，76岁。面部红斑、肿胀1年。皮肤科查体：中上面部对称性、弥漫性分布的红斑及非凹陷性水肿，皮损边界不清。皮损组织病理学示表皮大致正常，真皮浅层血管周围淋巴细胞为主的炎性细胞浸润。结合临床特点及组织病理学及特殊染色表现诊断为Morbihan病，目前长期随访中。     

肿瘤样钙质沉着症

报告1例肿瘤样钙质沉着症.患儿男,8岁.全身结节、肿块1年余.皮肤科检杳:颈部、躯干、四肢、臀部及手足可见约百个大小不一的结节和肿块,部分融合,边界清晰,少数包块顶端破溃,流出石灰状物质.皮损组织病理检查示真皮及皮下组织大量颗粒状灶性钙沉积.诊断:肿瘤样钙质沉着症.     

Steatocystoma multiplex localized only in the face

A 60-year-old man presented with lesions on his face to the Department of Dermatology, Wonju Christian Hospital on November 10, 1994. There were over 10, slightly elevated, flat-topped, yellowish colored, subcutaneous nodules on the face (Fig. 1). The lesions had first appeared on the left upper eyebrow at the age of 58 years, and since then they had abruptly increased in size and number and had spread into both temporal areas. Their size varied from 3 to 10 mm in diameter. No other lesions were observed on the extremities or trunk. The patient's past and family history were noncontributory and the results of routine laboratory findings were within normal limits or were negative.
Histopathologic examination of the lesion on the forehead showed a folded empty cyst in the mid-dermis. The wall of the cyst was composed of two or three layers of squamous epithelium without a granular layer, and they contained flattened sebaceous lobules of varying sizes (Fig. 2). These findings were consistent with steatocystoma. Some of the lesions were removed, but the patient refused further treatment.     

砷角化病并发多发性鲍温病1例

患者男,61岁。双手和足跖皮肤角化性丘疹37年,双手斑块破溃7年。曾因银屑病连续服用某医院自制药丸1年。皮损组织病理示:表皮角化过度伴角化不全,棘层肥厚,表皮内细胞异型性,散在不典型核分裂相和个别角化不良细胞。诊断:砷角化病并发多发性鲍温病。     

Molluscum contagiosum-like lesions in lepromatous leprosy

A 32-year-old male patient presented with multiple, asymptomatic, papulonodular lesions some of which were umbilicated simulating the clinical features of molluscum contagiosum. On examination the patient was found to be suffering from lepromatous leprosy. Slit-skin smear showed a BI of 6+ and histopathological examination of the nodular lesion showed features of lepromatous leprosy. The patient was treated with MDT-MB and improved remarkably in a few months.     

A Rare Case of Plantar Epithelioma Cuniculatum Arising from a Wart

A 68-year-old man, a known case of hypertension, coronary artery disease and old cardiovascular accident with right-sided hemiplegia, came with the chief complaints of a large cauliflower like growth with pus discharge on the left heel since 15 years. The patient had sustained a penetrating injury by a thorn on the left heel region few days before the lesion appeared. Dermatological examination revealed a single verrucous lesion measuring 7 × 7 cm on the left heel region associated with discharge of foul smelling cheesy material. There was also a enlarged right inguinal lymph node which was non-tender, firm, measuring 2 cm in diameter with normal overlying skin. X-ray left ankle was done which showed some soft tissue swelling. A skin biopsy showed hyperkeratosis, acanthosis and parakeratosis. Elongated rete ridges with keratinocyte hyperplasia, forming a large mass pressing on the underlying dermis were seen. There was formation of multiple large keratin filled invaginations and crypts. No atypical cells were seen. Based on history, clinical examination and investigations, a diagnosis of epithelium cuniculatum type of verrucous squamous cell carcinoma was made. A wide excision with a flap cover was performed in consultation with the oncosurgeon and the excision sample was sent for histopathological re-examination, which confirmed the diagnosis of epithelioma cuniculatum.     

Nevus lipomatosus superficialis on the face

A 17-year-old woman presented with asymptomatic, multiple plaques around the right mandibular area of the face extending from the cheek to the neck. These lesions had gradually increased in size and number for 8 years, and then were stationary. When she came to us, there were a few skin-colored or pale yellowish papules and plaques ranging from 0.2 to 1 cm in diameter (Fig. 1). The patient stated that initially the papules developed discretely, and then these papules were confluent and grouped slowly with new lesions. The most recent lesions were skin-colored papules which were soft to the touch, the older lesions were yellowish plaques with firm consistency and a smooth shiny surface. The patient's general condition had been good at the initial visit and the laboratory findings including blood cell counts, urinalysis, and routine blood chemistry tests were all within normal limits. A roentgenogram of the mandibular area did not reveal any significant findings. The presumptive clinical diagnosis of connective tissue nevus was made.
Histologic examination of biopsy specimen taken from the neck showed lobules of fat cells embedded among the collagen bundles at the level of papillary dermis and collagen bundles were proliferated irregularly (Fig. 2). The individual fat cells were mature and of normal size. The lobules were not encapsulated and did not communicate with the subcutaneous fat tissue. The epidermal changes of the lesions consisted of mild hyperkeratosis with follicular plugging and slightly increased numbers of capillaries were observed around the dermal fat cells (Fig. 3). Therefore, it was diagnosed as nevus lipomatosus superficialis (NLS) which developed multiple lesions very rarely on the face. After surgical removal of the lesion, no evidence of recurrence has been observed 1 year postoperatively.