原发性皮肤毛霉病一例

患者男,52岁。鼻背部红斑并皮下结节,软腭溃烂,偶有疼痛并伴鼻出血3年余,左眼眶下出现0.8 cm × 0.4 cm大小结节1月余。患者曾接受伊曲康唑、氟康唑等抗真菌药物治疗,无满意疗效。患者一般情况好,既往有肺结核病史,Ｔ淋巴细胞亚群示CD3减少。皮损组织病理检查示真皮中下层有炎细胞及多核巨细胞浸润,HE和PAS染色见粗大较短的无隔菌丝。经真菌培养及分子生物学鉴定为多变根毛霉。该临床分离株在体外对两性霉素B敏感,对伊曲康唑、酮康唑、氟康唑均耐药。经两性霉素B治疗6周后,患者皮损明显消退,两性霉素B总用量为821 mg。治疗结束后,手术活检取鼻背部及软腭组织做真菌培养和组织病理检查。组织病理中炎性细胞明显减少,未发现菌丝。26 ℃、32 ℃（± 3 ℃）中恒温培养3周均未见真菌生长。据此,该患者已达到临床、组织病理学和真菌学治愈。治疗期间自觉食欲差,有药物性肾功能异常、一过性低血钾。     

多变根毛霉引起原发皮肤毛霉病1例

报告1例由多变根毛霉引起的皮肤毛莓病。患者男．33岁。右上肢外伤后弥漫性斑块伴肿胀、化脓7年余。免疫功能检测CD4^ T细胞略低(28％)，皮损组织病理检查示真皮中下层有炎细胞及多核巨细胞浸润，并见粗大较短的无隔菌丝经真菌培养菌种鉴定为多变根毛霉患者曾接受伊曲康唑、特比荼芬和氟康唑等抗真菌药物治疗．均无满意疗效．最后经用两性霉素B治疗痊愈．随访6个月未复发。     

多变根毛霉致面部皮肤毛霉病一例

患者女,45岁.面部皮疹3年不愈.3年前鼻部出现一红色豌豆大小结节,曾在当地医院行手术切除,术后再次出现新发结节,且逐渐扩大.2007年11月在我院耳鼻喉科就诊,行手术活检,当时病理科报告为感染性肉芽肿,结核不能排除.耳鼻喉科拟诊皮肤结核,给予异烟肼,利福平抗结核治疗6个月,疗效不佳,皮疹范围扩大.     

国内首例总状共头霉所致原发性皮肤毛霉病及文献复习

目的:报道1例总状共头霉所致的原发性皮肤毛霉病并进行文献复习。方法:患者,女,67岁。反复右踝结节、渗液伴疼痛3年。取患者皮损进行真菌镜检及培养,对皮损进行组织病理检查,并对分离菌种行r DNA ITS测序鉴定。结果:显微镜下可见宽而无分隔、成直角分支的菌丝。培养见白色菌落生长,生长较快,菌落呈疏松絮状,灰褐色绒毛状,边缘呈羊毛状向外延伸。皮损组织病理示:真皮全层弥漫性炎细胞浸润,散在多核巨细胞,可见大量团块状菌丝。PAS和嗜银染色阳性。分子测序鉴定为总状共头霉。确诊后外科结合伊曲康唑等治疗取得良好效果。结论:该病例致病菌为总状共头霉,外科治疗结合伊曲康唑治疗有效。     

Primary cutaneous infection by Mycobacterium avium: a case report and literature review

Nontuberculous mycobacteria (NTM) are becoming increasingly important cutaneous pathogens as the number of susceptible patients increases. Nevertheless, primary cutaneous infection by one particular species, Mycobacterium avium complex (MAC), remains relatively unusual, particularly in immunocompetent patients. We review the English-language literature on primary cutaneous MAC in patients who were neither immunocompromised nor pharmacologically immunosuppressed. We offer an additional report of a healthy patient who presented to our clinic with primary cutaneous MAC following seemingly innocuous trauma to the leg.     

Primary cutaneous adenoid cystic carcinoma: a case report and literature review

Primary cutaneous adenoid cystic carcinoma (ACC) is a rare tumor, with less than 50 cases reported to date. We report an additional case of primary cutaneous ACC arising on the scalp of a 57-year-old woman. The clinical presentation, histologic findings, and subsequent treatment are described. A brief review of the literature is provided.     

Primary cutaneous coccidiodomycosis: case report and review of the literature

BACKGROUND: Coccidiodomycosis is a systemic infection caused by Coccidioides immitis, a dimorphic fungus endemic in the south of the USA and the north of Mexico. The disease usually affects the lungs. Primary cutaneous infection is extremely rare. We present a report of a patient with primary cutaneous infection located on the nose. To our knowledge, such a presentation has never previously been reported in the literature. OBSERVATIONS: The patient had a 3-cm-diameter elevated nodule with a verrucous aspect located on the tip of her nose. The histopathologic features of the lesion were consistent with coccidioidomycosis. CONCLUSIONS: To our knowledge, this is the first report of primary cutaneous coccidioidomycosis located on the tip of nose.     

Primary cutaneous adenosquamous carcinoma: a case report and review of the literature

BACKGROUND: Adenosquamous carcinoma (ASC) of skin is a rare but distinctive neoplasm that usually exhibits an aggressive course. To date, 13 well-documented and undisputed cases of primary cutaneous ASC have been reported. This term has been used for tumors with better prognosis, such as mucoepidermoid carcinomas and acantolytic squamous cell carcinomas, originating confusion. We report a primary cutaneous ASC and review the literature. METHODS: In this report a woman with primary ASC of the skin was studied. Histopathological examination and immunohistochemical stains were performed. RESULTS: The tumor had two components: conventional squamous cell carcinoma merging with adenocarcinoma. After a local recurrence and lymph node metastases, the patient has no evidence of disease 8 months later. CONCLUSIONS: Pathologists should reserve the term ASC for tumors exhibiting the above mentioned appearance. In such circumstances, a metastatic origin must always be excluded.     

肺部奴卡菌病并皮肤播散1例（附文献复习）

奴卡菌病是一种少见的皮肤和／或系统感染性疾病，主要由星形奴卡菌感染引起。笔者近期诊治一例，现报道如下，并复习近期文献报道，就奴卡菌病的临床表现、诊断、治疗及预后等做一简要分析，以供临床诊治参考。     

Primary cutaneous amoebiasis: case report with review of the literature

BACKGROUND: Primary cutaneous amoebiasis is a rare clinical entity. The lesions can be successfully treated if suspected and correctly diagnosed. We report an interesting case with review of the literature. METHODS: A 25-year-old man presenting with primary cutaneous amoebiasis with extensive involvement of the anterior abdominal wall is described. Correct diagnosis eluded us for 2 years. Clinical suspicion and a simple bedside test (wet drop preparation examination) were sufficient to diagnose the lesion. Successful treatment was achieved with oral Metronidazole followed by split skin grafting. Only six cases of primary cutaneous amoebiasis could be traced in the literature. CONCLUSIONS: Primary cutaneous amoebiasis is extremely rare. Diagnosis is usually not suspected because of its rarity. Cutaneous amoebiasis responds readily to proper treatment, yet, if unrecognized and neglected, produces significant morbidity and may be fatal.     

Primary cutaneous adenoid cystic carcinoma: a case report and review of the literature

Primary cutaneous adenoid cystic carcinoma is a rare cancer, with only 61 cases reported in the literature. We report an additional case and review the latest recommendations for workup and treatment.     

Primary cutaneous osteoblastic osteosarcoma: a case report and review of the current literature

Osteosarcoma is a malignant bone‐forming tumour that typically arises within the metaphysis of long bones. Extraskeletal osteosarcoma is a rare variant that usually arises in the deep soft tissues, especially in the legs. We report a 65‐year‐old white man with an ulcerated, nodular lesion of the forearm. Based on the histological features and immunohistochemical profile of the tumour, a diagnosis of osteoblastic osteosarcoma was made. Osteosarcoma arising in the skin is a rare condition that has seldom been reported in the English literature.     

Primary cutaneous meningioma of the scalp: a case report and review of literature

Meningiomas of the skin are rare tumors that can pose considerable diagnostic challenges to the pathologist. This study presents a case of primary cutaneous meningioma in a newly born baby girl that presents with a subcutaneous nodule on the left posterior occipital scalp. A Magnetic Resonance Imaging examination failed to detect any communication between the tumor site and the meninges. The mass was excised and intra -operatively, there was no evidence of connection between the tumor and the underlying tissues. Microscopically, the tumor was composed of banal looking, mitotically inactive spindle-shaped cells with a whorled configuration. Some cells were concentrically arranged around blood vessels. Immunohistochemical studies were positive for epithelial membrane antigen and vimentin. Immunostains for cytokeratin, S-100 protein, vascular (CD34 and CD31) and muscle markers (Desmin and smooth muscle actin) were negative. The diagnosis of cutaneous meningioma was established. A review of literature was presented.     

Erythrokeratoderma variabilis: case report and review of the literature

We report two patients, mother and daughter, with Erythrokeratoderma variabilis (EV). This rare genodermatosis is characterized by the presence of two components: migratory erythema and fixed hyperkeratosis. Our patients experienced symptomatic relief of pruritus associated with erythema with the use of an oral, low-sedating H₁antihistamine. Revision of the literature in order to allocate the frequency of pruritus in EV and discussion of this association will follow.     

Primary cutaneous mucormycosis (zygomycosis) caused by Apophysomyces elegans

A 53 year-old male diabetic presented with a month-old, painful ulcer with necrotic margins over the right thigh. Wound debridement was done twice and the ulcer showed recurrent growth of a white, cottony filamentous structure. Cutaneous mucormycosis was suspected and confirmed by histopathology and a culture isolate of Apophysomyces elegans . The patient was treated with liposomal amphotericin-B and itraconazole followed by partial thickness skin grafting, and then discharged after being prescribed posaconazole syrup for three weeks. Regular follow-up was done and during the last visit after six months following discharge, the ulcer was found to have healed well with no recurrence of the fungus.     

Primary cutaneous osteosarcoma of the scalp: a case report and review of the literature

We report on an 84-year-old man with a solitary, nodular lesion on the scalp. The patient had been previously submitted to electrodessications of the scalp due to multiple solar keratoses. Histopathologically, the lesion showed features of a high-grade conventional osteoblastic osteosarcoma involving the dermis. Computed tomography showed no involvement of the underlying bone tissues. Clinical examination and extensive total body radiologic workup revealed absence of bone lesions in any body site, thus suggesting a final diagnosis of primary cutaneous extraskeletal osteosarcoma. The clinico-pathological features of the case are discussed in light of the rare cases previously described in the literature.     

Primary cutaneous plasmacytoma. A case report and review of the literature

Primary extramedullary plasmacytoma of the skin is a very rare disease; to our knowledge, only a few cases have been published in the world literature. In this paper, a patient who had a primary cutaneous plasmacytoma of the lower lip for 20 years is described. Serological, radiological and histological examinations excluded the possibility of an underlying multiple myeloma. The position of cutaneous plasmacytomas within the group of malignant plasma cell neoplasias is discussed and the relevant literature is reviewed.     

Primary cutaneous adenoid cystic carcinoma with brain metastases: case report and literature review

Primary cutaneous adenoid cystic carcinoma (ACC) is a rare skin tumor that is unlikely to metastasize. We present a case of primary cutaneous ACC in a 67‐year‐old male with axillary lymph node, pulmonary and brain metastases. To the best of our knowledge, this is the first reported case of cutaneous ACC with distant metastases to the brain.     

Primary cutaneous ganglioneuroma: a report of two cases and literature review

Primary cutaneous ganglioneuroma is a rare neoplasm first described by Collins et al. in 1972. Eight cases have been reported in the English literature to date. We report two cases of solitary cutaneous ganglioneuroma, one constituting, to our knowledge, the first reported case of this entity occurring on the face. Clinically, both lesions were firm flesh-colored papules and asymptomatic, being removed primarily for cosmesis. Neither patient had any significant past medical history. Histologically, both neoplasms consisted of relatively well-circumscribed spindle cell proliferations of axons and Schwann cells with interspersed mature ganglion cells. There was also focal myxoid change. The spindle cell component stained positively for S-100 protein, and the ganglion cells stained positively for glial fibrillary acidic protein and neurofilaments by routine immunohistochemistry.     

Plaque-like cutaneous mucinosis: case report and literature review

Midline mucinosis was observed in a 14-year-old man, which was confined to the midline of the back and appeared as asymptomatic, nonindurated, hyperpigmented plaques. Skin biopsies showed prominent interstitial mucinosis with perivascular lymphocytic infiltration. A literature review of plaque-like mucinosis revealed 14 previous cases with this distinct presentation that may overlap with reticular erythematous mucinosis and connective tissue disease. Midline mucinosis has been previously reported in prepubertal children but is rare.