Merkel细胞癌1例

患者男,56岁。腹部皮下结节4个月余,无自觉症状。体检：上腹部、中腹部及左季肋部可触及10余个散在皮下结节,直径0．5-1．8cm。组织病理示：瘤细胞呈巢团状、片状排列,浸润性生长,胞浆少。核膜清晰,核仁显著,部分可见核分裂相。免疫组化结果示：CK20（＋＋）,CKL（＋＋）,CgA（＋＋）,Syn（＋＋＋）,CD99（＋＋）,ki67〉70％。病理诊断：（腹壁）Merkel细胞癌。     

CD4^＋CD25^＋T细胞和NK细胞与SLE病情活动相关性的研究

目的：了解CD4^＋CD25^＋T细胞和NK细胞与SLE病情活动的相关性。方法：用流式细胞仪检测17例SLE患者治疗前后和11例正常人外周血中CD3^＋T（总T）、CD4^＋T、CD8^＋T、NK细胞、CD4^＋CD25^＋T、CD4^＋CD25^-T细胞。结果：SLE活动期CD8^＋T细胞百分率升高（P〈0．05），导致CD4^＋／CD8^＋比例降低（P〈0．05），CD4^＋CD25^＋T、NK细胞百分率明显降低（P〈0．01），而CD3^＋T、CD4^＋T细胞、CD4^＋CD25^-T细胞百分率无明显改变（P〉0．05）；治疗后患者SLEDAI评分下降而NK细胞和CD4^＋CD25^＋T细胞百分率均明显上升（均P〈0．01）；SLEDAI评分与CD4^＋CD25^＋T细胞百分率有相关性（P〈0．05）。结论：SLE存在CD4^＋T、CD8^＋T细胞亚群分布和活化的异常；CD4^＋CD25^＋T细胞数量明显降低，且量的变化与疾病活动相关；NK细胞数量虽然也明显降低，治疗后也上升，但量的变化与疾病活动无明显相关。     

转移性上皮样肉瘤

报告1例转移性上皮样肉瘤。患者女,22岁,因右踝部结节10年,溃疡3个月余,发热伴右腹股沟区包块,疼痛1个月就诊,溃疡边缘皮肤组织病理检查示皮下大片状坏死,周边可见异形上皮样细胞增生;免疫组化染色结果示AEI/AE3（＋）,CD68（＋）,EMA（＋）,波形蛋白（＋＋）诊断为上皮样肉瘤,右腹股沟肿瘤组织病理检查示大片状坏死,可见肉瘤细胞,免疫组化染色结果示肌球蛋白（＋）,余与皮损检查结果相同。诊断为转移性上皮样肉瘤。     

原发性皮肤弥漫大B细胞淋巴瘤,腿型

报告1例原发性皮肤弥漫性大B细胞淋巴瘤（腿型）。患者女，82岁。左小腿出现3个红色结节2个月，组织病理检查发现真皮内淋巴样细胞浸润，无嗜表皮现象，细胞体积大，肿瘤细胞CD20（＋），CD79α（＋），Bcl-2（＋），Bcl-6（＋），Ki-67 70％（＋），MUM-1（＋），Pax-5（＋），CD10（-），诊断为原发性皮肤弥漫性大B细胞淋巴瘤（腿型），全身检查未发现皮肤以外系统受累证据，行局部肿瘤切除及口服糖皮质激素治疗。     

白塞病患者外周血T细胞凋亡和Fas表达的相关性

目的：探讨Fas（CD95）在T淋巴细胞表达及其介导的凋亡与白塞病（BD）的关系。方法：通过Annexin V（AV）荧光探针,使用5色流式细胞仪检测了Fas介导的凋亡及其在BD患者CD4^＋和CD8^＋T细胞的表达。结果：与非活动期患者相比,BD活动期患者外周血AV^＋CD4^＋CD3^＋细胞和CD95^＋AV^＋CD4^＋CD3^＋细胞的百分数明显减少。结论：T细胞抵抗Fas介导的凋亡与BD病情加重有关,Fas介导的T细胞凋亡与BD病情减轻有关。     

白癜风自体表皮移植联合光疗与调节性T细胞水平的关系

目的探讨CD4^＋CD25^＋Foxp3^＋调节性T细胞水平在白癜风自体表皮移植联合光疗中的变化。方法用流式细胞仪直接免疫荧光检测稳定期自体表皮移植联合窄谱中波紫外线（NB-UVB）治疗前后的20例白癜风患者及19例正常人外周血CD4^＋CD25^＋调节性T细胞转录因子Foxp3^＋的表达水平。结果稳定期白癜风移植患者接受照光前的CD4^＋CD25^＋Foxp3^＋调节性T细胞百分率比正常人稍低,差异无显著性（P〉0．05）,联合NB-UVB始疗后的患者CD4^＋CD25^＋Foxp3^＋调节性T细胞百分率较照光前明显增加,差异有显著性（P〈0．05）,与正常组相比差异无显著性（P〉0．05）。结论CD4^＋CD25^＋Foxp3^＋调节性T细胞可能在白癜风光疗中起一定的作用,NB—UVB光疗可能通过增加调节性T细胞数量来促进移植后复色。     

早期梅毒患者外周血T淋巴细胞亚群检测结果分析

目的：检测早期梅毒患者外周血T淋巴细胞亚群,了解机体在梅毒感染早期的细胞免疫改变。方法：选取早期梅毒患者21例,对照组12例。应用流式细胞仪检测外周血CD3＋、CD4＋、CD8＋淋巴细胞亚群,并对结果进行统计学分析。结果：梅毒组患者CD3＋、CD4＋、CD8＋T细胞比例均高于对照组,但只有CD4＋T细胞比例差异有统计学意义（P=0.016）,CD3＋、CD8＋T细胞比例及CD4＋/CD8＋差异均无统计学意义（P=0.340）。结论：早期梅毒患者细胞免疫增强,有利于消除梅毒螺旋体感染。     

母细胞性浆细胞样树突细胞肿瘤一例北大核心CSCD

患者女,19岁,左下肢暗红色斑丘疹1年余,右腹股沟可触及一樱桃大小淋巴结。皮肤肿物组织病理检查：皮肤正常结构消失,可见淋巴样肿瘤细胞弥漫浸润,细胞中等大小,核仁不清楚;免疫组化：CD4（＋＋）、CD56（＋＋）、CD123（＋＋＋）,TdT部分阳性。骨髓穿刺行流式细胞检查：异常细胞占59．9％,表达CD123st（IL-3Ra）、HLA—DRst、CD56、CD304（BDCA-4）、CD7、CD11b、CD33、CD36、CXCR4和CD13dim,部分细胞表达CD4和CD117。透射电镜观察骨髓细胞：可见大量形态大小均一的淋巴样细胞,细胞表面可见粗大突起,胞核胞质比例高,胞核圆形居中,有呈脑回样深切迹,异染色质块状边集,核仁多见,少量胞质,其中可见内质网、线粒体等细胞器,内质网均呈浆细胞样同心圆状排列。骨髓细胞表现兼具树突细胞及浆细胞特征。诊断：母细胞性浆细胞样树突细胞肿瘤。     

特异性免疫治疗对特应性皮炎T细胞亚群及NK细胞的影响

目的：探讨特异性免疫治疗对特应性皮炎T细胞亚群及NK细胞的影响。方法：采用流式细胞仪检测45例特异性皮炎（atopic dermatitis，AD）患者和30例健康献血员外周血CD3^＋、CD4^＋、CD8^＋T细胞、B细胞、NK细胞的构成比，计算CD4／CD8比值；并比较27例AD患者经特异性免疫（specific immunotherapy，SIT）治疗后T细胞亚群、NK细胞的变化。结果：AD患者CD4^＋、NK细胞构成比、CD4^＋/CD8^＋比值均低于正常对照组（P〈0．05），而CD3^＋、CD8^＋、B细胞与正常组相比差异无统计学意义（P〉0．05）。AD患者经SIT治疗6～18个月后，CD4^＋、NK细胞构成比、CD4^＋／CD8^＋比值均高于治疗前患者，差异有统计学意义（P〈0．05）。结论：AD患者存在细胞免疫功能低下，SIT治疗可显著提高AD患者细胞免疫功能，对AD患者不失为较为有效的对因治疗方法。     

鼻部NK/T细胞淋巴瘤1例

报告1例鼻部NK/T细胞淋巴瘤患者。患者男,16岁。鼻腔糜烂、出血6个月,鼻尖溃疡、穿孔,伴发热3个月。体格检查：T38.8℃,外鼻部塌陷、表面皮肤呈干性坏死,沿中线对称性分布;鼻尖部穿孔、双鼻下甲、中隔糜烂;免疫组化染色;LCA（＋）CD（＋）,CD45RO（＋）,CD56（＋）;组织病理诊断;鼻部NK/T细胞淋巴瘤。     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Self‐resolving superficial primary cutaneous mucormycosis in a 7‐week‐old infant

A 7‐week‐old girl, born at 30 weeks' gestational age, presented to clinic for evaluation of a crop of vesicular lesions that were noted after removal of a bandage that had been in place for 4 days. A punch biopsy of the lesion revealed fungal elements that were later identified as Rhizopus spp. The lesion began to self‐resolve, and no further treatment was needed, with full resolution of the lesion by 1 month after presentation. Clinicians should be aware of the variable presentations of mucormycosis and consider fungal infection in the differential diagnosis when evaluating vulnerable patients with skin eruptions.     

Multiple New-Onset Subcutaneous Nodules of the Upper Extremity Digits: Giant Cell Tumor of Tendon Sheath and Lipoma

A black woman with the concurrent onset of two subcutaneous nodules located on the digits of her upper extremities is described. Initially, a single systemic disorder was considered; yet, the lesions differed in morphology and consistency. Microscopic examination of the nodules showed a giant cell tumor of tendon sheath and a lipoma. Although Occam's “razor” suggests that multiple lesions in the same person are more likely to represent variable manifestations of a single disorder than several different diseases in that individual, the simultaneously appearing lesions in this patient represented two different conditions.