表现为红斑和皮下结节的结节病一例

报告1例同时表现为红斑和皮下结节的结节病。患者女,55岁。左眉暗红斑,颞部多发皮下结节2个月余。皮肤科检查:左侧眉弓直径约1 cm暗红斑,颞部多发皮下结节,直径0.5~1.5 cm,质硬,边缘不规则。皮损组织病理示:真皮或皮下脂肪层大量的上皮样细胞肉芽肿及多核巨细胞浸润,大部分呈裸结节。诊断:结节病。     

Pathogenesis of elastofibroma

On the occasion of a case report on histiocytoma associated with elastofibroma-like parts on the shoulder, the extreme rarity of elastofibroma was doubted. This thesis was confirmed by post-mortem reports from Turku and Prague as well as by clinical experiences from Japan. Its possible relationship to other subcutaneous tumors rich in collagen and elastin was mentioned, and the abundant production of elastin was discussed as a variation of a one-sided metabolic mistake of the cells producing parenchyma. The symmetric or multiple, but principally the extracutaneous localization of elastofibromas may also direct our attention to developing factors other than traumatic ones, especially those being hereditary or ethnical.     

Subcutaneous granuloma annulare in a patient with rheumatoid arthritis and diabetes mellitus

A case is reported of multiple subcutaneous nodules over the forehead and scalp of a 67-year-old male with moderately severe seropositive rheumatoid arthritis and corticosteroid-induced diabetes mellitus. The histology was initially reported as consistent with a rheumatoid nodule, but on review, was regarded as typical of subcutaneous granuloma annulare (SCGA). The nodules resolved spontaneously within 4 months, which is also in keeping with SCGA. A brief review of the relevant literature is presented.     

A case of rheumatoid nodulosis successfully treated with surgery

We report the case of a 76 year-old male with multiple subcutaneous nodules, but without joint symptoms or deformities, who was diagnosed histopathologically with rheumatoid nodulosis after resection of the nodules. Rheumatoid nodulosis is a disease characterized by multiple subcutaneous nodules that are histopathologically similar to rheumatoid nodules, a high titer of rheumatoid factor, and radiologically detectable cystic bone lesions, but with none or few of the systemic manifestations orjoint activity of rheumatoid arthritis (RA). It is considered to be a benign variant of RA. This rare disease must be considered when a case of multiple subcutaneous nodules is encountered, even in aged males withoutjoint symptoms or deformities.     

Lipomembranous changes in nodular-cystic fat necrosis

Three cases of nodular-cystic fat necrosis presenting with focal lipomembranous changes are reported. The lesions consisted of solitary (cases 1 and 3) or multiple (case 2) subcutaneous nodules on the upper (case 1) or lower (cases 2 and 3) extremities which had evolved over weeks to years. At surgical excision, solitary or multiple, freely mobile nodules within a cystic cavity were observed. Histologically, encapsulated fat nodules showing variable amounts of necrosis without marked inflammatory changes were present. Focal lipomembranous changes were observed in some nodules. Our observations seem to support the concept that lipomembranous changes are nonspecific and uncommon patterns of fat necrosis caused by a wide variety of local or systemic events that may cause a compromise in the blood supply of the subcutaneous tissue.     

Multiple papules and nodules on the face and neck caused by the larvae of an unknown nematode: A noncreeping type eruption

Cutaneous larva migrans is caused by various nematodes. Skin manifestations may include superficial or creeping eruptions, folliculitis, and migratory subcutaneous nodules. We report a 52-year-old man with asymptomatic, multiple eruptive papules and nodules on the face and neck caused by the larvae of an unknown nematode. The patient never had any creeping or migratory eruptions. Our case is very unusual and differs from previously reported cases of cutaneous larva migrans.     

Juvenile case of multiple morphea profunda resulting in joint contracture that was successfully treated with cyclosporin A: A case report and review of the published works

Morphea profunda refers to inflammatory and sclerotic lesions that start primarily from the deep dermis, subcutaneous fat and fascia. Its pediatric case published work is limited. Here, we report the case of an 8‐year‐old girl with a 5‐year history of multiple subcutaneous nodules on her extremities and a right wrist joint contracture who had been previously diagnosed with juvenile idiopathic arthritis and treated with salazosulfapyridine, low‐dose prednisolone (PSL) and methotrexate. We performed biopsies of two subcutaneous nodules, which revealed the typical morphology of morphea profunda. She was administrated a tapered course of oral PSL then cyclosporin A (CyA) for 20 weeks which completely resolved her joint contracture and subcutaneous nodules. We reviewed 11 previously reported cases of morphea profunda and found that some include circumscribed/linear morphea that develop into subcutaneous tissues, indicating that “classical” morphea profunda arising within the deep tissues has rarely been reported. Our report is the first to demonstrate the efficacy of CyA for treatment of morphea profunda, and the possibility of CyA as a treatment option to reduce oral steroid doses in juvenile cases.     

MULTIPLE SUBCUTANEOUS LIPOGRANULOMAS ASSOCIATED WITH SYSTEMIC LUPUS ERYTHEMATOSUS-LIKE SYMPTOMS

A case of a 45 year old woman with multiple subcutaneous nodules and systemic lupus erythematosus-like symptoms is reported. Histologically the nodules were identical to sclerosing lipogranuloma. The oily substance within the nodules was suspected to be due to depot penicillin injected ten years before. The patient was treated with corticosteroids and finally died of pulmonary fibrosis. This case may be included in the entity of adjuvant diseases of man.     

CEREBRAL AND SUBCUTANEOUS CYSTICERCOSIS TREATED WITH ALBENDAZOLE

Background. Cysticercosis is the most common parasitic disease of the central nervous system in the world, but cysticercosis cutis has been reported much less frequently. Because 54% of patients present with subcutaneous nodules, we report here the association of cysticercosis cutis in a patient with neurocysticercosis and review the literature and treatment options. Case Report. The patient presented with multiple, asymptomatic subcutaneous nodules over the trunk and the extremities, associated with central nervous system involvement. Examination of an excised nodule by light microscopy revealed a larval cyst in the deep dermis surrounded partly by a fibrous pseudocapsule. Computed tomographic scanning of the skull showed multiple, nonenhancing, and calcified cysts in both cerebral hemispheres. Treatment with albendazole, 15 mg/kg/day for 30 days, was highly effective. At follow-up 6 months later, most subcutaneous nodules had disappeared or were markedly reduced in size, and the cerebral lesions had much improved. Conclusions. Albendazole, a newer paracidal drug, seems to be more effective and less expensive than some other drugs in use for the treatment of neurocysticercosis.     

Childhood erythema nodosum associated with kerion celsi: a case report and review of literature

Erythema nodosum (EN) in association with kerion celsi is a rare condition in children, with only 11 cases having been reported in the English literature. We describe a new case in a 7-year-old boy in whom the disorder had begun 2 months before. He had many inflamed, boggy, suppurative nodules over the left occipitoparietal area of the scalp and, 2 weeks later, developed multiple painful, erythematous subcutaneous nodules of the shins, thighs, and upper limbs. EN was confirmed by histologic examination. Our review of the literature of all cases of EN during kerion showed that it usually occurs at or slightly after the height of infection or after drug introduction. Trichophyton mentagrophytes was involved in the majority of cases, and improvement of EN usually occurs with griseofulvin.     

呈带状分布的小汗腺螺旋腺瘤

报告1例多发性小汗腺螺旋腺瘤。患者女,23岁．右侧上肢紫红斑10余年,皮下结节7年,皮肤科检查示右侧躯干、上肢泛发米粒至黄豆大紫红色结节．呈带状排列,组织病理检查：真皮下部可见多个瘤细胞团块,瘤组织由2种细胞组成,一种细胞核大、淡染,位于细胞团块中央,另一种细胞核小、深染,排列在瘤细胞索周边。     

Subcutaneous nodules caused by Pseudomonas aeruginosa without sepsis

Pseudomonas aeruginosa infection can cause a wide array of skin manifestations. While some infections are mild, as are the cases with hot tub folliculitis and toe web or nail infection, others are a result of sepsis and can be fatal without prompt treatment. The classic skin finding of P. aeruginosa sepsis is Ecthyma gangrenosum, but other signs such as papules, petechiae, and hemorrhagic bullae can also be seen. Suppurative panniculitis can also be caused by P. aeruginosa sepsis and clinically manifests as solitary or multiple subcutaneous nodules. Reports in the literature describe these nodules in the setting of clinical sepsis or with positive blood cultures. We report a case of localized subcutaneous nodules on the leg caused by P. aeruginosa in a patient without sepsis or positive blood cultures. The source of the infection was thought to be from a traumatic inoculation. This raises the possibility that P. aeruginosa can cause subcutaneous nodules from a localized infection, perhaps via lymphangitic spread without the manifestations of sepsis.     

A Mimic of Self‐Healing Juvenile Cutaneous Mucinosis?

A 14‐year‐old boy presented with a chronic history of atypical papular mucinosis consisting of multiple subcutaneous nodules and confluent papular skin lesions. He initially presented at age 2 years with the rapid onset of numerous subcutaneous nodular lesions that completely resolved over a period of years. Clinical and histologic evidence, together with his clinical course, were suggestive of self‐healing juvenile cutaneous mucinosis (SHJCM), but a few years later, during childhood, he experienced a recurrence of the subcutaneous nodules involving the limbs, trunk, and face, in addition to new findings of multiple flesh‐colored papules coalescing into plaques on his neck and back. Although his early childhood course and histologic picture were suggestive of SHJCM, the progressive nature of his disorder is not like that seen in SHJCM and appears different from other reported disorders involving cutaneous mucinosis.     

Infantile myofibromatosis: a case study and review of literature.

Infantile myofibromatosis is an unusual condition generally presenting in the newborn period. The case being reported is that of a female newborn who had multiple lesions that involved skin, subcutaneous tissue, skeletal muscles, bone, and lungs. The disease was diagnosed because of the easily palpable skin tumors and subcutaneous nodules that were obvious immediately after birth. The diagnosis was established by histopathological examination of one nodule that showed a spindle-celled mesenchymatogenic lesion demonstrating the morphological and immuno-phenotype characteristics of myofibroblastic differentiation. The histologic picture, combined with the clinical manifestations and the imaging findings, are consistent with infantile myofibromatosis. The physical condition of the newborn was excellent and remains so six months later. The tumors of the skin and the subcutaneous nodules have gradually regressed without therapy. At the age of six months, four (4) nodules are palpable; the infant is under continuous observation.     

Multiple cutaneous granular-cell tumors

A 54-year-old woman presented with subcutaneous nodules and a prior diagnosis of multiple, cutaneous granular-cell tumors. The first case of granular cell tumor was reported in 1854. It remains a rare tumor, which is most commonly seen in women. One-half are usually located in the head and neck region, mostly on the tongue. Approximately one third are cutaneous and 25 percent of the cases occur as multiple lesions.     

Subcutaneous panniculitis-like T-cell lymphoma with vacuolar interface dermatitis resembling lupus erythematosus panniculitis

Lupus erythematosus (LE) panniculitis (LEP) is a form of chronic cutaneous LE most often characterized by erythematous subcutaneous nodules. The histopathology of LEP may be distinctive, allowing a diagnosis even in the absence of any other LE features. Lymphocytic infiltration of the panniculus is termed lymphocytic lobular panniculitis. This entity has been reported in both LEP and subcutaneous panniculitis-like T-cell lymphoma. We describe a 67-year-old woman who presented with multiple dermal and subcutaneous nodules on her legs and hips. Biopsy specimens of roughly 15 lesions were interpreted as being diagnostic of LEP, however, with each subsequent biopsy specimen more atypical cells were observed. The patient responded only to moderate doses of oral prednisone, and failed intralesional triamcinolone acetonide, oral immunosuppressive agents, oral antimalarial agents, and oral thalidomide. Three years after the onset of her disease, ulcerated plaques and nodules developed. At this time a T-cell receptor gene rearrangement was present and subcutaneous panniculitis-like T-cell lymphoma was diagnosed. Despite multiple doses of chemotherapy she died approximately 1 year after diagnosis. Patients with apparent LEP that have atypical lymphocytes in their biopsy specimens should be followed up closely for the development of T-cell malignancy.     

Bronchial carcinoid tumor with skin metastases.

The occurrence of multiple dermal and subcutaneous nodules and tumors as a significant sign in a case of a metastatic bronchial carcinoid is reported. The clinical manifestations of bronchial carcinoid often differ from those associated with the more common malignant carcinoids of the intestinal tract. It is possible that these differences might be due to an enzymatic defect in the bronchial carcinoid tumors.     

Encapsulated Necrosis Associated with Behçet's Syndrome

We reported a case of a 45-year-old woman with encapsulated necrosis associated with Behçet's syndrome. The lesions were characterized by multiple, small subcutaneous nodules on the extremities. Histologically, a nodule consisted of degenerative adipocytes encapsulated by fibrous tissue. A membranocystic lesion was also observed in the cavity of the nodule. The patient had a long-term history of Behçet's syndrome and suffered from erythematous subcutaneous nodules, resembling erythema nodosum on the extremities with a tendency to recurrence. These observations indicate that Behçet's syndrome could be implicated in the development of encapsulated necrosis as an underlying disease.     

Familial syringoma: Report of two cases with a published work review and the unique association with steatocystoma multiplex

Syringoma is a benign neoplasm of eccrine origin. Clinically, it manifests as small skin-colored to yellowish soft papules usually localized around the eyes and on the upper cheeks of middle-aged women. Familial cases have rarely been reported and may be inherited as an autosomal dominant trait or result from either germ line or somatic mutations. Syringoma can coexist with various conditions, notably Down syndrome. Herein, we report a family with multiple syringomas affecting members of three following generations and describe in detail a 36-year-old woman and her 17-year-old son. In the latter, steatocystoma multiplex, which is regarded as a benign cystic neoplasm of the folliculosebaceous unit or a nevoid malformation differentiated in the direction of the sebaceous duct, was associated. Acral distribution of steatocystoma multiplex and its presentation as subcutaneous nodules in this patient were unique.     

Subcutaneous sarcoidosis localised to sites of previous desensitizing injections

Subcutaneous sarcoidosis is a specific cutaneous lesion of systemic sarcoidosis that is rarely reported. Clinically, it is characterized by multiple, asymptomatic subcutaneous nodules mainly located on the forearms. Adverse effects of desensitization injections mostly consist of local transient reactions. Nodular lesions may also develop at the site of injection; these have been attributed to the aluminium hydroxide contained by many vaccines. We report a 49–year old woman with a history of two outbreaks of acute sarcoidosis (Löfgren syndrome) in 1994 and 1999, who developed lesions of subcutaneous sarcoidosis in the upper part of both arms, at the sites of desensitization injections for extrinsic asthma immunotherapy.