丘疹性蕈样肉芽肿一例

患者男，27岁，因左胸部、左腋窝丘疹3年就诊，无自觉症状，皮损持续不退。组织病理检查示棘层轻度增生肥厚，皮突延长，真皮浅层苔藓样淋巴样细胞浸润，部分移入表皮，形成Pautrier微脓肿。免疫组化示LCA（+）、CD45RO（+）、CD3（+）、CD4（+）、CD8散在（+）、CD20（-）、CD68（-），CD30（-）。皮肤激光共聚焦显微镜显示棘层中散在有轻度折光的椭圆或圆形细胞影，直径4 ~ 8 μm。诊断：丘疹性蕈样肉芽肿。治疗：外用丙酸氟替卡松乳膏、异维A酸凝胶，窄波紫外线照射，丘疹变软，色泽变淡。

Papular mycosis fungoides: a case report

A 27-year-old man presented with a 3-year history of persistent asymptomatic papules on the left chest and axirlary fossa. Multiple skin biopsies were performed and histopathology revealed mild acanthosis, extension of the dermal papilla, lichenoid lymphoid infiltrates in upper dermis. Some lymphoid cells migrated into the epidermis and formed Pautrier's microabscesses. Immunohistochemistry revealed that the infiltrating cells were positive for LCA, CD45RO, CD3, CD4 and CD8 (scattered), but negative for CD68 or CD30. Cutaneous laser confocal microscopy showed the shadow of scattered, oval or round, slightly refractive cells measuring 4-8 pm in diameter. A diagnosis of papular mycosis fungoides was made. The papules were softened with the lightening of lesional color after treatment with narrow-band ultraviolet B, topical fluticasone propionate cream and isotretinoin gel.