性病性淋巴肉芽肿合并皮肤鳞状细胞癌一例

患者男，53岁，冠状沟增生物2年，腹股沟包块红肿、疼痛、破溃2月余。体检：双侧腹股沟淋巴结红肿约2 cm × 1.5 cm，质硬，触痛，右侧腹股沟肿大淋巴结中心波动，其上见多处破溃及黄白色脓性分泌物流出，如喷水壶状。多个肿大或破溃淋巴结被腹股沟韧带分隔，形成明显的沟槽征。冠状沟两侧可见1 cm × 2 cm不规则疣状增生，质硬，表面角化。龟头系带处红肿，有波动，并有破溃伴黄白色脓液渗出，右侧阴囊肿胀。龟头系带处分泌物及左右侧腹股沟穿刺液多次真菌培养阴性，细菌培养阴性，抗酸染色阴性，沙眼衣原体培养初次为阴性，衣原体内源性质粒PCR检测阳性，omp1-限制性片段长度多态性（RFLP）分型为L3型。Western印迹示血清沙眼衣原体主要外膜蛋白（MOMP）抗体阳性，多形外膜蛋白H（PmpH）抗体 > 1 ∶ 800，衣原体多代培养阳性。右腹股沟疣状增生处活检示皮肤高分化鳞状细胞癌。诊断：性病性淋巴肉芽肿合并皮肤鳞状细胞癌。

Lymphogranuloma venereum complicated by squamous cell carcinoma: a case report

A 53-year-old man was admitted to the hospital for verrucous hyperplasia on the circular sulcus for 2 years as well as erythematous painful swelling, ulcer and rupture of inguinal lymph nodes for more than 2 months. Physical examination revealed erythematous, indurated and painful swelling of bilateral inguinal lymph nodes. Fluctuation could be felt at the centre of the right swollen inguinal lymph nodes, where several pores were seen with yellowish-white purulent fluid flowing out, giving the appearance of a watering can. Multiple swollen or ulcerative lymph nodes were separated by the inguinal ligament forming the "groove sign".There were irregular, indurated, verrucous, proliferative and keratinized lesions sized 1 cm × 2 cm on both sides of the circular sulcus. The right scrotum was obviously swelling. Erythematous, fluctuating swelling, ulcer and rupture of the glans fraenum were also observed with yellowish-white purulent exudates. Neither the secretion from the skin lesions on the surface of bilateral inguinal lymph nodes nor the puncture sample from the right groin was positive for multiple fungal or bacterial culture, acid-fast stain or first culture of C. trachomatis.However, the endogenous plasmid of Chlamydia was successfully amplified by PCR from these samples, and restriction fragment length polymorphism (RFLP) analysis of the major outer membrane protein (MOMP) suggested that the genotype of the Chlamydia strain was L3. Western blot revealed the presence of anti-MOMP antibodies and anti-Pmp H antibodies (titer: ＞ 1: 800) in serum. Culture of C. trachomatis also gave positive results after multiple passage. Biopsy of the verrucous hyperplasia on the right groin is consistent with well-differentiated squamous cell carcinoma of the skin. A diagnosis of lymphogranuloma venereum complicated by cutaneous squamous cell carcinoma was made.