儿童色素减退性蕈样肉芽肿在皮肤镜及反射式共聚焦显微镜下的特征

目的 探讨临床表现为色素减退的儿童蕈样肉芽肿在皮肤镜及反射式共聚焦显微镜（RCM）下的特征，分析皮肤镜联合RCM与组织病理诊断色素减退性蕈样肉芽肿的一致性。方法 2014年11月至2015年10月皮肤科门诊收集皮肤镜及RCM下疑似色素减退性蕈样肉芽肿患者15例，获取并分析影像资料。所有患者均经组织病理、免疫组化及相关检查。结果 皮肤镜联合RCM诊断疑似色素减退性蕈样肉芽肿15例，其中13例经病理证实为色素减退性蕈样肉芽肿。色素减退性蕈样肉芽肿皮肤镜下特征表现为皮纹明显，可见白色糠秕状鳞屑；色素减退呈网格状、斑马样或波点状模式；血管呈点状、短细线状、精子样或星状模式。RCM特征为表皮各层及真表皮交界处较多高折光细胞，部分可见Pautrier微脓疡，基底层色素环折光减弱，色素环外较多高折光细胞分布。结论 色素减退性蕈样肉芽肿在皮肤镜和RCM下有特征性表现，可作为儿童色素减退性蕈样肉芽肿早期筛查及辅助诊断的方法。

Dermoscopy and reflectance confocal microscopy features of hypopigmented mycosis fungoides in children

Zhang Lingling, Huang Jun, Xu Ai′e Department of Dermatology, Hangzhou Third People′s Hospital, Hangzhou 310009, China Corresponding author: Xu Ai′e, Email: xuaiehz@msn.com 【Abstract】 Objective To investigate dermoscopy and reflectance confocal microscopy （RCM） features of hypopigmented mycosis fungoides （HMF） in children, and to evaluate the consistency in diagnosis of HMF between histopathological examination and the combination of dermoscopy with RCM. Methods A total of 15 outpatients with suspected HMF who visited the Department of Dermatology were enrolled into this study from November 2014 to October 2015, and their dermoscopy and RCM images were collected. All the patients underwent histopathological, immunohistochemical and other related examinations. Results Based on dermoscopy and RCM images, 15 cases were suspected to be HMF, and 13 cases were confirmed to be HMF. Dermoscopy images of HMF showed obvious skin lines, white scurf?like scales, reticular, zebra?like or dotted depigmentation, and blood vessels distributed in punctiform, short linear, spermatozoa?like or stellate patterns. RCM images of HMF showed many highly refractive cells in each layer of the epidermis and dermal?epidermal junction, Pautrier′s microabscess in some regions, and dermal papillary rings with decreased refractivity which were surrounded by many highly refractive cells in the basal layer. Conclusion HMF has characteristic dermoscopy and RCM images, so dermoscopy and RCM can serve as useful methods for early screening and auxiliary diagnosis of HMF in children.