误诊为色素痣的血管角皮瘤患儿皮损皮肤镜及反射式共聚焦显微镜分析  

Dermoscopy and reflection confocal microscopy analysis of skin lesions in children with angiokeratoma misdiagnosed as pigmented nevus

作　　者：张圆圆 罗鸯鸯[1] 孙磊[1] 汤建萍[1] 李珂瑶 岳淑珍 周斌[1] ZHANG Yuan-yuan;LUO Yang-yang;SUN Lei(Department of Dermatology,Hunan Children’s Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院皮肤科,长沙410007

出　　处：《实用皮肤病学杂志》2023年第1期18-20,24,共4页Journal of Practical Dermatology

基　　金：湖南省儿童医院院级课题C类

摘　　要：目的探讨误诊为色素痣的血管角皮瘤皮损临床特点及皮肤影像学镜下特征.方法回顾性分析被误诊为色素痣的8例血管角皮瘤患儿皮损的皮肤影像学临床资料.结果共收集误诊为色素痣的血管角皮瘤患儿8例(皮损发生在下肢6例,肩部1例,面部1例).组织病理学改变均可见真皮浅层毛细血管扩张,形成囊腔样结构,内可见大量红细胞,管周稀疏炎性细胞浸润.皮肤镜下表现:紫红色和(或)淡红色背景下,大量圆形、椭圆形、形状不规则的紫黑色、紫红色、两者混合存在的腔隙样结构,外周见蓝白幕.局部可见白色鳞屑6例,棕褐色鳞屑1例,黑色结痂2例,红斑1例.反射式共聚焦显微镜(RCM)镜下表现:表皮局部变薄,真皮乳头层扩张,内可见大小不等的薄壁管性结构,管腔内见血流,内可见大量中低折光细胞.其中4例见灶状角化不全,角化过度,棘层肥厚;1例皮损局部真皮浅层见不等量中高折光细胞浸润.8例患儿皮损手术切除后随访,未见复发,目前仍在随访中.结论不典型血管角皮瘤皮损肉眼易误诊为色素痣,组织病理学检查仍是诊断和鉴别血管角皮瘤的金标准.皮肤镜及RCM检查对血管角皮瘤的诊断、鉴别诊断具有重要辅助价值,可作为无创、快速的辅助检测手段.Objective To investigate the clinical features and skin imaging characteristics of angiokeratoma which easily misdiagnosed as pigmented nevus.Methods The clinical data and skin imaging of angiokeratoma misdiagnosed as nevus were analyzed retrospectively.Results A total of 8 children with angiokeratoma misdiagnosed as pigmented nevus were collected.The lesions occurred in lower limbs(6 cases),shoulder(1 case)and face(1 case).Histopathological investigation showed dilatation of capillaries in the superficial dermis,forming a cystilike structure with a large number of red blood cells,and perivascular sparse inflammatory cells infiltration.Under purplish red and/or light red background,a large number of round,oval,or irregularly shaped lacunae-like structures,purplish black,purplish red,or mixed with both,were observed in dermatoscopy,with blue and white curtain in the periphery.There were white scales locally in 6 cases,brown scales in 1 case,black scab in 2 cases and erythema in 1 case.Reflection confocal microscopy(RCM)revealed:local thinning of the epidermis,dilation of dermal papilla layer,thin-walled tubular structures of different sizes,blood flow in the lumen,and a large number of medium and low refractive cells.4 cases showed focal paraceratosis,hyperkeratosis and spinous hypertrophy.1 case showed the superficial dermis infiltrated with medium and high refraction cells.No recurrence was found in the postoperative follow-up of 8 children after surgical resection of skin lesions,which is still being followed up.Conclusions Atypical angiokeratoma is easily misdiagnosed as pigmented nevus by gross examination.Histopathological examination is still the gold standard for diagnosis and differentiation of angiokeratoma.Dermatoscopy and RCM examination pose important auxiliary value in the diagnosis and differential diagnosis of angiokeratoma,and can be used as a non-invasive and rapidx ailuiary detection method.

关 键 词：血管角皮瘤 痣 色素 皮肤镜 反射式共聚焦显微镜 误诊 

分 类 号：R732.23[医药卫生—肿瘤]