掌跖蕈样肉芽肿一例  

Mycosis fungoides palmaris et plantaris： a case report

作　　者：吴玮[1] 马寒[2] 范瑞强[1] 梁海莹[1] 李华莉[1] 黄江影[1] 

机构地区：[1]广东省中医院皮肤科,广州510120 [2]中山大学附属第三医院皮肤科

出　　处：《中华皮肤科杂志》2012年第7期485-487,共3页Chinese Journal of Dermatology

摘　　要：患者男，41岁。手足反复脓疱和脱屑1年，左足趾肿物4个月。体检：双手拇指、食指为主及掌侧大鱼际肌部位、双足趾及双足跖前1／3处可见不规则淡红色斑片，表面有小片状白色鳞屑，局部红斑基础上见深在性小水疱、脓疱，破溃后形成点状或融合成片状浅糜烂面，表面结黄褐色痂，部分趾指甲增厚、变形明显。左足第4趾掌跖关节前端一约4cm×3．5cm×3．5cm肿物，质稍硬，表面糜烂，伴较多脓性分泌物渗出及新生肉芽组织生长，混合后形成较厚黑色血痂，触痛明显。甲床和足趾肿物组织病理检查：表皮、真皮全层和皮下脂肪弥漫性致密小到中等大淋巴细胞浸润，细胞有异形，其间混杂少量炎性细胞，亲表皮现象明显，见Pautier微脓疡。免疫组化检查：异形淋巴样细胞LCA、波形蛋白、CD3、CD45RO、CD4、Bcl-2均阳性，CD8、CD5、CD10均为散在阳性，Ki-67〉80％N性，CD79a、CD20、CD30、细胞角蛋白、S-100、Bcl-6、间变性淋巴瘤激酶、HMB45、CD1a、P63均为阴性。诊断：掌跖蕈样肉芽肿。A 41-year-old man presented with recurrent pustules and scales on both hands and feet for 1 year and with neoplasm on the left toe for 4 months. On physical examination, there were multiple irregular rufons patches with lamellar white scales on bilateral thumbs, forefingers, thenar eminence, toes, and the one- third anterior part of bilateral soles. Deep-seated pustules and vesicles arising on some erythematous patches were disrupted with the formation of punctiform or patches of erosions covered by yellow brown crusts. Some toenails and fingernails were thickened and deformed. An obviously tender neoplasm measuring 4cm×3.5cm×3.5cm was observed in the anterior part of the left fourth toe, which was a little indurated and obviously tender with superficial erosion, large amount of purulent exudates and fresh granulation tissue mixing to form black and thick blood crusts on the surface. Biopsy of the nail bed of the right index finger and neoplasm on the left toe revealed a diffuse, dense, and mixed infiltrate of small- to medium-sized atypical lymphocytes and a few inflammatory cells. Meanwhile, epidermotropism and Pautrier＇s microabscess were visible. Immunohistochemistry showed that the abnormal lymphocytes were positive for leukocyte common antigen （LCA）, Vimentin, CD3, CD45RO, CD4, Bcl-2, partly positive for CDS, CDS, CD10, Ki-67 （〉 80%）, but negative for CD79a, CD20, CD30, cytokeratin, S-100, Bcl-6, anaplastic lymphoma kinase （ALK）, HMB45, CDla or P63. Based on the above findings, a diagnosis of mycosis fungoides palmaris et plantaris was made.

关 键 词：肉芽肿 蕈样 淋巴瘤 T细胞 皮肤 病例报告[文献类型] 

分 类 号：R739.5[医药卫生—肿瘤]