嗜酸性粒细胞增多性血管淋巴样增生15例临床及病理分析  

Angiolymphoid hyperplasia with eosinophilia: clinicopathological analysis of 15 cases

作　　者：刘勇[1] 纪华安 蒋延英[3] 

机构地区：[1]天津市第三中心医院皮肤科天津市人工细胞重点实验室,天津300170 [2]天津中医药研究院附属医院病理科,天津300120 [3]天津市第三中心医院病理科,天津300170

出　　处：《临床皮肤科杂志》2016年第1期11-14,共4页Journal of Clinical Dermatology

摘　　要：目的:探讨嗜酸性粒细胞增多性血管淋巴样增生(angiolymphoid hyperplasia with eosinophilia,ALHE)的病因、临床表现、病理变化、鉴别诊断、治疗及预后。方法:收集最近3年共15例ALHE患者的临床及病理资料并进行回顾性分析。结果:15例患者中皮损多样,为丘疹、结节、斑块或皮下包块,数目不定;2例出现外周血嗜酸性粒细胞增多,1例Ig E水平升高;组织病理提示13例位于真皮层,2例出现皮下组织变化,血管内皮细胞肿胀并凸向管腔,细胞无异形性及有丝分裂象,血管周围可见广泛的炎性细胞浸润,主要包括淋巴细胞、嗜酸性粒细胞和组织细胞;免疫组化检查示CD34(+),CD20(+),CD3(+),CD1a(-);5例孤立皮损患者手术切除后未复发,10例多发患者外用0.1%他克莫司乳膏2周,4例瘙痒及疼痛症状消失,5例部分丘疹消退,后期经CO_2激光治疗后7例复发。结论:ALHE少见且病因不明,皮损特点及临床症状多样化,实验室检查无特异性,诊断主要依靠组织病理检查,主要病理改变为血管增生,内皮细胞肿胀并凸向管腔形成"墓碑征"及胞质内空泡,伴混合性炎性细胞浸润,免疫组化检查可作为辅助诊断;ALHE患者单发皮损手术效果好,多发皮损经药物及激光治疗缓解后易复发。Objective： To explore the etiology, clinical manifestation, pathologic changes, differential diagnosis, management and prognosis of angiolymphoid hyperplasia with eosinophilia （ALHE）. Methods： A retrospective analysis of 15 cases with ALHE was performed. Results： Various number of papules, nodules and plaques presented in all 15 cases. Elevated periph- eral blood eosinophil ce11（PBEC） counts were in 2 cases while one patient had high serum IgE level. Pathology showed der- mal changes in 13 cases, and changes in subcutaneous tissue in 2 cases. The swollen endothelial cells protruded into the vascular lumen, with neither atypical cells nor mitotic activity. Perivascular infiltrate of lymphocytes, eosinophils and histio- cytes was evident. Immunohistochemical examination showed CD34（＋）, CD20 （＋）, CD3 （＋）, CDla（-）. 5 cases with solitary lesions did not recur after surgery. Among the 10 patients treated with topical 0.1% tacrolimus ointment for 2 weeks, pruritus and pain disappeared in 4 cases, and lesions partially disappeared in 5 cases. Following treatment with CO2 laser, recurrence occurred in 7 of 11 cases. Conclusions： ALHE is rare with unknown etiology and divergent clinical features. Because of non-specific laboratory findings, diagnosis is mainly relied on histological examination. The main pathological changes are vascular proliferation, cytoplasmic vacuoles swollen endothelial cells protruding into the lumen to form a ＂tombstone＂ appear- ance and perivascular infiltrate of various inflammatory cells. Immunohistochemical staining is helpful for diagnosis. Surgery is a good option for ALHE patients with single lesion, but high tendency of recurrence occurs in patients with multiple lesions after alleviation with drugs and laser therapy.

关 键 词：嗜酸性粒细胞增多性血管淋巴样增生 

分 类 号：R543[医药卫生—心血管疾病]