临床资料 患者,男,46 岁. 因"面颊、腰背部及四肢伸侧多发暗红丘疹结节1年余,伴瘙痒"来我科就诊.患者1年前发现面颊、腰背部及四肢伸侧暗红丘疹,伴痒感,外院曾以"湿疹、虫咬皮炎及结节性痒疹"等治疗,疗效欠佳,后皮损缓慢增多,搔抓后结痂,来我科就诊.患者长期居住于湖北省恩施市,无明确麻风接触史.否认肝炎、结核及麻风等传染病史.否认家族中有类似疾病史.

AbstractBackgroundThis study aimed to assess the independent prognostic value of tumor size compared with other clinical and pathologic features of primary invasive cutaneous melanoma (CM).MethodsThis study included 28,593 patients with primary invasive CM in Surveillance, Epidemiology, and End Results Program database diagnosed from 2004 through 2016. Tumor size was divided into five subgroups (≤6, 7‐12, 13‐30, 31‐42, and >42 mm). The primary endpoint was melanoma‐specific survival (MSS).ResultsThe relationship between tumor size and survival was piecewise. After adjusting for age, sex, primary site, histopathologic cell type, Breslow thickness, ulceration, mitotic rate, regional metastasis, and distant metastasis, the hazard ratio (HR) of MSS increased with increasing tumor size until a peak at 31‐42 mm (HRs, 1.33, 1.59, 2.41, respectively; all P < .0001), and then decreased when tumor size was larger than 42 mm using tumor size ≤ 6 mm as the reference (HR, 2.11; 95% confidence interval [CI], 1.84 −2.42; P < .0001). This pattern mostly remained after stratification by T subcategories from T1 to T4 in localized primary CM except that tumor size >42 mm subgroup had the shortest MSS in T4. In addition, tumor size with a cutoff value of 12 mm showed stronger prognostic value for MSS (HR, 2.32; 95% CI, 1.80‐2.98; P < .0001) than Breslow thickness and mitotic rate in primary CM with T1N0M0.ConclusionsTumor size was an important independent prognostic factor for MSS in patients with primary invasive CM. Tumor size larger than 30 mm would provide additional and important prognostic information in each T subcategory of localized CM. Furthermore, tumor size with a cutoff value of 12 mm has great potential in improving the accuracy of melanoma T1 substaging.

住院医师规范培训是医学生毕业后教育的重要组成部分,对培训临床高层次医师极为重要,它承担了医学终生教育的承前(医学院校基本教育)和启后(继续医学教育)的重要地位,是临床医生成长过程的关键所在.而皮肤科作为临床医学中的一门基础学科,因其临床实用性强,且对医师基本功要求高,因此如何做好皮肤科住院医师临床诊断的思维能力训练,就成为规范化培训教学研究的重点.文章借武汉华中科技大学同济医学院附属协和医院皮肤科开展住院医师全新模式的教学查房,对此种创新性的临床规范化培训方法进行了初步的探讨及研究,为更好的培养皮肤科合格的住院医师总结了经验.

Objective:To determine the effect of total glucosides of paeony (TGP) on atopic dermatitis in mice. Methods:An atopic dermatitis model was established on the back of NC/Nga mice with DNCB. Thirty mice were divided into 3 groups:control group, model group and TGP group ( 10 mice in each group) . The mice of TGP group were treated by TGP for 14 days. The levels of serum cytokines including IL-4 and IL-5, IFN-γ and IgE were detected with ELISA kit at day 8th and 15th. Results:TGP could significantly decrease the skin thickness and weightness at 8 days and 15 days (P<0.05). The levels of IL-4,IL-5 and IgE were significantly decreased , while the level of IFN-γ was increased in TGP group, compared with other groups. Conclusion:TGP has protective effects on atopic dermatitis in mice, which may be through inhibiting produc￣tion of IgE, IL-4 and IL-5, and promoting the secretion of IFN-γ.

目的:评价加巴喷丁联合氟芬那酸丁酯软膏治疗带状疱疹后遗神经痛的临床效果.方法:将入选的94例患者随机分为两组,治疗组(48例)每日分3次口服加巴喷丁300~900 mg,最大1200 mg,同时予氟芬那酸丁酯软膏均匀外搽皮损,3次/d.对照组(46例)口服卡马西平0.1 g,消炎痛25 mg,均3次/d.两组疗程均为4周.结果:治疗4周后,治疗组总有效率为87.50%,对照组为69.57%,差异有统计学意义(字2=4.51,P<0.05).两组治疗前VAS评分比较差异无统计学意义(t=0.578,P>0.05),治疗4周后,治疗组低于对照组,疼痛缓解程度较大,差异有统计学意义(t=11.190,P<0.05).两组患者治疗过程和随访期间,无不良反应发生.结论:带状疱疹后遗神经痛患者,加巴喷丁联合氟芬那酸丁酯软膏应用,能迅速缓解疼痛症状,显著提升患者生活质量,不良反应较少,临床值得运用.

A case of myopericytoma is reported.A 66-year-old female presented with a subcutaneous nodule on the right lateral heel for 6 years.Histopathological examination showed a tumor mass with clear boundaries in the dermis.The tumor mass consisted of solid cellular regions and vascular lacunae of various sizes.The cells in the solid areas included round or short spindle cells with eosinophilic cytoplasm,concentrically arranged around the blood vessels,forming a typical onion-ring appearance.There were no atypical cells.The tumor cells were positive for calponi,H-caldesmon and SMA.The diagnosis of myopericytoma was made.

BackgroundMultinucleate cell angiohistiocytoma (MCAH) is an uncommon benign fibrohistiocytic and vascular proliferation, which usually occurs as slow-growing grouped reddish-brown to purple papules and nodules on the distal extremities or face. Patients with generalized MCAH are extremely rare and to our knowledge, there are no more than 11 cases reported previously in the medical literature.ObjectiveTo describe the clinical, histopathologic features and immunohistochemical characteristics of all reported cases of generalized MCAH and investigate any potential clinicopathological correlations.MethodsA systematic review of the literature was done with information collected and organized in a table. A new case report is also described in a 42-year-old female with generalized MCAH. Histopathologic and immunohistochemical features of multiple biopsies were analyzed.ResultsMen and women are equally affected. It is crucial to take multiple biopsies preferably from newly formed lesions to reach the correct diagnosis. The divergent results in immunohistochemistry staining for CD68 and estrogen receptor (ER) alpha necessitate further studies to reach a precise etiology and pathogenesis and secure it with certainty.ConclusionAwareness of the clinicopathological hallmarks is important to avoid underdiagnosis of MCAH and the immunohistochemical features may contribute to understanding the pathogenesis of this rare disease.

报告1例临床表现为靶样损害的动脉瘤样纤维组织细胞瘤.患者女,60岁.因左大腿内侧结节1个月余就诊.皮肤科检查:左大腿内侧可见一直径约1 cm,黑褐色结节,边缘环绕紫红色晕,无触痛.皮损手术全切行组织病理检查示表皮角化过度,表皮突下延,基底层色素增加,真皮浅中部增生的纤维组织细胞及胶原纤维形成境界清楚的团块,其内可见血窦样结构,但无血管内皮细胞,并可见含铁血黄素沉积,无细胞异形性,普鲁士蓝染色阳性.免疫组化肿瘤细胞不表达Ⅷ因子、CD34、CD31、S-100蛋白、平滑肌肌动蛋白(SMA)、结蛋白(desmin)、细胞角蛋白(CK)和CD68,而波形蛋白(vimentin)阳性表达.结合临床诊断表现为靶样损害的动脉瘤样纤维组织细胞瘤.术后随访6个月余未见复发或转移.

A 46-year-old male patient developed scatterred reddish-brown plaques and nodules on the back 6 years prior to the presentation. Then, the lesions gradually spread to the axillary fossa and protothorax, and became indurated with slight itching in winter. Laboratory examination revealed hypergammaglobulinemia. Computed tomography(CT)scan showed multiple nodular or patchy shadows in both lungs, lymphadenectasis in axillary, mediastinal and inguinal regions, and spleen enlargement. Histopathological examination of skin lesions showed granulomatous infiltrates with plenty of lymphocytes, histiocytes and mature plasma cells in the middle and lower dermis with the presence of lymphoid follicle-like structures, but no cell atypia was observed. Immunohistochemical study showed positive staining for CD38, CD138, CD79a, κ and λ light chains. According to clinical manifestations and laboratory examination results, the patient was diagnosed with cutaneous and systemic plasmacytosis.

Objective To investigate the effect of rutaecarpine ointment on atopic dermatitis in mice and its possible mechanisms. MethodsDNCB was repeatedly applied on the back of NC/Nga mice to establish the animal model of atopic dermatitis. Thirty-six mice were divided into 3 groups: control group, model group and rutaecarpine ointment group, with 12 mice in each group. The treatment of rutaecarpine ointment lasted for 14 days. Levels of several cytokines, including interleukin (IL)-4, IL-5, interferon (IFN)-γ and immunoglobulin E (IgE), from the serum samples were detected by ELISA kit at 8 and 15 days of the experiment. Meanwhile, skin samples underwent the measurement of thickness and weight at 8 and 15 days of the experiment.ResultsRutaecarpine ointment could signiifcantly decrease the skin thickness and weight at 8 and 15 days of the experiment. Meanwhile, rutaecarpine ointment markedly decreased the level of IL-4, IL-5 and IgE, and increased the level of IFN-γ from the serum samples at 8 and 15 days of the experiment.ConclusionThe therapeutic effect of rutaecarpine on atopic dermatitis-like skin lesions may be taken through inhibiting IgE, IL-4 and IL-5 synthesis and promoting the secretion of IFN-γ.

Dear Editor: The calcyclin-binding protein (CacyBP) was initially named for its ability to interact with calcyclin (S100A6) at a physiological range of Ca2+ concentration1. However, Matsuzawa and Reed2 found that the human analog of mouse CacyBP interacted with Siah-1 and named this protein the Siah-1 interacting protein (SIP); therefore, it is now widely called CacyBP/SIP. Additionally, CacyBP/SIP and Siah-1 associate with Skp-1, acting as an ubiquitinating complex that degrades non-phosphorylated β-catenin in the presence of p532. In breast cancer, CacyBP/SIP mRNA and protein levels were significantly higher than that of adjacent non-tumor tissues. Poor cellular differentiation, lymph node invasion, and clinicopathological staging in breast cancer were associated with CacyBP/SIP expression3, with similar findings in pancreatic cancer4. Although initially identified as a binding protein of S100A6, CacyBP/SIP has demonstrated an ability to bind with other S100 proteins such as S100B, S100P, S100A1, and S100A125. Widely and routinely used for immunohistochemical detection of malignant melanoma (MM), protein S100 and the upregulated expression of S100A6 were correlated with unfavorable prognoses of MM6,7,8; however, the expression levels of CacyBP/SIP have not been investigated. In this study, we compared the immunohistological expression of CacyBP/SIP in 20 primary MM, 20 metastatic MM, 20 benign melanocytic nevus (BN), and 10 normal skin samples. Paraffin-embedded sections (4-µm in thickness) were deparaffinized with xylene for 10 min and rehydrated through a graded ethanol series. Antibody-binding epitopes were retrieved by pressure-cooking the tissue sections in 10 mM/L sodium citrate buffer (pH 7.0; Yatoro, Tokyo, Japan) for 10 min and the nonspecific binding was blocked using 10% normal rabbit serum (Novus Biologicals, Littleton, CO, USA). The sections were then incubated with an antibody against CacyBP/SIP (1 : 200; Novus Biologicals, Littleton, CO, USA) at 4℃ overnight. Immunodetection was conducted using a standard streptavidinbiotin amplification method with 3-amino-9-ethylcarbazole as a chromogen followed by light counterstaining with hematoxylin. In each specimen, 3 high-power fields (HPFs, ×200) of strong reaction were randomly selected, 100 tumor cells were counted in each field, and the average percentage of positively stained cells in each of the 3 HPFs was computed for each sample. We also evaluated the staining intensity of the specimens using the staining intensity of sebaceous glands as internal positive control. The staining intensity was semiquantitatively classified as negative, mild, moderate, and strong. The results of the one-way ANOVA were considered statistically significant at p<0.05. In normal skin, weak expression of CacyBP/SIP was detected along the basal epidermis. Strong expression was observed in the sebaceous glands with weak to moderate staining in hair follicle and eccrine glands (Fig. 1A). The BN cells generally expressed low amounts of CacyBP/SIP with 48.16±6.639 percent positivity (Table 1, Fig. 1B), suggesting that there was no difference between the staining of junctional and intradermal components. However, the staining intensity of primary and metastatic MM was mostly moderate to strong, which was significantly stronger than that of BN (p<0.05) (Table 1, Fig. 1C, D). Further, the percent positivity of CacyBP/SIP in primary and metastatic MMs were 74.00±5.674 and 90.71±2.001, respectively, again significantly higher than that of BN (primary MM vs. BN, p<0.05; metastatic MM vs. BN, p<0.01). Moreover, the expression levels of CacyBP/SIP in metastatic MMs were significantly higher than those of primary MMs (p<0.05). Fig. 1 Expression of calcyclin-binding protein/Siah-1 interacting protein in (A) normal skin; sebaceous and glands were depicted in the box, (B) benign melanocytic nevus, (C) primary malignant melanoma (MM), and (D) metastatic MM. Scale bar=100 µm. Table 1 Expression of CacyBP/SIP in MM and BN Because S100A2, S100A6, S100A7, and S100P are variably and spatiotemporally expressed in the epidermis and skin appendages9,10, the S100-binding protein and CacyBP/SIP were expected to be present in the skin samples. We first demonstrated the immunohistological localization of CacyBP/SIP in normal epidermis, hair follicle, sebaceous gland, and eccrine gland suggesting a physiologic role of S100-CacyBP/SIP in maintaining the epidermal and appendageal homeostasis. It has been reported that S100A6 is expressed in melanocytic lesions6 and is significantly correlated with the depth of invasion (Clark levels)7. Moreover, since the upregulation of CacyBP/SIP was also documented in pancreatic cancers4, we speculated the overexpression of CacyBP/SIP in MMs, which was the case. The expression levels of CacyBP/SIP were, in fact, significantly higher than those of BN, with the metastatic MM exhibiting higher expression of CacyBP/SIP than the primary MM. Although the biological significance of its upregulation remains unknown, CacyBP/SIP enhances the polyubiquitination and degradation of β-catenin, possibly accelerating melanoma progression by inhibiting β-catenin-mediated apoptosis2. In conclusion, the upregulated expression of CacyBP/SIP may potentially be related to the melanoma progression; therefore, further studies are needed to elucidate a functional role of CacyBP/SIP.

报告1例穿通型毛母质瘤.患者女,58岁.颈部右侧一质硬性结节伴轻度瘙痒1年余.皮肤科检查:颈部右侧一大约1 cm×1 cm的圆形质硬结节,边界清楚,表面附有黑褐色痂.手术切除后行皮损组织病理学检查:真皮可见由嗜碱性细胞、过渡细胞及影细胞组成的肿瘤团块,并与表皮相通.结合临床及病理表现诊断为穿通型毛母质瘤.

目的:分析传染性软疣(Molluscum Contagiosum,MC)的临床病理特点.方法:收集58例MC患者的临床和病理资料进行综合分析.结果:MC发病男女比例约2.9∶1,多无自觉症状.皮疹成人多位于下腹部、股内侧和外生殖器部位,而儿童多在面、躯干和四肢.虽然MC为常见皮肤病,本组中发现其临床误诊率为46.6%.组织病理特征为小叶状、内生性生长的结节,角质形成细胞胞质中存在包涵体,即软疣小体,可继发感染或并发表皮囊肿等.结论:MC继发感染或并发表皮囊肿等其他皮肤损害时,临床表现多不典型,组织病理可确诊.

夏天到了,许多爱美的女性纷纷换上短袖衫或者无袖的连衣裙,可当她们脱下厚重的衣服,暴露出自己两上臂外侧布满的带刺样的暗红色或带黑色的小丘疹时,却开始苦恼了. 像这样的青年女孩,在裙衫漫舞、皮肤斗艳的夏季,我们医生每天都要接待不少.其实这是一种毛囊周围的皮肤过度角化的结果,多发生于上臂的伸侧和大腿的外侧,可见于一些人脸侧的颏部,并有红中带有血丝的斑,后者医学上叫“红斑毛囊角化病”,多在5岁以后出疹子,一部分与遗传有关,也有一些是饮食结构不当,多见于一些喜欢肉食、甜食,不太喜欢吃青菜素食的青年男女.一些维生素A缺乏的人可有此疹子出现,部分人可能内分功能失调或局部代谢有些失常,如甲状腺功能异常或应用了皮质激素,一些与痤疮有关.

Cathepsin D is an aspartic lysosomal endopeptidase present in most mammalian cells. Overexpression of cathepsin D is associated with the progression of several human cancers including melanoma. We examined the expression levels of cathepsin D in 20 primary malignant melanomas, 20 metastatic malignant melanomas, 20 benign nevus pigmentosus and 10 normal skin samples in Japanese. In normal skin, granular or dotted pattern of positive staining was observed along the granular layer of epidermis and hair follicle with apparent moderate to strong staining in sebaceous and eccrine glands. The percent positivity and staining intensity of cathepsin D in primary and metastatic malignant melanomas were significantly higher than that of nevus pigmentosus. Moreover, the expression levels of cathepsin D in metastatic malignant melanomas were significantly higher than those of primary malignant melanomas. Data from our and previous reports strongly supports a notion that the upregulation of cathepsin D may be critically involved in the malignant transformation and progression of melanocytic tumors.

患者男,22岁.因指、趾甲萎缩变形7年余,颈部及胸、背部网状色素沉着2年余,于2011年11月4日到我院就诊.患者7年前无明显诱因双手指甲萎缩变形,随后双足趾甲也出现类似表现,先后在多家医院诊断为"甲癣"、"甲营养不良",给予相应治疗均无明显好转,后患者放弃治疗.2年前,患者颈部出现网状色素沉着斑,无自觉症状,皮损逐渐增多蔓延至胸、背部等处.患者发病以来无结膜充血、畏光、头发及牙齿异常等其他症状,大小便正常.

皮肤平滑肌瘤较少见,病因尚不明确,多发性者更为罕见.现将武汉市协和医院皮肤科确诊1例多发性皮肤平滑肌瘤报告如下. 1 病历摘要 患者男,54岁.右小腿起结节20余年,渐增多,于2010年10月21日就诊.患者20年前无明显诱因于右小腿胫前出现大小不等结节,肤色或淡红色,无明显自觉症状,皮疹渐增多.近七八年渐出现疼痛感,曾在当地就诊,未明确诊断,未予处理.

BACKGROUND:Despite our growing knowledge regarding the biology of S100 family proteins in cancers and internal diseases, limited data are available with their distribution in normal skin and in sweat gland tumors. OBJECTIVE:To study the expression and distribution pattern of multiple S100 proteins in normal skin and in the tumors of sweat glands. METHODS:Immunohistological staining was performed using S100A2, S100A4, S100A6, S100A7, S100A8/9, S100A11, and S100P in 41 cases of various kinds of sweat gland tumors and in 13 cases of normal skin. RESULTS:In normal skin, S100A2, S100A6, S100A7, and S100P staining were observed in the sweat glands. S100A2 positively stained in the outer layer of the eccrine duct. S100A6 immunolabeling was observed in the secretory portion of the eccrine gland. Myoepithelial cells of the apocrine gland were positive for S100A2 and S100A6. S100A7 was positive in the acrosyringium, ductal, and secretory portions of the eccrine gland and in the inner layer of the apocrine gland. Intense S100P staining was detected in the inner layer of the acrosyringium and eccrine ducts. Langerhans cells and melanocytes showed strong immunoreactivity to S100A4. Extramammary Paget's disease (EMPD) expressed S100A7 and S100P with partial S100A6 and S1004 staining. Eccrine poroma expressed S100A2 and S100A7 with partial labeling with S100A6. Syringoma expressed S100A2, S1007, and S100P. Apocrine hidrocystoma expressed S100A2 with partial S100A6 and S100A7 immunoreactivity. Syringocystadenoma papilliferum expressed S100A2, S100A6, S100A7, and S100P. CONCLUSION:S100A2, S100A6, S100A7, and S100P proteins are specifically involved in structure-related distribution and are potentially useful for differential diagnoses of sweat gland tumors.

BackgroundS100 proteins belong to a family of calcium-binding proteins that regulate cell proliferation and differentiation. Despite our growing knowledge about the biology of S100 proteins in some human cancers, little is known about the expression of S100 family members in epidermal tumors and their clinical significance.ObjectiveTo determine the expression of S100A2, S100A4, S100A6, S100A7, as well as matrix metalloproteinases 9 (MMP9) in a spectrum of epidermal tumors with benign and malignant characteristics.MethodsImmunohistological staining was performed for S100A2, S100A4, S100A6, S100A7, and MMP9 in 101 cases of various types of epidermal tumors, viz., squamous cell carcinoma (SCC), Bowen's disease (BD), actinic keratosis (AK), basal cell carcinoma (BCC), keratoacanthoma (KA), and seborrheic keratosis (SK). Thirteen specimens of normal skin (NS) served as control.ResultsS100A2, S100A6, and S100A7 positive immunostaining was variably observed in different epidermal tumors. S100A4 staining was not observed in any epidermal tumors, but was clearly visible in dendritic cells. MMP9 immunostaining was positive only in 22/26 (84.62%) of SCC and 2/15 (13.33%) of BD cases. Expression of S100A2, S100A6, and S100A7 was increased in tumor cells compared to NS. However, only S100A6 expression was significantly associated with malignant transformation of epidermal tumors. Moreover, S100A6 expression was correlated with MMP9 expression in metastatic SCC.ConclusionsEpidermal tumors show increased expression of S100A2 and S100A7 proteins. S100A4 may be a useful and distinct marker for epidermal dendritic cells. Expression of S100A6 and MMP9 in combination is associated with the development of SCC.

Objective To investigate the effects of epigallocatechin-3-gallate （EGCG） on epithe- lial-mesenchymal transition （EMT） through transforming growth factor （TGF）-l/signal transducer and activators of transcription 3 （ STAT3 ） signal pathway in malignant melanoma. Methods The cell morphol- ogy, migration and invasion ability of TGFq31-stimulated B16 cells were studied under a phase-contrast mi- croscope 24 h after co-incubation with different concentrations （5, 25, and 50 rag/L） of EGCG. The mi- gration ability of the cells was detected by Scrape-wound migration assay, and the invasion ability was stud- ied by Transwell. Western blotting was employed to study the expression of p-stat3 and E-cadherin. The animal model of B16 tumour was established, and E-cadhein mRNA expression was detected by using re- verse transcription-polymerase chain reaction （RT-PCR）. Results （ 1 ） TGF-I （ 5 pg/L）-stimulated B16 cells were long-spindle shaped with loose cell-cell connection. Twenty-four h later after co-incubation with different concentrations of EGCG, B16 cells became more connected, with the degree of change pro- portional to EGCG concentrations. There were increased distance in Scrape-wound migration assay, and Tr- answell number was 97. 00 ＋9. 97, 60. 30 ±4. 00 and 38.75 ±7. 18 respectively. The invasion ability was negatively correlated to the EGCG concentration （ r = - 0. 92, P 〈 0. 05 ） ; （ 2 ） The effects of reduced p- STAT3 expression and increased E-cadherin expression under the effects of different concentrations of EGCG were concentration-dependent. The expression levels of p-STATS and E-Cadherin were also nega- tively correlated （ r = - 0. 805, P 〈 0. 05 ） ; （ 3 ） The obviously increased level of E-cadhein mRNA inEGCG intervened tumour tissue had statistically significant difference （ P 〈 O. O1 ）. Conclusion EGCG in- hibits EMT of B16 cells clearly through the TGF-[31/STAT 3 signal pathway.\r\n\r\nKey words: \r\nEpigallocatechin-3-gallate ;  Epithelial-mesenehymal transition ;  Transforminggrowth factor-131 ;  Melanoma