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病例漫谈7:玫瑰糠疹与点滴型皮肤病(蕈样肉芽肿) [复制链接]

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        At first glance, pityriasis rosea and guttate dermatosis seem to have more findings histopathologic in common than they have differences. Both have a superficial perivascular infiltrate of lymphocytes predominantly, spongiosis, and parakeratosis. They differ primarily in that pityriasis rosea has a moderately dense infiltrate, extravasated erythrocytes in what may be an edematous papillary dermis, readily noticeable spongiosis, and easily discernible acanthosis. Another difference is greater tendency toward formation of elongated mounds of parakeratosis or scale-crusts in guttate dermatosis. Last, some lesions of guttate dermatosis exhibit lymphocytes as solitary units or in tiny collections in foci in the spinous zone in company with little, if any, spongiosis and with a few lymphocytes aligned as solitary units in the basal layer.
        初看玫瑰糠疹和点滴型皮肤病的组织病理学结果,共同点似乎比差异性要多。二者都可见淋巴细胞为主的浅表血管周围浸润、海绵样变性,以及角化不全。其主要区别在于,玫瑰糠疹可见中度密集渗透和红细胞外渗,或见真皮乳头水肿、显著海绵样变性,以及棘层肥厚明显。另外,玫瑰糠疹更倾向于形成细长成堆的角化不全或轮廓规整的点滴型皮肤病。还有,某些点滴型皮肤病变显示孤立的淋巴细胞或棘突区小集合灶,伴有轻微海绵样病变,基底层少数孤立淋巴细胞排列。

        Pityriasis rosea tends to involve the torso from the neck to the knees and to consist of oval to round, salmon-pink papules and plaques with delicate scales that form collarettes. On the trunk, the lesions align themselves along lines of cleavage (Langer's lines). Days or a week or two before the appearance of the eruption, a larger scaly lesion ("mother" or "herald" patch) becomes manifest. Biopsy of this larger lesion reveals changes histopathologic similar to those in the later smaller lesions, but the perivascular infiltrate of lymphocytes often is both superficial and deep, there is less spongiosis, and acanthosis is more psoriasiform. Pityriasis rosea usually resolves without treatment in about six to nine weeks.
        玫瑰糠疹往往遍布躯干,可从颈部蔓延到膝盖,并由椭圆或圆形肉粉色丘疹和斑块组成,形成囊领。躯干上的病灶区沿郎格线排列。出疹前几天或一两个星期,开始出现大型的鳞状病变(“母系”或“先驱”补丁)。该病变活检显示,组织病理学变化与后期小型病变相似,但血管周围淋巴细胞浸润涉及了皮肤浅表和深部,有轻微海绵样病变、棘层肥厚,以及大量银屑。玫瑰糠疹通常可在约6至9个星期后自行治愈。

        Clinically, guttate dermatosis consists of drop-sized pink or tan papules covered by fine, wafer-like scales that favor the buttocks but may be present on the torso and extremities. They may be few or many. The lesions are not pruritic, but they persist indefinitely and are refractory to treatment. Histopathologically, guttate dermatosis shows little or no spongiosis.
         临床上,点滴型皮肤病表现为粉红色或棕褐色水滴大小的丘疹,覆有精细的晶片样鳞屑,主要分布于臀部,或见于躯干和四肢。或密集弥布,或零星离散。病变处无瘙痒,但该病持续久,难治疗。组织病理学显示,点滴型皮肤病很少发生海绵样病变。

        We use the term "guttate dermatosis" as an analogue of "digitate dermatosis," both of which are flattish lesions of mycosis fungoides. In times past, it was designated "small plaque parapsoriasis," which to this day is not considered by dermatologists and pathologists worldwide to be truly mycosis fungoides, but 25 years ago, those colleagues were adamant equally that "large plaque parapsoriasis" was not mycosis fungoides; no one thinks that now. Guttate dermatosis consists of round slightly scaly lesions of mycosis fungoides and digitate dermatosis of ellipsoid slightly scaly lesions of mycosis fungoides. The findings histopathologic in both are diagnostic of mycosis fungoides, those changes bring very similar, if not identical at times, to those encountered in the "large plaque parapsoriasis" expression of mycosis fungoides exemplified by parapsoriasis in plaques.
        我们用术语“点滴型皮肤病”来指代“指状皮肤病”,二者都是普通的蕈样肉芽肿病变。“点滴型皮肤病”过去特指为“小斑块银屑病”,但现今世界皮肤科医生和病理学家认为“小斑块银屑病”并不是真正的蕈样肉芽肿。但25年前,他们的同事同样坚定地认为“大斑块银屑病”不是蕈肉芽肿,现在却没有人这样认为了。点滴型皮肤病可分为圆形轻度鳞屑病变蕈样肉芽肿和椭球形轻度鳞屑病变蕈样肉芽肿指状皮肤病。二者的组织病理学结果是蕈样肉芽肿的特征,病变非常相似,偶尔在蕈样肉芽肿 (例如斑块银屑病)表达“大斑块银屑病”中有所不同。

        In short, small plaque parapsoriasis, like large plaque parapsoriasis, is mycosis fungoides. Terms like parapsoriasis en plaques, parakeratosis variegata, xanthoerythroderma perstans, pagetoid reticulosis, granulomatous slack skin, poikiloderma vasculare atrophicans, guttate dermatosis, and digitate dermatosis represent manifestations morphologic of a single neoplastic process, to wit, mycosis fungoides.
        简而言之,小型斑块银屑病与大型斑块银屑病一样,都是蕈样肉芽肿。下面这些术语,斑块银屑病、白斑角化不全症、持久性黄色红皮病、佩吉特病样网状细胞增生症、肉芽肿性皮肤松弛、血管萎缩性皮肤异色病、点滴型皮肤病、指状皮肤病,代表了单一肿瘤过程的表现形态,即,蕈样肉芽肿。

        Last, it should be mentioned that the findings histopathologic in erythema annulare centrifugum are indistinguishable from those of pityriasis rosea.
        最后,应当指出,离心性环状红斑的病理组织学结果与玫瑰糠疹极为类似,无法区分。


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