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Histopathologic Overlap Between Bullous Lupus Erythematosus and Linear IgA Bullous Dermatosis: A Comparative Study. 大疱性红斑狼疮与线性 IgA 大疱性皮肤病的组织病理学重叠:比较研究。
IF 1.1 4区 医学 Q4 DERMATOLOGY Pub Date : 2024-11-01 Epub Date: 2024-09-17 DOI: 10.1097/DAD.0000000000002825
Lavanya Murugesu, Rajalakshmi Tirumalae

Abstract: Bullous lupus erythematosus (BLE) and linear IgA disease (LAD) are rare autoimmune subepidermal blistering diseases, with overlapping features despite different pathogenetic mechanisms. Diagnosis is based on immunofluorescence and serology. This retrospective study was undertaken to compare the histopathologic features of BLE and LAD (11 cases each). The mean age was 36 years in both groups, and female preponderance was noted in BLE. Clinically, all cases presented as tense, itchy blisters distributed over the trunk, face, and extremities. Subepidermal neutrophil-rich blisters were seen in 60% BLE and 54.54% LAD cases. Eosinophils in the blisters were noted in 4 cases (36.4%) of linear IgA bullous dermatosis, but not in any of the BLE cases. The adjacent epidermal changes noted include spongiosis (33%; 40%), papillary microabscesses (22%; 20%), and basal tagging by neutrophils (77%; 70%). Superficial perivascular inflammation was seen in all cases while deep perivascular inflammation was observed in 54% BLE and 36% LAD cases. Lymphocytes were the predominant infiltrate. Increased dermal mucin was seen in 60% BLE and 45% LAD cases. None of the histopathologic features showed a statistically significant difference between the 2 groups. Hence, histopathology alone is of limited value in distinguishing the 2 groups. Diagnosis rests on immunofluorescence and serologic findings, which should be used even in cases that seem to be classic LAD or patients without history of systemic lupus erythematosus.

摘要:红斑狼疮(BLE)和线性 IgA 病(LAD)是罕见的自身免疫性表皮下水疱病,尽管发病机制不同,但特征却相互重叠。诊断依据是免疫荧光和血清学。这项回顾性研究旨在比较 BLE 和 LAD(各 11 例)的组织病理学特征。两组病例的平均年龄均为 36 岁,BLE 病例中女性居多。临床上,所有病例均表现为分布在躯干、面部和四肢的紧张性瘙痒水疱。60%的BLE和54.54%的LAD病例可见表皮下富含中性粒细胞的水疱。在 4 例(36.4%)线性 IgA 大疱性皮肤病患者的水疱中发现了嗜酸性粒细胞,但在所有 BLE 患者中均未发现。邻近表皮的变化包括海绵状增生(33%;40%)、乳头状微脓肿(22%;20%)和中性粒细胞基底标记(77%;70%)。所有病例均可见浅层血管周围炎症,而 54% 的 BLE 和 36% 的 LAD 病例可见深层血管周围炎症。淋巴细胞是主要的浸润。在 60% 的 BLE 和 45% 的 LAD 病例中可见真皮粘蛋白增加。两组病例的组织病理学特征均无显著统计学差异。因此,仅靠组织病理学来区分两组病例的价值有限。诊断主要依靠免疫荧光和血清学检查结果,即使是看似典型的LAD病例或无系统性红斑狼疮病史的患者,也应使用免疫荧光和血清学检查结果。
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引用次数: 0
Use of Albumin In Situ Hybridization to Diagnose Cutaneous Metastatic Hepatocellular Carcinoma With Poorly Differentiated Features: A Case Report and Review of the Literature. 使用白蛋白原位杂交诊断分化特征不佳的皮肤转移性肝细胞癌:病例报告和文献综述。
IF 1.1 4区 医学 Q4 DERMATOLOGY Pub Date : 2024-10-31 DOI: 10.1097/DAD.0000000000002854
Andrew J Gauger, Aofei Li, Mike Fritz, Terrence M Katona, Ahmed K Alomari

Abstract: Hepatocellular carcinoma (HCC) rarely metastasizes to the skin. When it occurs, it is often poorly differentiated making the diagnosis challenging. There exists a male predominance, and clinical presentation usually includes papules or nodules resembling pyogenic granulomas or dermal deposits. Histopathology shows malignant dermal cells. Hepatoid features including nests or cords of cells arranged in a trabecular or pseudoglandular pattern, sinusoidal formation, or the presence of bile exist in less than 50% of cases. Limitations exist with immunohistochemical staining, particularly in poorly differentiated neoplasms. Albumin in situ hybridization is more sensitive for detecting poorly differentiated HCC. Immunostaining in conjugation with albumin in situ hybridization enhances the detection of metastatic hepatocellular carcinoma. We report the case of a 74-year-old man with a history of HCC and a stable lung metastasis who presented with painful, growing bumps on his nose for 2 months. Examination revealed multiple, pink to white, shiny dermal-based papules with telangiectasias involving the right nasal tip and naris. Alpha-fetoprotein level was markedly elevated. Computed tomography showed expanding right lower lobe lung nodules. Histopathology of the cutaneous biopsy revealed features of a poorly differentiated basaloid carcinoma. Immunohistochemical staining was diffusely positive for glypican-3, focally positive for arginase-1, and negative for hepatocyte paraffin 1. Albumin in situ hybridization was diffusely positive, clinching the diagnosis of HCC. Metastatic HCC is a rare encounter for dermatopathologists. We aim to increase awareness of its occurrence in patients with advanced HCC and highlight the importance of clinical correlation when faced with poorly differentiated or unusual-looking basaloid neoplasms.

摘要:肝细胞癌(HCC)很少转移到皮肤。一旦发生转移,通常分化不良,因此诊断具有挑战性。患者以男性居多,临床表现通常包括类似化脓性肉芽肿或真皮沉积的丘疹或结节。组织病理学显示为恶性真皮细胞。只有不到50%的病例具有肝脏特征,包括以小梁或假腺体模式排列的细胞巢或细胞索、窦状结构或胆汁的存在。免疫组化染色存在局限性,尤其是在分化较差的肿瘤中。白蛋白原位杂交对检测分化较差的 HCC 更为敏感。免疫染色与白蛋白原位杂交结合可提高转移性肝细胞癌的检测率。我们报告了一例 74 岁的男性病例,他有 HCC 病史和稳定的肺转移灶。检查发现,他的右鼻尖和鼻翼出现多发、粉红色至白色、发亮的真皮丘疹和毛细血管扩张。甲胎蛋白水平明显升高。计算机断层扫描显示右肺下叶结节不断扩大。皮肤活检组织病理学显示为分化较差的基底样癌。免疫组化染色显示,glypican-3呈弥漫性阳性,精氨酸酶-1呈局灶性阳性,肝细胞石蜡1呈阴性。对于皮肤病理学家来说,转移性 HCC 是一种罕见病。我们的目的是提高晚期HCC患者对其发生率的认识,并强调在面对分化不良或外观异常的基底细胞瘤时临床相关性的重要性。
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引用次数: 0
Metastatic Mesothelioma of the Tunica Vaginalis Presenting as Scrotal and Abdominal Nodules: A Case Report and Review of the Literature. 表现为阴囊和腹部结节的阴道外膜转移性间皮瘤:病例报告与文献综述。
IF 1.1 4区 医学 Q4 DERMATOLOGY Pub Date : 2024-10-31 DOI: 10.1097/DAD.0000000000002848
Aubre Gilbert, Rebekah Wieland, Natasha Zacher, Kerri Rieger, Gerald J Berry, Roberto Novoa

Abstract: Mesothelioma of the tunica vaginalis testis (MMTVT) is a rare neoplasm comprising <3% of all cases of malignant mesothelioma (MM). MMTVT derives from the tunica vaginalis testis, an outpouching of the mesothelial-lined abdominal peritoneum that detaches from the abdominal cavity after the descent of the testis. Similar to pleural mesothelioma, asbestos exposure is a known risk factor. However, MMTVT has a better prognosis than pleural mesothelioma. Cutaneous metastases from MMTVT are exceedingly rare. Herein, we describe a case of a 67-year-old man with a history of asbestos exposure presenting with scrotal pain and indurated plaques on his lower abdomen and scrotum. Histologic sections showed a sheet-like dermal proliferation comprising epithelioid cells with necrosis and increased mitotic activity. The clinical and histologic differential diagnosis was broad, including metastatic carcinoma, melanoma, sarcoma, germ cell tumor, hematologic malignancy, neuroendocrine carcinoma, and malignant mesothelioma. By immunohistochemistry, the neoplastic cells were positive for WT1, D2-40, and AE1/AE3, with rare positivity for calretinin, consistent with a diagnosis of mesothelioma. Additional immunohistochemical studies provided no support for the other diagnostic considerations listed above. BAP1 showed retained nuclear expression (normal) by immunohistochemistry. A DNA sequencing panel identified copy number losses in CDKN2A, MTAP, CDKN2B, and NF2, which are frequently identified genetic alterations in malignant mesothelioma. Subsequent testicular imaging demonstrated a diffusely thickened scrotal wall with an enlarged left testicle. Overall, this represents a case of malignant mesothelioma presenting with cutaneous metastases to the scrotum and lower abdomen, with clinical and imaging features suggestive of primary MMTVT. The International Mesothelioma Interest Group recommends using at least 2 mesothelial markers, such as calretinin, WT1, CK5/6 or D2-40, and 2 epithelial markers, such as claudin-4, CEA, MOC-31, as well as a broad-spectrum cytokeratin stain (AE1/AE3) as part of an initial immunohistochemical panel. Metastatic mesothelioma should be included in the differential diagnosis of malignant epithelioid dermal tumors with unusual staining patterns.

摘要:阴道睾丸间皮瘤(MMTVT)是一种罕见的肿瘤,包括阴道睾丸间皮瘤(MMTVT)和阴道睾丸间皮瘤(MMTVT)。
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引用次数: 0
Superficial Papular Neuroma: Two Cases of a Distinctive Dermal Neoplasm. 表皮乳头状神经瘤:两例独特的皮肤肿瘤。
IF 1.1 4区 医学 Q4 DERMATOLOGY Pub Date : 2024-10-31 DOI: 10.1097/DAD.0000000000002872
Ronan Knittel, David Paton, Trevor W Beer

Abstract: Superficial papular neuroma is a rare cutaneous spindle cell lesion, with only 5 cases reported in 2 studies. We document 2 additional cases in a 45-year-old man and a 43-year-old woman (the first case identified in a woman). Clinically, superficial papular neuromas appear as a single, non-specific papule on the head, neck, or back. Histologically, these lesions are within the papillary and superficial reticular dermis, with nerve-like structures composed of bland spindle-shaped cells intersecting normal tissue with mild reactive acanthosis. The cells are SOX10 positive with neurofilament protein staining multiple axons within. The nerve-like structures in this study were occasionally surrounded by a thin rim of CD34 positivity, with no epithelial membrane antigen staining, similar to normal sensory neurons. Superficial papular neuroma are rare benign neoplasms with no reports of recurrence, even when incompletely excised.

摘要:浅表丘疹性神经瘤是一种罕见的皮肤纺锤形细胞病变,仅在两项研究中报告过 5 例。我们记录了另外两例病例,分别发生在一名 45 岁的男性和一名 43 岁的女性身上(首次发现女性病例)。临床上,浅表丘疹性神经瘤表现为头部、颈部或背部的单个非特异性丘疹。组织学上,这些病变位于乳头状和浅表网状真皮内,神经样结构由平淡的纺锤形细胞组成,与正常组织相交,伴有轻度反应性棘皮增生。这些细胞的SOX10呈阳性,神经丝蛋白染色显示其中有多条轴突。本研究中的神经样结构偶尔被薄薄的 CD34 阳性边缘包围,没有上皮膜抗原染色,与正常感觉神经元相似。浅表丘疹性神经瘤是一种罕见的良性肿瘤,即使未完全切除,也没有复发的报道。
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引用次数: 0
Selective Clonal Regression After Interferon Therapy in Metastatic Melanoma. 转移性黑色素瘤接受干扰素治疗后的选择性克隆消退
IF 1.1 4区 医学 Q4 DERMATOLOGY Pub Date : 2024-10-31 DOI: 10.1097/DAD.0000000000002873
Angel Fernandez-Flores

Abstract: Regression (total or partial) is a common phenomenon in melanoma. From a pathogenic perspective, it is highly complex and only partially understood, involving aspects of both the tumor and the individual. One of the determining factors is the clonal selection of the tumor, wherein some clones within the tumor survive while others perish. This clonal selection can sometimes occur as a selective mechanism after the initiation of a therapeutic intervention. In many of these cases, the effect is detrimental, because the surviving clone is resistant to the applied therapy. However, occasionally, the therapy can successfully select the less harmful clone. We present an example of the latter, where therapy with interferon induced regression of the metastatic-capable melanocytic population, with only the primary tumor melanocytic population persisting. To confirm this, we demonstrated BRAF mutational similarity between the 2 populations, and an additional NRAS mutation in the metastatic population, which was absent in the primary tumor.

摘要:退变(完全或部分)是黑色素瘤的一种常见现象。从致病的角度来看,这种现象非常复杂,而且只被部分理解,涉及到肿瘤和个体的方方面面。其中一个决定性因素是肿瘤的克隆选择,即肿瘤内的一些克隆存活下来,而另一些则消亡。这种克隆选择有时会在开始治疗干预后作为一种选择机制出现。在许多这种情况下,效果是有害的,因为存活下来的克隆对应用的疗法具有抵抗力。但有时,治疗也能成功地选择出危害较小的克隆。我们举例说明了后者的情况,即使用干扰素治疗可诱导具有转移能力的黑色素细胞群消退,只有原发肿瘤黑色素细胞群继续存在。为了证实这一点,我们证实了这两个群体之间的 BRAF 基因突变相似性,而且转移群体中还出现了一种 NRAS 基因突变,而原发肿瘤中却没有这种突变。
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引用次数: 0
Beyond the Surface: Dermoscopic, Clinical, and Histopathological Insights Into Secondary Extramammary Paget Disease of the Glans Linked to Urothelial Carcinoma. 超越表面:皮肤镜、临床和组织病理学透视与泌尿道癌相关的继发性龟头乳头外皮样病变。
IF 1.1 4区 医学 Q4 DERMATOLOGY Pub Date : 2024-10-31 DOI: 10.1097/DAD.0000000000002876
Alexandre Raphael Meduri, Benedetta Tirone, Lucia Lospalluti, Francesca Ambrogio, Gerardo Cazzato, Marco Bellino
{"title":"Beyond the Surface: Dermoscopic, Clinical, and Histopathological Insights Into Secondary Extramammary Paget Disease of the Glans Linked to Urothelial Carcinoma.","authors":"Alexandre Raphael Meduri, Benedetta Tirone, Lucia Lospalluti, Francesca Ambrogio, Gerardo Cazzato, Marco Bellino","doi":"10.1097/DAD.0000000000002876","DOIUrl":"10.1097/DAD.0000000000002876","url":null,"abstract":"","PeriodicalId":50967,"journal":{"name":"American Journal of Dermatopathology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
SOX-10 and Melan-A Immunostaining in Areas of Focal Acantholytic Dyskeratosis and Epidermolytic Hyperkeratosis Within Dysplastic Nevi Biopsies: An Observational Study. 发育不良痣活检组织中局灶性角化不良和表皮溶解性角化过度区域的 SOX-10 和 Melan-A 免疫染色:一项观察性研究。
IF 1.1 4区 医学 Q4 DERMATOLOGY Pub Date : 2024-10-31 DOI: 10.1097/DAD.0000000000002866
Kayley L Erickson, Raghav Tripathi, Bethany R Rohr

Background: Focal acantholytic dyskeratosis (FAD) and epidermolytic hyperkeratosis (EHK) are common incidental epidermal histologic findings within dysplastic nevi biopsies. We evaluate whether areas of FAD and EHK within dysplastic nevi biopsies stain with immunostains used to characterize melanocytic neoplasms.

Methods: In this case series, a natural language search of histopathology reports from our institution in the past year (2020-2021) identified dysplastic nevus biopsies with concurrent FAD and/or EHK. Tissue samples were examined for positive melanocytic immunostaining with SOX-10 and Melan-A in areas of FAD and EHK.

Results: Out of 32 biopsies, 20 of 26 FAD specimens (76.9%) and 2 of 6 EHK specimens (33.3%) showed unexpected suprabasal layer staining with a melanocytic marker that did not correspond to definitively identified melanocytes on the H&E-stained sections. The immunohistochemical staining of FAD and EHK was observed in 2 forms: nonspecific background staining or "true" staining (ie, seemed nuclear on SOX-10 or cytoplasmic on Melan-A).

Conclusions: This pilot examination provides evidence that areas of incidental FAD within dysplastic nevi biopsies demonstrate unexpected suprabasal layer staining with melanocytic markers. When dermatopathologists evaluate melanocytic neoplasms with melanocytic markers, it is possible the presence of incidental FAD could lead to over diagnosing pagetoid scatter within these lesions. This study is a proof of concept with mild to moderately dysplastic nevi that do not typically incur the use of melanocytic stains; however, the implication of this unexpected staining pattern would be important when using melanocytic markers on borderline melanocytic neoplasms that have incidental FAD. Close correlation with H&E is imperative to prevent misinterpretation in these cases.

背景:局灶性角化不全(FAD)和表皮溶解性角化过度(EHK)是发育不良痣活检中常见的偶然表皮组织学发现。我们对发育不良痣活检组织中的FAD和EHK区域是否与用于鉴定黑素细胞瘤的免疫印迹染色进行了评估:在本病例系列中,我们对本机构过去一年(2020-2021 年)的组织病理学报告进行了自然语言搜索,发现了同时存在 FAD 和/或 EHK 的发育不良痣活检组织。对组织样本进行检查,以确定FAD和EHK区域的SOX-10和Melan-A黑色素细胞免疫染色是否呈阳性:在 32 份活检样本中,26 份 FAD 标本中有 20 份(76.9%)和 6 份 EHK 标本中有 2 份(33.3%)的基底上层出现了意想不到的黑色素细胞标记物染色,但与 H&E 染色切片上明确识别的黑色素细胞并不一致。FAD和EHK的免疫组化染色有两种形式:非特异性背景染色或 "真正的 "染色(即SOX-10的核染色或Melan-A的胞浆染色):这项试验性检查提供的证据表明,在发育不良痣活检中偶然发现的 FAD 区域会出现意想不到的基底上层黑素细胞标记物染色。当皮肤病理学家用黑素细胞标记物评估黑素细胞瘤时,偶然出现的 FAD 有可能导致过度诊断这些病变中的表皮散在。这项研究是对轻度至中度发育不良痣的概念验证,这些痣通常不需要使用黑色素细胞染色剂;但是,当使用黑色素细胞标记物检测偶然出现 FAD 的边缘黑色素细胞瘤时,这种意外染色模式的意义将非常重要。在这些病例中,必须与 H&E 密切关联,以防止误诊。
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引用次数: 0
Perianal Pulse Granuloma Induced by Plant-Derived Baby Wipes. 植物制成的婴儿湿巾诱发肛周脉冲肉芽肿
IF 1.1 4区 医学 Q4 DERMATOLOGY Pub Date : 2024-10-31 DOI: 10.1097/DAD.0000000000002877
Robin H Wang, Jenna J Lullo, Madhu Dahiya, David B Eilers

Abstract: Pulse granulomas are unusual foreign body reactions to exogenous plant material, featuring the presence of hyaline ring structures and granulomatous inflammation. Pulse granulomas have been reported to occur in the oral cavity, gastrointestinal tract, and respiratory tract. Cutaneous pulse granulomas are exceedingly rare. All reported cases have been closely associated with underlying pathology such as chronic inflammatory conditions, trauma, or surgical procedures which likely facilitated implantation of exogenous plant material. We report a novel case of a cutaneous pulse granuloma presenting in the perianal region of an otherwise healthy man. The authors propose that the source of the exogenous plant material is plant-derived baby wipes, which the patient had been using daily to the perianal region.

摘要:脉冲肉芽肿是对外源性植物材料的不寻常异物反应,其特点是存在透明环状结构和肉芽肿性炎症。据报道,脉冲肉芽肿发生在口腔、胃肠道和呼吸道。皮肤脉冲肉芽肿则极为罕见。所有报道的病例都与潜在的病理因素密切相关,如慢性炎症、创伤或外科手术,这些因素可能会促进外源性植物材料的植入。我们报告了一例皮肤脉冲肉芽肿的新病例,该病例出现在一名健康男子的肛周。作者认为,外源性植物材料的来源是源自植物的婴儿湿巾,患者每天都用这种湿巾擦拭肛周。
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引用次数: 0
Relapsing Cutaneous Metastatic Breast Cancer: A Clinical Conundrum. 复发性皮肤转移性乳腺癌:临床难题。
IF 1.1 4区 医学 Q4 DERMATOLOGY Pub Date : 2024-10-15 DOI: 10.1097/DAD.0000000000002855
Yashika Doshi, Nelry Gonsalves, Bela J Shah
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引用次数: 0
Subcutaneous Sweet Syndrome With Vasculitis Features: Case Report and Review. 具有血管炎特征的皮下甜综合征:病例报告与回顾
IF 1.1 4区 医学 Q4 DERMATOLOGY Pub Date : 2024-10-15 DOI: 10.1097/DAD.0000000000002845
Jia Tang, Bing Lv

Background: Subcutaneous Sweet Syndrome (SSS) is a rare variant of Sweet Syndrome characterized by neutrophilic infiltration of subcutaneous adipose tissue without vasculitis. The presence of vasculitis in SSS is uncommon and poses diagnostic challenges.

Case presentation: A 38-year-old female presented with a one-year history of recurrent painful erythematous nodules on her limbs and face. Physical examination revealed asymmetrical erythematous patches and tender subcutaneous nodules with central necrotic eschars on the lower limbs. Laboratory tests were unremarkable except for a mildly elevated erythrocyte sedimentation rate. Histopathological analysis showed significant neutrophilic infiltration within the adipose lobules and vascular walls, along with extravasation of red blood cells, indicating vasculitis. The patient responded promptly to systemic corticosteroids; however, symptoms recurred upon tapering, necessitating ongoing steroid therapy.

Discussion: This case underscores the rare occurrence of vasculitis in SSS, expanding the histopathological spectrum of the disease. Literature review suggests that vasculitis in SSS may result from neutrophil-mediated vascular damage rather than immune complex deposition. The recurrent symptoms upon steroid tapering highlight the therapeutic challenges in managing SSS with vasculitis.

Conclusion: Recognition of vasculitis in SSS is crucial for accurate diagnosis and effective management. Further research is warranted to elucidate the pathogenesis and develop targeted treatment strategies for SSS with vasculitis.

背景:皮下斯威特综合征(SSS)是斯威特综合征的一种罕见变异型,其特点是皮下脂肪组织中性粒细胞浸润,但不伴有血管炎。SSS 中出现血管炎并不常见,给诊断带来了挑战:一名 38 岁的女性患者因四肢和面部反复出现疼痛性红斑结节已有一年病史。体格检查发现下肢有不对称的红斑和皮下触痛性结节,中央有坏死的痂皮。除红细胞沉降率轻度升高外,实验室检查无异常。组织病理学分析显示,脂肪小叶和血管壁内有明显的中性粒细胞浸润,并伴有红细胞外渗,这表明患者患有血管炎。患者对全身皮质类固醇治疗反应迅速,但症状在逐渐减轻后又复发,因此需要继续接受类固醇治疗:讨论:本病例强调了在 SSS 中发生血管炎的罕见性,扩大了该病的组织病理学范围。文献综述表明,SSS 中的血管炎可能是中性粒细胞介导的血管损伤所致,而非免疫复合物沉积。类固醇减量后症状复发,凸显了治疗伴有血管炎的 SSS 所面临的挑战:结论:识别 SSS 中的血管炎对于准确诊断和有效治疗至关重要。有必要开展进一步研究,以阐明其发病机制,并为伴有血管炎的 SSS 制定有针对性的治疗策略。
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引用次数: 0
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American Journal of Dermatopathology
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