Fair K P, Patterson J W, Murphy R J, Rudd R J
Departments of Pathology and Dermatology, University of Virginia Health Science Center, Charlottesville 22908-0214, USA.
J Am Acad Dermatol. 2000 Jul;43(1 Pt 1):102-7. doi: 10.1067/mjd.2000.100962.
Cutaneous deciduosis is an exceedingly rare manifestation of endometriosis potentially mistaken for malignancy and thus far documented solely within surgical scars. We describe two additional cases, one occurring in a pregnant 21-year-old woman as a solitary flat erythematous vulvar papule, an extraordinary location not previously recorded. Histologic examination in that case revealed a subepithelial nodular aggregate of atypical large dyscohesive cells with accompanying edema and inflammation. An immunohistochemical panel showed positivity of the cells for vimentin and Ki-1 (CD30). Intracellular sulfated mucin and glycogen were also demonstrated. In a second case, a 27-year-old woman had a nodule at the umbilicus, removed incidentally during the course of cesarean section. Microscopically there were several circumscribed, multilobulated, intradermal nodules with variably sized lumens formed by crowded large epithelioid cells. The disparate histologic appearance of these examples highlights an essential challenge in their diagnosis. Clinical recognition is difficult unless suggested by more characteristic history or location.
皮肤蜕膜样变是子宫内膜异位症极为罕见的一种表现形式，可能被误诊为恶性肿瘤，迄今为止仅在手术瘢痕中被记录。我们描述另外两例病例，一例发生在一名21岁孕妇身上，表现为孤立的扁平红斑性外阴丘疹，这是一个以前未被记录的特殊部位。该病例的组织学检查显示，上皮下有一群非典型的、大的、细胞间缺乏黏附力的细胞形成结节状聚集，并伴有水肿和炎症。免疫组化检查显示这些细胞波形蛋白和Ki-1（CD30）呈阳性。细胞内还证实有硫酸化黏蛋白和糖原。另一例中，一名27岁女性在剖宫产过程中偶然发现脐部有一个结节。显微镜下可见几个界限清楚、多叶状的真皮内结节，由密集的大上皮样细胞形成大小不一的管腔。这些病例不同的组织学表现凸显了诊断它们的一个关键挑战。除非有更具特征性的病史或部位提示，否则临床识别很困难。
