Balfour E, Olhoffer I, Leffell D, Handerson T
Department of Pathology, University of Arkansas for Mmedical Sciences, Little Rock, USA.
Am J Dermatopathol. 2003 Aug;25(4):338-40. doi: 10.1097/00000372-200308000-00010.
We document an unusual tattoo reaction presenting as verrucous plaques, which on histopathologic examination showed marked pseudoepitheliomatous epidermal hyperplasia. The patient is a 27-year-old female who presented to her dermatologist complaining of itchy overgrowth of her tattoo. Her symptoms began 2 months after tattoo placement approximately 1 year ago. Physical examination revealed verrucous plaques in the purple areas of the tattoo, suggesting a clinical diagnosis of a granulomatous tattoo reaction. A superficial biopsy showed epidermal hyperplasia somewhat reminiscent of a regressing keratoacanthoma. No tattoo was identified. A repeat shave biopsy demonstrated marked epidermal hyperplasia with focal keratin filled cystic dilatations, and local mild reactive keratinocytic atypia. In the surrounding dermis, there was dense chronic inflammation, fibrosis, and granules of dark red pigment. These findings suggest marked pseudoepitheliomatous hyperplasia secondary to the tattoo. Different reaction patterns have been described in association with tattoos, such as granulomatous and/or perivascular lymphocytic inflammation. However, there have been few cases reported of pseudoepitheliomatous hyperplasia arising at a tattoo site. Therefore, we encourage physicians to consider massive epidermal hyperplasia in the differential diagnosis of a verrucous tattoo reaction.
我们记录了一例表现为疣状斑块的罕见纹身反应，组织病理学检查显示有明显的假上皮瘤样表皮增生。患者为一名27岁女性，她向皮肤科医生主诉纹身部位出现瘙痒性过度生长。她的症状大约在1年前纹身2个月后开始出现。体格检查发现纹身紫色区域有疣状斑块，提示临床诊断为肉芽肿性纹身反应。浅层活检显示表皮增生，有点类似于消退期的角化棘皮瘤。未发现纹身。再次进行剃除活检显示有明显的表皮增生，伴有局灶性角质填充的囊性扩张以及局部轻度反应性角质形成细胞异型性。在周围真皮层，有密集的慢性炎症、纤维化以及暗红色色素颗粒。这些发现提示纹身继发明显的假上皮瘤样增生。与纹身相关的不同反应模式已有描述，如肉芽肿性和/或血管周围淋巴细胞炎症。然而，纹身部位出现假上皮瘤样增生的病例报道很少。因此，我们鼓励医生在疣状纹身反应的鉴别诊断中考虑明显的表皮增生。
