Cioc Adina M, Frambach Gwyn E, Magro Cynthia M
Department of Pathology, The Ohio State University, Columbus, OH 43210, USA.
J Cutan Pathol. 2005 Apr;32(4):263-7. doi: 10.1111/j.0303-6987.2005.00303.x.
Necrobiosis lipoidica (NL) is a member of the palisading granulomatous dermatitides that is associated, in most cases, with diabetes mellitus. However, there are an increasing number of cases of NL associated with other forms of systemic disease. We describe a novel case of NL associated with a light-chain-restricted plasmacellular infiltrate; subsequent investigations established an underlying monoclonal gammopathy.
Skin biopsy material was obtained and was processed in the usual fashion for hematoxylin and eosin (H and E) examination. Immunohistochemical staining was performed by utilizing kappa and lambda monoclonal antibodies (Dako Corporation, Carpentiera, CA, USA). Kappa and lambda in situ hybridization was also performed (Ventana Medical Systems, Tucson, AZ, USA).
A 55-year-old woman with a 5-year history of bilateral thigh subcutaneous nodules underwent a skin biopsy, showing typical changes of NL; there was a concomitant prominent perivascular plasmacellular infiltrate. Kappa light chain restriction was observed amid the plasmacellular infiltrate. Bone marrow biopsy and immunophenotyping studies revealed a clonal plasmacytosis with kappa light chain restriction.
Granulomatous inflammation, including NL, may be a cutaneous paraneoplastic expression of low-grade B-cell lymphoproliferative disease in the context of an underlying plasma cell dyscrasia.
类脂质渐进性坏死（NL）是栅栏状肉芽肿性皮炎的一种，在大多数情况下与糖尿病相关。然而，与其他形式的全身性疾病相关的NL病例越来越多。我们描述了一例与轻链限制性浆细胞浸润相关的NL新病例；随后的调查发现了潜在的单克隆丙种球蛋白病。
获取皮肤活检材料，并以常规方式进行苏木精和伊红（H&E）检查。利用kappa和lambda单克隆抗体（美国加利福尼亚州卡彭蒂耶拉市的达科公司）进行免疫组织化学染色。还进行了kappa和lambda原位杂交（美国亚利桑那州图森市的文塔纳医疗系统公司）。
一名有5年双侧大腿皮下结节病史的55岁女性接受了皮肤活检，显示出NL的典型变化；同时伴有明显的血管周围浆细胞浸润。在浆细胞浸润中观察到kappa轻链限制。骨髓活检和免疫表型研究显示存在kappa轻链限制的克隆性浆细胞增多。
包括NL在内的肉芽肿性炎症可能是在潜在浆细胞发育异常背景下低度B细胞淋巴增殖性疾病的皮肤副肿瘤表现。
