Shiomi Tatsushi, Yamamoto Tetsurou, Manabe Toshiaki
Laboratory of Diagnostic Pathology, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan.
J Cutan Pathol. 2007 Apr;34(4):346-51. doi: 10.1111/j.1600-0560.2006.00611.x.
Mycobacterial spindle cell pseudotumor is a rare tumor-like lesion characterized by the proliferation of spindle cells engorged with mycobacterial microorganisms. To our knowledge, only a few cases of cutaneous lesions have been described in the literature.
A 58-year-old Japanese woman presented with a nodule in her left forearm. She had systemic lupus erythematosus and interstitial pneumonia for 17 years, treated with prednisolone and azathioprine. She was also receiving insulin treatment for diabetes mellitus.
Histologically, the lesion was located in the deep dermis with extension into the subcutaneous fat tissue and was composed mainly of spindle cells focally showing a vaguely storiform pattern. In limited focal areas, foam cells, epithelioid histiocytes, and multinucleated giant cells were seen sparsely. Ziehl-Neelsen staining showed numerous acid-fast bacilli within the spindle cells and epithelioid histiocytes. The acid-fast bacilli were determined by culture and polymerase chain reaction to be Mycobacterium intracellulare.
We emphasize that mycobacterial spindle cell pseudotumor should be included in the differential diagnoses of a spindle cell lesion in the skin, especially in immunosuppressed patients.
分枝杆菌性梭形细胞假瘤是一种罕见的肿瘤样病变，其特征为充满分枝杆菌微生物的梭形细胞增殖。据我们所知，文献中仅描述了少数皮肤病变病例。
一名58岁的日本女性，左前臂出现一个结节。她患有系统性红斑狼疮和间质性肺炎17年，接受泼尼松龙和硫唑嘌呤治疗。她还因糖尿病接受胰岛素治疗。
组织学检查显示，病变位于真皮深层，延伸至皮下脂肪组织，主要由梭形细胞组成，局部呈模糊的束状排列。在有限的局部区域，可见散在的泡沫细胞、上皮样组织细胞和多核巨细胞。齐-尼氏染色显示梭形细胞和上皮样组织细胞内有大量抗酸杆菌。经培养和聚合酶链反应确定，这些抗酸杆菌为胞内分枝杆菌。
我们强调，分枝杆菌性梭形细胞假瘤应纳入皮肤梭形细胞病变的鉴别诊断中，尤其是在免疫抑制患者中。
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