Gencoglan Gulsum, Karaarslan Isil Kilinc, Dereli Tugrul, Kazandi Ali Can
Kocatepe University, School of Medicine, Afyonkarahisar, Turkey.
Skinmed. 2008 Jan-Feb;7(1):41-3. doi: 10.1111/j.1540-9740.2007.06500.x.
Case 1: A 58-year-old man presented with a solitary asymptomatic nodule on his thumb (Figure A). After trauma with a rusty nail approximately 20 years ago, he had developed a small papule, which had enlarged gradually for a few days initially before stabilizing. His personal and family medical histories were unremarkable. Dermatologic examination revealed a 1-cm crater-like nodule on the left palmar area. This was a firm and nontender lesion that was fixed to the overlying skin but moved freely from underlying structures. There were no similar lesions elsewhere on his body. Case 2: A 52-year-old man presented with a nodular lesion on the left palmar surface of his thumb. The 0.8-cm lesion was lightly colored, with a central cup-shaped epidermal depression and thin epidermis. The patient described an insect bite to the area 15 years earlier as the precipitating event. The firm and nontender lesion was fixed to the overlying skin but moved freely from underlying structures (Figure B). Case 3: A 36-year-old man consulted for a nodular lesion, located on his left palmar surface, that had not enlarged or changed since appearing 3 years ago. He described mechanical trauma to the area as precipitating the lesion. Clinical examination revealed a 0.6-cm, well-circumscribed nodule, with a dome shape and colored skin. Clinically, the nodular lesion appeared to be a benign tumor (Figure C). In each case, the nodule was excised totally and histopathologic examination revealed a well-circumscribed, nonencapsulated nodule within the mid-dermis. Thick, acellular collagen bundles were arranged randomly in short fascicles through the center of the lesion. Cellular areas consisting of histiocytes and fibroblasts with a storiform pattern at the periphery of lesion were observed, but nuclear atypia and mitotic activity were not. Results of immunohistochemical stain with CD34 were negative, but in all cases were strongly positive for Factor XIIIa. Slight epidermal hyperplasia was present with orthokeratotic hyperkeratosis and flattened rete ridges in the overlying epidermis (Figure A-1, Figure B-1, Figure C-1). The subcutaneous fat and adjacent skin were normal. No folliculosebaceous units at the periphery of the lesion were seen, but a few eccrine sweet glands were noted. No recurrence appeared in 18 months of follow-up.
病例1：一名58岁男性，其拇指上出现一个孤立的无症状结节（图A）。大约20年前，他被一枚生锈的钉子扎伤后，长出了一个小丘疹，起初几天逐渐增大，之后稳定下来。他的个人及家族病史均无异常。皮肤科检查发现左手掌区域有一个1厘米的火山口状结节。这是一个质地坚硬、无压痛的病变，与上方皮肤粘连，但与下方结构可自由移动。他身体其他部位没有类似病变。病例2：一名52岁男性，其左手拇指掌面出现一个结节性病变。这个0.8厘米的病变颜色较浅，中央有杯状表皮凹陷，表皮较薄。患者称15年前该区域被昆虫叮咬是诱发因素。这个质地坚硬、无压痛的病变与上方皮肤粘连，但与下方结构可自由移动（图B）。病例3：一名36岁男性因一个位于左手掌面的结节性病变前来咨询，该病变自3年前出现以来未增大或变化。他称该区域受到机械性创伤是诱发病变的原因。临床检查发现一个0.6厘米、边界清晰的结节，呈圆顶状，皮肤有颜色。临床上，该结节性病变似乎是一个良性肿瘤（图C）。在每个病例中，结节均被完整切除，组织病理学检查显示真皮中部有一个边界清晰、无包膜的结节。粗大、无细胞的胶原束在病变中心呈短束状随机排列。在病变周边观察到由组织细胞和成纤维细胞组成的细胞区域，呈车辐状排列，但未见核异型性和有丝分裂活性。CD34免疫组化染色结果为阴性，但在所有病例中，因子ⅩⅢa均呈强阳性。上方表皮有轻度表皮增生，伴有正角化过度和扁平的 rete 嵴（图A - 1、图B - 1、图C - 1）。皮下脂肪及相邻皮肤正常。病变周边未见毛囊皮脂腺单位，但可见少数小汗腺。随访18个月未见复发。
