Miteva Maria, Elsner Peter, Ziemer Mirjana
Department of Dermatology, Friedrich-Schiller-University, Jena, Germany.
J Cutan Pathol. 2009 Jan;36(1):26-33. doi: 10.1111/j.1600-0560.2008.00992.x. Epub 2008 Jun 17.
Insect bites produce diverse skin reactions. Although quite common, the histopathologic features of arthropod assaults have not ever been studied systemically.
Twenty biopsies from cases, clinically diagnosed as arthropod bite reactions between January 2003 and June 2007 were reviewed retrospectively. The aim of the study was to verify as to whether reliable histopathologic criteria could be established based on the frequency of findings observed.
Epidermal spongiosis (present in 16 of 20 cases), in particular spongiosis of the infundibular epithelium and acrosyringia as well as eosinophilic spongiosis, emerge as relevant diagnostic clues. A moderately dense, superficial and deep infiltrate consisting mainly of lymphocytes and eosinophils was prevalent in the dermis, with eosinophils tending to interstitial and periadnexal distribution. Of note, 19 of 20 (95%) cases revealed periadnexal involvement, whereas 16 of 20 (80%) had the infiltrate extending particularly along the sweat ducts and the coiled glands. In three biopsies, concomitant involvement of sweat glands, hair follicles and sebaceous glands was noted.
A practical histopathologic algorithm of arthropod bite recognition is proposed. The involvement of the sweat glands in the pattern of arthropod bite reaction is suggested as a new reliable diagnostic clue.
昆虫叮咬会引发多种皮肤反应。尽管相当常见，但节肢动物叮咬的组织病理学特征尚未得到系统研究。
回顾性分析了2003年1月至2007年6月期间临床诊断为节肢动物叮咬反应的20例活检病例。本研究的目的是根据观察到的发现频率，验证是否能够建立可靠的组织病理学标准。
表皮海绵形成（20例中有16例出现），特别是漏斗状上皮和顶泌汗腺导管的海绵形成以及嗜酸性海绵形成，成为相关的诊断线索。真皮中普遍存在主要由淋巴细胞和嗜酸性粒细胞组成的中度密集的浅层和深层浸润，嗜酸性粒细胞倾向于间质和腺周分布。值得注意的是，20例中有19例（95%）显示腺周受累，而20例中有16例（80%）的浸润尤其沿着汗腺导管和蟠管延伸。在3例活检中，发现汗腺、毛囊和皮脂腺同时受累。
提出了一种实用的节肢动物叮咬识别组织病理学算法。汗腺在节肢动物叮咬反应模式中的受累情况被认为是一种新的可靠诊断线索。
