Suchak Ravi, Verdolini Roberto, Robson Alistair, Stefanato Catherine M
Department of Dermatopathology, St John's Institute of Dermatology, St Thomas's Hospital, London SE1 7EH, UK.
J Cutan Pathol. 2010 Sep;37(9):982-6. doi: 10.1111/j.1600-0560.2009.01452.x. Epub 2009 Nov 9.
Early lesions of lichen sclerosus et atrophicus (LSA) may present as a mild lichenoid tissue reaction, occasionally together with basilar epidermotropism, mimicking early cutaneous T-cell lymphoma, mycosis fungoides (MF) variant. We report a case of extragenital LSA in which both histological patterns were present in the same clinically homogenous and stable lesion. A 27-year-old man presented with a history of white atrophic plaques on the trunk. A biopsy of an abdominal lesion revealed epidermal thinning, a superficial perivascular lymphoid cell infiltrate with focal epidermotropism, mild nuclear atypia and perinuclear halos. Immunophenotyping showed decreased CD5 and CD7, with a slight predominance of CD8-positive T-lymphocytes. All these changes were suggestive of MF. However, a repeat biopsy 3 months later from the same stable plaque revealed features diagnostic of LSA. LSA mimicking early MF histologically has been reported in genital skin. Conversely, MF may clinically and histopathologically resemble LSA. With gene rearrangement studies, clonal proliferation may not be detected in early MF but has been reported to occur in LSA. Awareness of the histopathologic spectrum of LSA within a stable plaque is important to avoid a potential diagnostic pitfall, and should prompt a repeat biopsy.
硬化萎缩性苔藓（LSA）的早期病变可能表现为轻度苔藓样组织反应，偶尔伴有基底细胞亲表皮现象，酷似早期皮肤T细胞淋巴瘤蕈样肉芽肿（MF）变异型。我们报告一例发生于生殖器外的LSA，在同一临床均质且稳定的皮损中同时存在这两种组织学模式。一名27岁男性，躯干有白色萎缩性斑块病史。腹部皮损活检显示表皮变薄，浅层血管周围淋巴细胞浸润伴灶性亲表皮现象、轻度核异型性及核周晕。免疫表型分析显示CD5和CD7表达降低，CD8阳性T淋巴细胞略占优势。所有这些改变提示为MF。然而，3个月后对同一稳定斑块再次活检显示为LSA的诊断特征。在生殖器皮肤中曾有LSA在组织学上酷似早期MF的报道。相反，MF在临床和组织病理学上可能类似LSA。通过基因重排研究，早期MF可能检测不到克隆性增殖，但据报道LSA中会出现克隆性增殖。认识稳定斑块内LSA的组织病理学谱对于避免潜在的诊断陷阱很重要，且应促使进行重复活检。
