Weaver Joshua, Billings Steven D
Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Am Acad Dermatol. 2009 Dec;61(6):1028-32. doi: 10.1016/j.jaad.2009.04.025.
Stasis dermatitis is a common skin condition secondary to chronic venous insufficiency. Characteristic dermatologic changes in well-developed disease include bilateral erythematous, scaly, and slightly discolored papules and plaques on the lower legs. Earlier signs, such as prominent superficial veins and pitting ankle edema, are well known. Early recognition of signs and appropriate diagnosis can lead to timely treatment that can prevent painful complications, such as leg ulcers which are at risk for development of squamous cell carcinoma.
Herein we describe a yet unrecognized early sign of venous dermatitis-a solitary lesion, some mimicking neoplastic processes.
Thirty-seven cases of stasis dermatitis submitted with the clinical diagnosis of a solitary lesion were identified. Thirty-three had no clinical history of venous insufficiency. All cases of stasis dermatitis presenting for the first time as a solitary lesion were reviewed retrospectively both clinically and pathologically.
Squamous cell carcinoma was most commonly suspected (33%), followed by basal cell carcinoma (24%), and a variety of other solitary lesions. The histopathology was characteristic of stasis dermatitis in all cases with absent or mild spongiosis (82%), variable acanthosis and dermal fibrosis, and proliferation of papillary dermal thick-walled vessels were prominent (2-3+) in nearly all cases (>or=90%) along with hemosiderin-laden macrophages and extravasated red blood cells (>or=95%).
The study is limited by its retrospective nature and absence of clinical images on all cases.
Stasis dermatitis may present as a solitary lesion mimicking a neoplasm. Early recognition of stasis dermatitis can lead to appropriate treatment and possibly prevent further morbidity.
淤积性皮炎是一种继发于慢性静脉功能不全的常见皮肤疾病。病情严重时其特征性的皮肤变化包括小腿双侧出现红斑、鳞屑及颜色略深的丘疹和斑块。早期症状，如明显的浅表静脉和凹陷性踝部水肿，已为人熟知。早期识别症状并进行恰当诊断能够实现及时治疗，从而预防诸如腿部溃疡等疼痛性并发症，腿部溃疡有发展为鳞状细胞癌的风险。
在此我们描述一种尚未被认识的静脉性皮炎早期症状——单个损害，有些类似肿瘤性病变。
识别出37例临床诊断为单个损害的淤积性皮炎病例。其中33例无静脉功能不全的临床病史。对所有首次表现为单个损害的淤积性皮炎病例进行临床和病理回顾性分析。
最常被怀疑的是鳞状细胞癌（33%），其次是基底细胞癌（24%），以及各种其他单个损害。所有病例的组织病理学表现均为淤积性皮炎特征，无或仅有轻度海绵形成（82%），棘层增厚和真皮纤维化程度不一，几乎所有病例（≥90%）真皮乳头层厚壁血管增生显著（2 - 3级），同时伴有含铁血黄素巨噬细胞和红细胞外渗（≥95%）。
本研究受其回顾性性质限制，且并非所有病例均有临床图像。
淤积性皮炎可能表现为类似肿瘤的单个损害。早期识别淤积性皮炎可实现恰当治疗，并可能预防进一步的发病。
