Anatelli Florencia, Chapman M Shane, Brennick Jeoffry
From the Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Am J Dermatopathol. 2010 May;32(3):306-309. doi: 10.1097/DAD.0b013e3181b9e5ab.
An 80-year-old woman presented with a 3 mm pearly, translucent papule in her left upper cutaneous lip of 2 months duration which was biopsied to rule out basal cell carcinoma. Histopathologic examination revealed acellular, basophilic material in the superficial dermis, extending to the base of the biopsy. There was neither an epithelial component nor an inflammatory reaction associated with it. The amorphous, nonpolarizable material stained with Alcian Blue (pH 2.5) and with colloidal iron, but was negative with a Periodic acid-Schiff stain, indicative of an acidic mucin, such as weakly sulfated mucin of salivary gland origin or a dermal-origin mucin. The material was digested with hyaluronidase, consistent with the mesenchymal-origin mucin hyaluronic acid (HA). Additional clinical history was obtained; the patient had previous HA (Restylane) injections at another institution. We report a case of superficially applied HA and consider the histopathologic differential diagnosis of endogenous and injected mucin in the dermis.
一名80岁女性，左上唇皮肤出现一个3毫米大小、珍珠样、半透明丘疹，持续2个月，对其进行活检以排除基底细胞癌。组织病理学检查显示，浅表真皮层有嗜碱性无细胞物质，延伸至活检标本底部。既没有上皮成分，也没有与之相关的炎症反应。这种无定形、非极化物质用阿尔辛蓝（pH 2.5）和胶体铁染色，但过碘酸希夫染色呈阴性，提示为酸性黏蛋白，如唾液腺来源的弱硫酸化黏蛋白或真皮来源的黏蛋白。该物质被透明质酸酶消化，与间充质来源的黏蛋白透明质酸（HA）一致。进一步了解了临床病史；该患者此前在另一家机构接受过HA（瑞蓝）注射治疗。我们报告一例浅表应用HA的病例，并探讨真皮内源性和注射性黏蛋白的组织病理学鉴别诊断。
