Salhi A, Wassef M, Enjolras O
Université de médecine d'Alger, Algérie.
Ann Dermatol Venereol. 2010 Nov;137(11):718-21. doi: 10.1016/j.annder.2010.08.002. Epub 2010 Sep 17.
Authentic bone tissue can be observed in the skin, in both the epidermis and dermis, where it produces cutaneous osteomas. These lesions are classed as either primary or secondary ossifications. Secondary ossifications are the consequence of inflammatory lesions such as acne or injuries while primary ossifications are neither preceded by preexisting lesions nor associated with other lesions.
A 22-year-old man with no prior history consulted for a grainy, erythematous, telangiectatic retroauricular plaque on the right side. Palpation revealed hard grainy lesions giving a tactile sensation of small stones. Histological analysis showed an ossification in the dermis resulting from mature bone in contact with dilated vessels. A diagnosis of venous malformation with osseous metaplasia was initially proposed, but the patient insisted that no vascular anomaly had preceded the grainy lesions. Further histological analysis demonstrated that the vascular anomalies were restricted to the ossified regions and the final diagnosis was of primary cutaneous osteoma.
In our patient, the absence of any endocrine anomalies and of any vascular malformation supported the diagnosis of primary cutaneous osteoma. Certain vascular anomalies such as haemangiomas or venous malformation can lead to bone formation. The coexistence in the dermis of osteomas and dilated vessels initially led us to suspect osteomas secondary to venous malformation. However, the absence of any vascular anomalies preceding the cutaneous osteoma contradicted this diagnosis. In venous malformations, phleboliths are usually seen as a result of calcium deposits on thrombus rather than authentic osteomas. Our patient had no standard primary solitary osteoma of either the nodular or the plaque type, and this case thus constitutes a new original form of primary cutaneous osteoma.
在皮肤中，无论是表皮还是真皮，都可以观察到真正的骨组织，在那里会产生皮肤骨瘤。这些病变可分为原发性或继发性骨化。继发性骨化是痤疮或损伤等炎症性病变的结果，而原发性骨化既不是由先前存在的病变引起，也与其他病变无关。
一名22岁无前科病史的男性因右侧耳后出现颗粒状、红斑性、伴有毛细血管扩张的斑块前来就诊。触诊发现坚硬的颗粒状病变，有触摸小石子的感觉。组织学分析显示真皮内有骨化，由与扩张血管接触的成熟骨形成。最初提出诊断为伴有骨化生的静脉畸形，但患者坚称在出现颗粒状病变之前没有血管异常。进一步的组织学分析表明血管异常仅限于骨化区域，最终诊断为原发性皮肤骨瘤。
在我们的患者中，没有任何内分泌异常和血管畸形支持原发性皮肤骨瘤的诊断。某些血管异常，如血管瘤或静脉畸形，可导致骨形成。骨瘤和扩张血管在真皮中共存最初使我们怀疑是静脉畸形继发的骨瘤。然而，皮肤骨瘤之前没有任何血管异常与这一诊断相矛盾。在静脉畸形中，静脉石通常是血栓上钙沉积的结果，而不是真正的骨瘤。我们的患者没有结节型或斑块型的标准原发性孤立性骨瘤，因此该病例构成了原发性皮肤骨瘤的一种新的原始形式。
