Yeh Iwei, Evan George, Jokinen Chris H
Department of Pathology, University of California, San Francisco, 94115, USA.
Am J Dermatopathol. 2011 Aug;33(6):e66-9. doi: 10.1097/DAD.0b013e3182120ae3.
A 55-year-old man with scleroderma treated with prednisone and etanercept presented with enlarging sporotrichoid nodules on the forearm. Microscopically, there were large circumscribed dermal and subcutaneous nodules of spindled and epithelioid cells, resembling a spindle cell neoplasm. Small foci of neutrophils were also present, and a subsequent Ziehl-Neelsen stain highlighted beaded acid-fast bacilli in the interstitium. Tissue culture demonstrated Mycobacterium chelonae. Cutaneous mycobacterial spindle cell pseudotumor is an exceedingly rare lesion, with only 6 previously reported cases. Although these included patients with autoimmune disease receiving immunosuppressive therapy, this is the first case reported in association with a tumor necrosis factor alpha inhibitor, etanercept. Furthermore, this represents the first mycobacterial spindle cell pseudotumor described in association with M. chelonae. Mycobacterial spindle cell pseudotumor should be considered in the differential diagnosis of cutaneous spindle cell proliferations, especially in immunocompromised patients.
一名55岁的硬皮病男性患者，接受泼尼松和依那西普治疗，前臂出现逐渐增大的孢子丝菌样结节。显微镜下可见界限清楚的真皮和皮下大结节，由梭形细胞和上皮样细胞构成，类似梭形细胞瘤。也可见小灶性中性粒细胞，随后的齐-尼氏染色显示间质中有串珠状抗酸杆菌。组织培养证实为龟分枝杆菌。皮肤分枝杆菌性梭形细胞假瘤是一种极其罕见的病变，此前仅有6例报道。虽然这些病例包括接受免疫抑制治疗的自身免疫性疾病患者，但这是首例与肿瘤坏死因子α抑制剂依那西普相关的报道病例。此外，这也是首例与龟分枝杆菌相关的分枝杆菌性梭形细胞假瘤病例。在皮肤梭形细胞增殖性病变的鉴别诊断中，尤其是免疫功能低下的患者，应考虑分枝杆菌性梭形细胞假瘤。
