Onishi Masazumi, Takahashi Kazuhiro, Watabe Daisuke, Onodera Hanae, Akasaka Toshihide
Department of Dermatology, Iwate Medical University, Morioka, Japan.
Case Rep Dermatol. 2011 May;3(2):170-4. doi: 10.1159/000330460. Epub 2011 Aug 25.
We describe a 61-year-old Japanese woman who had been aware of a lesion on her left thigh for 10 years. Pathological examination demonstrated a well-circumscribed encapsulated nodule at the dermal-subcutaneous boundary, composed of eosinophilic spindle cell bundles, connective tissue, and numerous small vessels. Immunohistochemically, these eosinophilic cells were positive for a-smooth muscle actin. The granulomatous areas in the tumor were composed focally of epithelioid cells and lymphocytes. The epithelioid cells were negative for a-smooth muscle actin. We diagnosed this case as an angioleiomyoma with epithelioid granuloma. Malignant tumors with granulomatous change have sometimes been reported in the literature, but benign tumors with epithelioid granuloma, such as the present one, are rare. We thought that epithelioid cell granuloma might transform to angioleiomyoma through the action of IL-1 released from vascular smooth muscle cells.
我们描述了一位61岁的日本女性，她左侧大腿上的一处病灶已被发现10年。病理检查显示，在真皮-皮下交界处有一个边界清晰的包膜结节，由嗜酸性梭形细胞束、结缔组织和众多小血管组成。免疫组化显示，这些嗜酸性细胞α-平滑肌肌动蛋白呈阳性。肿瘤中的肉芽肿区域局部由上皮样细胞和淋巴细胞组成。上皮样细胞α-平滑肌肌动蛋白呈阴性。我们将该病例诊断为伴有上皮样肉芽肿的血管平滑肌瘤。文献中有时会报道伴有肉芽肿性改变的恶性肿瘤，但像本病例这样伴有上皮样肉芽肿的良性肿瘤很少见。我们认为上皮样细胞肉芽肿可能通过血管平滑肌细胞释放的白细胞介素-1作用转化为血管平滑肌瘤。
