Department of Dermatology, Tokyo-to Saiseikai Central Hospital, Japan.
Clin Exp Dermatol. 2013 Jan;38(1):25-9. doi: 10.1111/j.1365-2230.2012.04373.x. Epub 2012 Aug 27.
A 59-year-old patient with diabetes mellitus had been treated with human recombinant insulin for 4 years. He developed a solid mass on his left abdomen at the insulin injection site, which had an overlying pigmented verrucous plaque and keratinized papules, similar to acanthosis nigricans (AN). On histological examination, the mass was found to contain a deposit of amyloid in the dermis, with hyperkeratosis, papillomatosis and acanthosis in the epidermis. Using immunohistochemistry, the amyloid deposits were found to be positive for insulin. A few cases of localized insulin-derived amyloid deposits at injection sites have been reported previously, but none had significant epidermal changes. The coexistence of dermal insulin-derived amyloidosis and an overlying AN-like change, as found in our patient, has not been reported previously, to our knowledge. The presence of a tumour-like lesion at the injection site should be carefully examined, as injection of insulin into amyloid deposits can result in insulin resistance.
一位 59 岁的糖尿病患者，已接受了 4 年的人重组胰岛素治疗。他在胰岛素注射部位的左侧腹部出现了一个实性肿块，表面有色素性疣状斑块和角化性丘疹，类似于黑棘皮病（AN）。组织学检查发现，肿块真皮内有淀粉样物质沉积，表皮有过度角化、乳头瘤样增生和棘层肥厚。免疫组化检查发现，淀粉样物质沉积呈胰岛素阳性。以前曾有报道过少数局部胰岛素来源的淀粉样物质沉积在注射部位的病例，但没有明显的表皮变化。据我们所知，我们的患者同时存在真皮胰岛素来源的淀粉样变性和表面类似 AN 的改变尚属首例报道。在注射部位出现肿瘤样病变时应仔细检查，因为将胰岛素注射到淀粉样物质沉积中会导致胰岛素抵抗。
