Hurt M A, Santa Cruz D J
Department of Pathology, University of Texas Health Science Center, San Antonio 78284-7750.
Am J Surg Pathol. 1990 Aug;14(8):764-73.
This report describes four cases of a previously undocumented circumscribed idiopathic inflammatory fibrosclerotic lesion of the skin. The lesions occurred in two black women and two white men; they had been apparent from months to a year. The nodules were solitary; two were located on the arm, one on the calf, and one on the posterior neck. The clinical diagnoses included nodules, keratinous cyst, pilar tumor, pilomatricoma, vascular leiomyoma, dermatofibroma, and metastatic carcinoma. The lesions were grossly white, homogeneous, and circumscribed; one was located in the superficial subcutis and three in the reticular dermis. Histologically, they were sharply circumscribed and surrounded by a dense peripheral rim of lymphocytes and plasma cells. Peripheral germinal centers were noted in two cases. All cases had variable amounts of fibrosis centrally, giving them the low-power appearance of lymph nodes; however, no subcapsular or medullary sinuses were found. In the center of the lesions, the mononuclear infiltrate was accompanied by eosinophils and neutrophils. Virtually imperceptible vasculature was noted in portions of three lesions; in the fourth lesion, high endothelial venules were seen in the lymphoid portions, and "targetoid" perivascular sclerosis was seen in the central portions. There appears to be a transition from the early, mostly inflammatory, lesions to the sclerotic ones. The process seems to be reactive in nature. No obvious local or systemic etiology was found in our series, and follow-up of 2 to 5 years has been noncontributory. These mixed-cell proliferations resemble the extracutaneous masses that have been described in numerous viscera--particularly the lung--as "inflammatory pseudotumors" or "plasma cell granulomas." In our opinion, these lesions also bore a superficial resemblance to cutaneous lymphoid hyperplasia secondary to insect bites. Other differential diagnostic considerations include dermatofibroma, nodular fasciitis, Kimura's disease, epithelioid (histiocytoid) hemangioma, and reactive lymph nodes.
本报告描述了4例皮肤局限性特发性炎性纤维硬化性病变，此前尚无相关文献记载。这些病变发生在两名黑人女性和两名白人男性身上；病程数月至一年不等。结节均为单发；两个位于手臂，一个位于小腿，一个位于后颈部。临床诊断包括结节、角质囊肿、毛发肿瘤、毛母质瘤、血管平滑肌瘤、皮肤纤维瘤和转移性癌。病变肉眼观呈白色、均质且边界清晰；一个位于皮下浅层，三个位于网状真皮层。组织学上，病变边界清晰，周围有密集的淋巴细胞和浆细胞外周环。两例可见外周生发中心。所有病例中央均有不同程度的纤维化，使其在低倍镜下呈现淋巴结样外观；然而，未发现被膜下或髓窦。在病变中心，单核细胞浸润伴有嗜酸性粒细胞和中性粒细胞。在三个病变的部分区域可见几乎难以察觉的血管；在第四个病变中，在淋巴样区域可见高内皮微静脉，在中央部分可见“靶样”血管周围硬化。似乎存在从早期主要为炎症性病变到硬化性病变的转变。该过程似乎本质上是反应性的。在我们的病例系列中未发现明显的局部或全身病因，2至5年的随访也无阳性发现。这些混合细胞增殖类似于在许多内脏器官——尤其是肺——中被描述为“炎性假瘤”或“浆细胞肉芽肿”的皮肤外肿块。我们认为，这些病变在表面上也类似于昆虫叮咬继发的皮肤淋巴组织增生。其他鉴别诊断考虑因素包括皮肤纤维瘤、结节性筋膜炎、木村病、上皮样（组织细胞样）血管瘤和反应性淋巴结。
