Department of Dermatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, U.S.A.
Br J Dermatol. 2014 Dec;171(6):1397-401. doi: 10.1111/bjd.13202. Epub 2014 Oct 26.
Histopathological findings in biopsy specimens from patients with cutaneous small-vessel vasculitis (CSVV) secondary to solid-organ malignancy have not been previously reported.
We aimed to understand better the differences in histopathological findings between biopsy specimens from patients with CSVV associated with solid-organ malignancies and patients with CSVV secondary to other causes.
From a previously published group of patients with CSVV and solid-organ malignancy, we identified patients with available histopathology slides of biopsy specimens. We compared histopathological findings from these patients with those from 68 previously published patients with Henoch-Schönlein purpura not associated with solid-organ malignancy (60% male).
We identified 15 patients (eight male, 53%) with available slides from biopsy specimens. The mean age of these patients with solid-organ malignancy-associated CSVV was 66·6 years, compared with 45·8 years in the Henoch-Schönlein purpura cases not associated with solid-organ malignancy (P < 0·001). Solid-organ malignancy-associated CSVV was less likely to demonstrate papillary dermal oedema (P = 0·04), papillary dermal inflammation (P < 0·001) and lymphocytes (P < 0·001), and more likely to have plasma cells (P = 0·02). Additionally, we detected nonsignificant differences in the presence of histiocytes (P = 0·05), intravascular thrombosis (P = 0·052) and microabscess formation (P = 0·06).
CSVV associated with solid-organ malignancies tended to have deeper dermal involvement and a different cellular milieu from cases not associated with solid-organ malignancies. In addition, the patients with CSVV with solid-organ malignancies were significantly older than those without. Prospective studies with age-matched controls are needed to determine the clinical significance of the histopathological differences in solid-organ malignancy-associated CSVV.
此前尚未报道过继发于实体器官恶性肿瘤的皮肤小血管血管炎（CSVV）患者活检标本的组织病理学发现。
我们旨在更好地了解与实体器官恶性肿瘤相关的 CSVV 患者与继发于其他原因的 CSVV 患者活检标本的组织病理学发现差异。
我们从之前发表的一组 CSVV 合并实体器官恶性肿瘤患者中，确定了有活检标本组织病理学切片的患者。我们将这些患者的组织病理学发现与之前发表的 68 例无实体器官恶性肿瘤的亨诺克-舒恩莱因紫癜患者（60%为男性）进行了比较。
我们确定了 15 例（8 名男性，53%）有活检标本组织病理学切片的患者。这些实体器官恶性肿瘤相关 CSVV 患者的平均年龄为 66.6 岁，而无实体器官恶性肿瘤的亨诺克-舒恩莱因紫癜患者的平均年龄为 45.8 岁（P＜0.001）。实体器官恶性肿瘤相关 CSVV 更不可能出现乳头真皮水肿（P=0.04）、乳头真皮炎症（P＜0.001）和淋巴细胞（P＜0.001），而更可能出现浆细胞（P=0.02）。此外，我们还发现组织细胞（P=0.05）、血管内血栓形成（P=0.052）和微脓肿形成（P=0.06）的存在存在无统计学差异。
与实体器官恶性肿瘤相关的 CSVV 倾向于具有更深的真皮受累和与无实体器官恶性肿瘤的 CSVV 不同的细胞环境。此外，与无实体器官恶性肿瘤的 CSVV 患者相比，CSVV 合并实体器官恶性肿瘤的患者年龄明显更大。需要进行年龄匹配的对照前瞻性研究，以确定实体器官恶性肿瘤相关 CSVV 组织病理学差异的临床意义。
