Patterson Andrew T, Beasley Knox J, Kobayashi Todd T
Ohio State University College of Medicine, Columbus, OH, USA.
Department of Dermatology, San Antonio Uniformed Services Health Education Consortium, Lackland Air Force Base, San Antonio, TX, USA.
J Cutan Pathol. 2016 Feb;43(2):142-7. doi: 10.1111/cup.12569. Epub 2015 Sep 3.
Fibroelastolytic papulosis is a rare, acquired fibroelastolytic disorder that presents clinically as white-to-yellow papules and plaques most commonly occurring on the neck of elderly patients. The term fibroelastolytic papulosis encompasses two closely related conditions previously described as pseudoxanthoma elasticum-like papillary dermal elastolysis (PDE) and white fibrous papulosis of the neck (WFPN). Here we present a case of a 78-year-old white female with a several-year history of numerous, asymptomatic 2-3 mm yellowish, non-follicular papules distributed symmetrically over the posterior neck, axillae, arm and antecubital fossae. Histopathologic examination revealed thickened and clumped elastotic fibers admixed with thick, sclerotic appearing collagen bundles in the mid and deep reticular dermis. Rare melanophages, loss of vertically oriented elastic fibers and scattered elastotic globes were noted in the papillary dermis. Based on the shared clinicopathologic features showed in this case, strong consideration should be made for the additional inclusion of papillary dermal elastosis as existing along the disease continuum of fibroelastolytic papulosis. This occurrence of fibroelastolytic papulosis shows unique histopathologic findings of pseudoxanthoma elasticum-like PDE, papillary dermal elastosis and WFPN, further supporting the theory that these entities exist as variants along the fibroelastolytic papulosis spectrum.
纤维弹性溶解丘疹病是一种罕见的后天性纤维弹性溶解障碍性疾病,临床上表现为白色至黄色丘疹和斑块,最常见于老年患者的颈部。纤维弹性溶解丘疹病这一术语涵盖了两种先前被描述为弹性假黄瘤样乳头真皮弹性溶解(PDE)和颈部白色纤维丘疹病(WFPN)的密切相关病症。在此,我们报告一例78岁白人女性病例,其有数年病史,后颈部、腋窝、手臂和肘窝对称分布着众多无症状的2 - 3毫米淡黄色、非毛囊性丘疹。组织病理学检查显示,在网状真皮中层和深层,弹性纤维增厚并聚集,混有增厚、呈硬化外观的胶原束。在乳头真皮中可见罕见的噬黑素细胞、垂直排列的弹性纤维缺失以及散在的弹性小球。基于该病例所显示的共同临床病理特征,应高度考虑将乳头真皮弹性溶解作为纤维弹性溶解丘疹病疾病连续谱中的一种情况额外纳入。该纤维弹性溶解丘疹病病例呈现出弹性假黄瘤样PDE、乳头真皮弹性溶解和WFPN独特的组织病理学表现,进一步支持了这些实体作为纤维弹性溶解丘疹病谱中的变体而存在的理论。