Llamas-Velasco Mar, Stengel Berhard, Pérez-González Yosmar Carolina, Mentzel Thomas
Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain.
Pathology Department, Institute of Pathology, Güstrow, Germany.
Am J Dermatopathol. 2018 Jun;40(6):442-444. doi: 10.1097/DAD.0000000000001088.
Erythema elevatum diutinum (EED) is a rare dermatosis with evolving histopathological features that vary according to the age of the lesions, with a variable fibrosis and a fascicled proliferation of spindle cells in late phases. The authors present an otherwise healthy 57-year-old woman with multiple indurated nodules on the inner aspect of both feet. Skin biopsy showed storiform interlacing bundles of spindled cells with plump nuclei and some areas with neutrophils and leukocytoclasia. CD34 and S100 were negative. This case is noteworthy clinically due to its location and its histopathological presentation that comprises a wide differential diagnosis, including inflammatory pseudotumor, dermatofibrosarcoma protuberans, superficial nodular fasciitis, hyalinized leiomyoma, sclerosing spindle cell perineuroma, and sclerotic fibroma. The authors have reviewed the main histopathological and immunohistochemical features that help in the differential diagnosis of this rare variant of EED. A careful search for leukocytoclasia and neutrophilic vasculitis is mandatory to establish the right diagnosis of nodular or late-stage EED and avoid the pitfall of considering this a neoplastic process.
持久性隆起性红斑（EED）是一种罕见的皮肤病，其组织病理学特征会随着皮损年龄的变化而演变，后期会出现不同程度的纤维化和梭形细胞束状增生。本文作者报告了一例57岁的健康女性，其双足内侧出现多个硬结性结节。皮肤活检显示梭形细胞呈漩涡状交错排列，细胞核饱满，部分区域有中性粒细胞和核尘。CD34和S100均为阴性。该病例在临床上值得关注，因其发病部位及组织病理学表现需要进行广泛的鉴别诊断，包括炎性假瘤、隆突性皮肤纤维肉瘤、浅表性结节性筋膜炎、透明变性平滑肌瘤、硬化性梭形细胞神经鞘瘤和硬化性纤维瘤。作者回顾了有助于鉴别这种罕见的EED变体的主要组织病理学和免疫组化特征。仔细查找核尘和嗜中性血管炎对于正确诊断结节性或晚期EED至关重要，可避免将其误诊为肿瘤性病变。
