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色素减退性蕈样肉芽肿,模仿白癜风。

Hypopigmented Mycosis Fungoides Mimicking Vitiligo.

机构信息

Department of Dermatology, Ajou University School of Medicine, Suwon, Korea.

出版信息

Am J Dermatopathol. 2021 Mar 1;43(3):213-216. doi: 10.1097/DAD.0000000000001750.

Abstract

Hypopigmented mycosis fungoides (HMF) is a clinical variant of MF with a presentation similar to other hypopigmented diseases, especially vitiligo. In this article, we report an adult case of HMF mimicking vitiligo. A 53-year-old man presented with an asymptomatic well-defined focal and hypopigmented patch with erythematous to brownish macules on the flank which had been developing over several months without other cutaneous findings. He had no past medical or trauma history. Skin biopsy from the hypopigmented patch indicated a slightly band-like, superficial dermal infiltrate of lymphocytes with mild cytologic atypia and epidermotropism. Fontana-Masson and Mart-1 stains showed a decrease in the epidermal pigment and the number of basal melanocytes. In addition, CD4 and CD8 stains were positive, predominantly the CD8 stain, and loss of CD7 stain was noted in the epidermal atypical lymphocytes. A T-cell receptor gene rearrangement study from the hyperpigmented area showed monoclonality. Finally, we diagnosed the patient with HMF. After about 17 months of treatment with narrow-band ultraviolet B, the hypopigmented lesion had notably improved in both the clinical and histological aspects. The clinical appearance of our case was similar to vitiligo while clinical improvement was also exceptionally similar to the skin findings from follicular repigmentation after narrow-band ultraviolet B treatment in vitiligo. Therefore, dermatologists should consider the clinical differential diagnosis of HMF in patients with an asymptomatic hypopigmentation, especially in dark-skinned Asian patients.

摘要

色素减退性蕈样肉芽肿(HMF)是 MF 的一种临床变异型,表现类似于其他色素减退性疾病,尤其是白癜风。在本文中,我们报告了一例成人 HMF 模仿白癜风的病例。一名 53 岁男性,无自觉症状,在侧腹出现一界限清楚的局限性色素减退斑,伴红斑至褐色斑疹,数月来逐渐出现,无其他皮肤表现。患者无既往病史或外伤史。色素减退区皮肤活检显示,轻度带状、表浅真皮淋巴细胞浸润,轻度细胞学异型性和表皮亲润性。Fontana-Masson 和 Mart-1 染色显示表皮色素减少和基底黑素细胞数量减少。此外,CD4 和 CD8 染色阳性,主要是 CD8 染色阳性,表皮不典型淋巴细胞中 CD7 染色缺失。来自色素正常区域的 T 细胞受体基因重排研究显示为单克隆性。最终,我们诊断患者为 HMF。窄带紫外线 B 治疗约 17 个月后,色素减退性皮损在临床和组织学方面均显著改善。我们的病例临床表现类似于白癜风,而临床改善也与窄带紫外线 B 治疗白癜风后毛囊复色的皮肤表现非常相似。因此,皮肤科医生应考虑在无症状性色素减退患者中进行 HMF 的临床鉴别诊断,尤其是在深色皮肤的亚洲患者中。

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