Ding Mei-Yun, Zuo Hai-Liang, Sun Yan, Zhang Jian-Cheng, Yang Yong, Ma Fu-Jiang, Hu Xiao-Li, Zhan Jiang-Hua
Department of Plastic Surgery, Tianjin Children's Hospital (Children's Hospital, Tianjin University), Tianjin, China.
Department of General Surgery, Tianjin Children's Hospital (Children's Hospital, Tianjin University), Tianjin, China.
Transl Pediatr. 2024 Jun 30;13(6):987-993. doi: 10.21037/tp-23-607. Epub 2024 Jun 27.
Acral persistent papular mucinosis (APPM) is a rare idiopathic subtype of localized lichen myxedematosus. To date, there have been less than 41 APPM cases reported worldwide, however, almost all patients were older than 18 years of age. A 7-year-old child was first reported in this paper.
A 7-year-old boy was admitted to our hospital with a solitary skin-colored papule on the radial side of the middle segment of his right index finger. The patient wanted to know the exact diagnosis and remove it because the flexion movement of the middle segment had been affected. Thus, a surgery was performed. Histopathological examination of a biopsy specimen obtained from the papule on the radial side of the middle segment of his right index finger showed a focal and well-circumscribed deposit of mucin in the papillary and middermis. The deposit never extended deeply into the reticular dermis. Mucin spared a subepidermal area in the papillary dermis. Alcian blue stains can highlight the mucin. The papule was histologically diagnosed as an APPM and excised surgically. The wound gradually healed after the operation, and no obvious recurrence, scar or other discomfort was observed during follow-up so far.
To the best of our knowledge, this is the rare case of a child APPM presenting as a solitary papule affecting the flexion movement of the middle segment. Since it is a rare disease, we report this case to contribute to future research on the diagnosis and pathogenesis of APPM.
肢端持久性丘疹性粘蛋白病（APPM）是局限性粘液性苔藓的一种罕见特发性亚型。迄今为止，全球报道的APPM病例少于41例，然而，几乎所有患者年龄均超过18岁。本文首次报道了一名7岁儿童的病例。
一名7岁男孩因右示指中段桡侧出现单个肤色丘疹入院。由于该中段的屈曲运动受到影响，患者想知道确切诊断并将其去除。因此，进行了手术。对从右示指中段桡侧丘疹获取的活检标本进行组织病理学检查，结果显示在乳头层和真皮中层有局灶性且边界清楚的粘蛋白沉积。该沉积从未深入到网状真皮层。粘蛋白在乳头层真皮中保留了一个表皮下区域。阿尔辛蓝染色可使粘蛋白显色。该丘疹经组织学诊断为APPM并进行了手术切除。术后伤口逐渐愈合，随访至今未观察到明显复发、瘢痕或其他不适。
据我们所知，这是罕见的儿童APPM病例，表现为单个丘疹并影响中段的屈曲运动。由于这是一种罕见疾病，我们报告此病例以促进未来对APPM诊断和发病机制的研究。
