Ratoosh S L, Cohen P R, Troncoso P
Department of Dermatology, University of Texas Medical School, Houston 77030.
J Dermatol Surg Oncol. 1994 Sep;20(9):613-8. doi: 10.1111/j.1524-4725.1994.tb00154.x.
Leprosy is a chronic systemic infection caused by the bacillus Mycobacterium leprae. Cutaneous neoplasms have been observed in patients with leprosy. Also, albeit less commonly, M. leprae have been documented in the lesions of skin cancer.
To describe a 62-year-old man with chronic sun exposure and exposure to armadillos who subsequently developed lepromatous leprosy, to discuss the cutaneous malignancies that have occurred in patients with leprosy, and to review the literature concerning the concurrent presence of an infectious pathogen and a cutaneous neoplasm in the same lesion.
Our patient's basal cell carcinomas were excised, his abdominal plaques were biopsied, and his leprosy infection was treated with dapsone and rifampin. The types of cutaneous malignancies in leprosy patients and infectious pathogens concurrently found in lesions of skin tumors were summarized after evaluating previously published reports.
Skin biopsies from our patient demonstrated M. leprae bacilli not only in his abdominal plaques, but also in all of his basal cell carcinoma lesions. Fungal, mycobacterial, and viral pathogens have concurrently been observed in skin lesions of basal cell carcinomas, Kaposi's sarcoma, melanoma, mycosis fungoides, and squamous cell carcinoma.
Patients with leprosy can develop skin cancers and the histologic interpretation of those skin cancers can show evidence of leprosy. It is uncertain to what degree the decreased cell-mediated immunity in patients with lepromatous leprosy either enhances their susceptibility to and/or influences the course of their cutaneous neoplasms; also, in these patients, the coexistence of M. leprae organisms and cutaneous malignancy in the same lesion is likely to be secondary to the high bacillary load that is present.
麻风病是由麻风分枝杆菌引起的一种慢性全身性感染。麻风病患者中已观察到皮肤肿瘤。此外，虽然较少见，但在皮肤癌病变中也有麻风分枝杆菌的记录。
描述一名62岁长期暴露于阳光且接触犰狳后发生瘤型麻风病的男性患者，讨论麻风病患者中发生的皮肤恶性肿瘤，并回顾关于同一病变中感染性病原体与皮肤肿瘤并存的文献。
切除我们患者的基底细胞癌，对其腹部斑块进行活检，并用氨苯砜和利福平治疗其麻风病感染。在评估先前发表的报告后，总结了麻风病患者的皮肤恶性肿瘤类型以及在皮肤肿瘤病变中同时发现的感染性病原体。
我们患者的皮肤活检显示，麻风分枝杆菌不仅存在于其腹部斑块中，还存在于所有基底细胞癌病变中。在基底细胞癌、卡波西肉瘤、黑色素瘤、蕈样肉芽肿和鳞状细胞癌的皮肤病变中同时观察到真菌、分枝杆菌和病毒病原体。
麻风病患者可发生皮肤癌，这些皮肤癌的组织学解释可显示麻风病的证据。瘤型麻风病患者细胞介导免疫功能下降在多大程度上增强了他们对皮肤肿瘤的易感性和/或影响其病程尚不确定；此外，在这些患者中，同一病变中麻风分枝杆菌与皮肤恶性肿瘤并存可能是由于存在高菌量所致。
