Chevallier A, Battaglione V, Brunner C, Michiels J F, Perrin C, Hofman P
Service d'Anatomie Pathologique, Hôpital Pasteur, CHU de Nice, France.
Arch Anat Cytol Pathol. 1998;46(3):193-8.
The authors report a case of a 70 year-old man with a past of myelodysplasia and presenting a voluminous lesion of the thigh corresponding to a cutaneous malacoplakia. Histologic study showed a dermo-hypoderma granuloma with numerous Von Hansemann cells containing some Michaelis-Gutmann bodies. Immunohistochemical study showed a positivity of these cells with the antibodies against CD68 (KP1, Mac 387, PGM1), the lysozyme and the alpha-chemotrypsine. Ultrastructural study confirmed the histiocytic origin of this infiltration by showing some regular and voluminous inclusions with a clear center and a peripheral and dense ring, and also some bacteria measuring 3 to 5 microns. Bacteriological study isolated an Escherichia coli. The evolution was favourable after surgical excision and antibiotherapy. Cutaneous malacoplakia is a very rare disease, usually with a perineal localization, and occurring in immunodeficient host. Michaelis-Gutmann bodies are sometimes difficult to identify by light microscopy underlying the rule of the immunohistochemical and the ultrastructural studies to perform the diagnosis.
作者报告了一例70岁男性病例，该患者既往有骨髓发育异常病史，大腿出现一个巨大病变，病理检查为皮肤软斑病。组织学研究显示真皮 - 皮下组织肉芽肿，有大量含米氏小体的冯·汉塞曼细胞。免疫组织化学研究显示这些细胞对针对CD68（KP1、Mac 387、PGM1）、溶菌酶和α - 胰凝乳蛋白酶的抗体呈阳性。超微结构研究通过显示一些有清晰中心和周边致密环的规则且大量的包涵体以及一些3至5微米大小的细菌，证实了这种浸润的组织细胞起源。细菌学研究分离出一株大肠杆菌。手术切除和抗生素治疗后病情好转。皮肤软斑病是一种非常罕见的疾病，通常发生于会阴部位，且多见于免疫缺陷宿主。米氏小体有时通过光学显微镜难以识别，这凸显了免疫组织化学和超微结构研究在诊断中的作用。
