毛霉病七例临床与病理分析

Clinical and histopathologic analysis of 7 cases of mucormycosis

目的探讨毛霉病的临床表现、预后和病理表现之间可能存在的关系。方法回顾性分析1989-2006年我院诊治的7例经真菌培养证实为毛霉病患者的临床资料和病理切片。结果7例中鼻脑毛霉病1例、皮肤毛霉病6例，其中2例为毛霉性坏死性筋膜炎。鼻脑毛霉病和毛霉性坏死性筋膜炎患者病情进展快，均以死亡告终；其皮损组织病理表现呈混合性炎症细胞浸润，坏死明显，可见大量菌丝和侵血管现象。4例以浸润性红斑为主要表现的皮肤毛霉病患者病情进展慢，有2例已治愈；其皮损组织病理呈肉芽肿性炎症，菌丝较少，未见明显的侵血管现象。7例均未见明确的菌丝侵神经现象。结论毛霉病皮损组织病理表现呈混合性炎症细胞浸润，菌丝多，出现明显侵血管现象者预后较差。

Objective To investigate the relationship between the clinical manifestations, prognosis and histopathological findings of mucormycosis. Methods The clinical data on and pathological findings from 7 cases of mucormycosis confirmed by fimgal culture in the institute from 1989 to 2006 were analyzed retrospectively. Results There was 1 case of rhinocerebral mucormycosis and 6 cases of cutaneous mucormycosis, among them, 2 were mucormycotic necrotizing fasciitis （MNF）. The condition of patients with rhinocerebral mucormycosis or MNF aggravated rapidly and all the 3 patients died from mucormycosis. Histopathological examination showed mixed infiltrates of inflammatory cells as well as necrosis and angioin vasion. On the contrary, the condition of the remaining 4 patients with cutanesus mucormycosis, who presented mainly with indurated erythematous patch, progressed slowly, and 2 patients were cured. Histologically, the lesions were characterized by granulomatous infiltration with a few hyphae; no typical angioinvasion phenomenon was noted. There was no evidence of perineural invasion with hyphae in any of the 7 cases. Conclusion In patients with mucormycosis, histopathological findings characterized by mixed infiltrates of inflammatory cells, numerous hyphae and typical angioinvasion phenomenon may herald a poor prognosis.