急性痘疮样苔藓样糠疹60例临床病理分析

Clinicopathologic analysis of 60 cases of pityriasis lichenoides et varioliformis acuta

目的 探讨急性痘疮样苔藓样糠疹（PLEVA）的临床病理特征.方法 回顾分析60例PLEVA患者的临床和病理资料.结果 60例PLEVA患者中,2～18岁32例（53.3％）,19 ～ 49岁28例（46.7％）.皮损分布情况：弥漫型50例（83.3％）,中心型2例（3.3％）,外周型8例（13.4％）.发病前有上呼吸道感染史19例（31.6％）.组织病理学检查：60例均具有基底细胞液化变性和真皮内血管周围炎改变.角质层内中性粒细胞脓肿26例（43.3％）,表皮内坏死角质形成细胞41例（68.3％）,发生广泛液化变性30例（50.0％）,有淋巴细胞移入表皮43例（71.6％）,有Pautrier微脓肿形成者2例,有程度不等的真皮浅层红细胞外溢者46例（76.7％）,真皮内有血管壁纤维素样坏死者3例,演变为蕈样肉芽肿1例.20例患者行免疫组化检查,其中3例示T细胞单克隆性增生.结论 PLEVA临床表现有特征性,临床与病理的密切结合是诊断该病的金标准.

Objective To explore the clinicopathologic features of pityriasis lichenoides et varioliformis acuta （PLEVA）.Methods A retrospective analysis was performed.Clinical and histological data were collected from 60 patients with PLEVA.The clinicopathologic features of PLEVA were analyzed.Results Among the 60 patients with PLEVA,32 （53.3%） were aged 2-18 years,and 28 （46.7%） aged 19-49 years.Skin lesions were distributed in a diffuse pattern in 50 （83.3%） patients,in a central pattern in 2 （3.3%） patients,and in a peripheral pattern in 8 （13.4%） patients.Nineteen （31.6%） patients had a history of upper respiratory infection.Histopathological examination revealed liquefactive degeneration of basal cells and perivasculitis in the dermis in all the 60 cases,neutrophil abscess formation in the stratum corneum in 26 （43.3%） cases,keratinocyte necrosis in the epidermis in 41 （68.3%） cases,generalized liquefactive degeneration in 30 （50.0%） cases,migration of lymphocytes into the epidermis in 43 （71.6%） cases,Pautrier＇s microabscess formation in 2 cases,varying degrees of extravasation of erythrocytes into the epidermis in 46 （76.7%） cases,fibrinoid necrosis of blood vessel walls in the dermis in 3 cases.PLEVA progressed into granuloma fungoides in 1 patient.Twenty patients underwent immunohistochemical examination,and 3 of them showed monoclonal hyperplasia of T cells.Conclusions PLEVA has characteristic clinical manifestations,and the combination of pathological and clinical examination is the gold standard for its diagnosis.