早期蕈样肉芽肿紫外线治疗前后组织病理变化分析

Histopathological Analysis of early mycosis fungoides before and after ultraviolet phototherapy

目的：探讨早期蕈样肉芽肿（MF）的组织病理要点、光疗前后组织病理变化,为早期诊断以及光疗治疗提供病理上的支持。方法：收集24例经组织病理检查证实为MF患者光疗前后的48份皮损组织标本。分析光疗前后亲表皮性、角质层变化、表皮变化、炎性浸润模式、血管扩张、真皮纤维化、以及其他真皮变化。结果：治疗前后皮损组织标本的病理表现在淋巴细胞表皮Paget样分布（χ^2=4.55,P〈0.05）、Pautrier微脓肿（χ^2=10.08,P〈0.01）、真皮苔藓样浸润（χ^2=6.0,P〈0.05）及纤维化（χ^2=14.84,P〈0.01）等方面差异有统计学意义。结论：光疗是治疗早期MF的有效方法。光疗可以改变MF亲表皮性、真皮浸润模式、纤维化程度以及血管扩张。在组织病理上判断治疗是否有效以及描述光疗治疗早期MF病理变化时应注意亲表皮性、真皮浸润模式、纤维化程度以及血管扩张的改变。

Objectives：Although phototherapy is effective and safe for early mycosis fungoides（MF）,the histological changes before and after treatment have not been well characterized.In the present study,we characterized the histopathological changes in early MF before and after phototherapy in order to facilitate early diagnosis and to evaluate therapeutic efficacy.Methods：48 skin samples from 24 patients with early MF,which were confirmed by histopathology,were collected before and after phototherapy.The changes in following parameters were analyzed：epidermotropism,epidermis,and pattern of inflammatory infiltrate,vascular dilation,fibrosis,and other changes in the dermis.Results：Significant changes before and after treatment included the Pagetoid infiltration（χ~2=4.55,P〈0.05）,Pautrier microabscesses（χ~2=10.08,P〈0.01）,lichenoid inflammatory infiltration（χ~2=6.0,P〈0.05）and fibrosis（χ~2=14.84,P 0.01）in all skin samples.Conclusion：Phototherapy was effective for early stage MF.Phototherapy changes the epidermotropism,dermal inflammatory infiltration,fibrosis and vascular dilation.The pathologists should pay attention to these changes when determining whether the phototherapy is effective,and describing the changes after phototherapy.