反射式共聚焦显微镜观察幼年黄色肉芽肿20例

Observation of juvenile xanthogranuloma using reflectance confocal microscopy: 20 cases reports

目的:探讨幼年黄色肉芽肿在反射式共聚焦显微镜(reflectance confocal microscopy,RCM)下影像特征及其在幼年黄色肉芽肿早期诊断中的意义。方法:收集20例幼年黄色肉芽肿患儿行RCM检查,依据RCM图像表现选取相应部位组织取材行组织病理检查,对比RCM图像和组织病理检查结果,总结幼年黄色肉芽肿RCM下的共同图像特征。结果:20例幼年黄色肉芽肿患儿的RCM图像显示:表皮轻度海绵水肿,可见逐渐增多的圆形、椭圆形中等折光细胞,充满整个真皮浅层,形如泡沫状外观,部分细胞融合形成大量环状明亮的高折光区、中央低折光区结构,正常环状真皮乳头结构部分融合,散在炎性细胞浸润。同部位组织病理检查示:真皮浅层可见大量泡沫细胞和Touton巨细胞,证实中等折光圆形、椭圆形结构为泡沫细胞,明亮的环形高折光区、中央低折光区结构为Touton巨细胞;RCM图像与组织病理像对比,结果具有较好的一致性。结论:反射式共聚焦显微镜检测有助于确定取材部位,提高组织病取材的阳性率,使今后早期无创诊断幼年黄色肉芽肿成为可能。

Objective： To investigate the imaging features of juvenile xanthogranuloma under reflectance confocal microscopy （RCM） and to evaluate the significance of RCM in early diagnosis of juvenile xanthogranuloma. Methods： RCM was used to image lesions of juvenile xanthogranuloma in 20 children, followed by biopsies for histopathological examination. A comparison was conducted between the RCM images and histopathological findings. The common RCM image features of juvenile xan- thogranuloma were also summarized. Results： RCM imaging in 20 patients showed epidermal sponge edema, and infiltration of the moderately refractive circular and elliptical cells in the superficial dermis. Some ceils clustered to form a large number of annular bright high refractive regions with central low refractive regions. Sporadic inflammatory infiltration was evident. Histopathological examination showed a large number of foam cells and Touton giant cells in the superficial dennis. The comparative studies demonstrated that the moderately refractive circular and elliptical ceils were foam cells, while annular bright high refractive regions with central low refractive region were Touton giant cells. RCM images were highly consistent with histopathological and immunohistochemical findings in these patients. Conclusion： RCM can help determine the sites of biopsy, and improve the accuracy of pathological diagnosis of juvenile xanthogranuloma, which make it possible for early non-invasive diagnosis of juvenile xanthogranuloma in the future.