皮肤镜和反射式共聚焦显微镜检查在幼年黄色肉芽肿中的诊断价值

The diagnostic value of dermoscopy and reflective confocal microscopy in juvenile xanthogranuloma

目的:总结幼年黄色肉芽肿(JXG)在皮肤镜及反射式共聚焦显微镜(RCM)下特征,探讨皮肤镜、RCM及二者联合应用对JXG的诊断价值。方法:分析43例拟诊为JXG患儿皮损的皮肤镜及RCM镜下表现,由4名皮肤科医师采用五级法诊断,绘制受试者工作特征(ROC)曲线,行DeLong检验。结果:(1)皮损组织病理检查确诊40例为JXG,1例皮脂腺异位,1例spitz痣,1例肥大细胞瘤。(2)确诊患儿皮肤镜图像特征:15例皮损外观呈“落日征”,中央线状、分枝状血管;23例外观“落日征”,中央黄色小球云、棕褐色色素沉着、白色纤维条;2例呈“云状”棕黄色。(3)确诊患儿RCM图像特征:34例真皮层见大量形状不规则中等折光细胞,不等量环状靶形细胞;4例未见环状靶形细胞;2例角化过度,灶状角化不全,棘层以下显影不清。(4)RCM与皮肤镜单独诊断JXG的ROC曲线下面积比较,差异无统计学意义(P>0.05);单用皮肤镜、单用RCM分别与二者联合应用诊断JXG的ROC曲线下面积比较,差异均有统计学意义(P<0.05)。结论:皮肤镜及RCM可作为JXG早期筛查方法,二者联合比单独诊断更有价值。

Objective: To summarize the characteristics of juvenile xanthogranuloma(JXG) by dermoscopy and reflective confocal microscopy(RCM) and to evaluate the diagnostic value of dermoscopy, RCM, and the combination of the two for JXG.Methods: Lesions of 43 children with suspected JXG were analyzed under dermoscopy and RCM microscopy. The five-level diagnosis was done by four dermatologists. ROC curve was drawn and DeLong test was performed. Results:(1)Histopathological examinations revealed 40 cases of JXG, 1 case of sebaceous ectopia, 1 case of Spitz nevus, and 1 case of mast cell tumor.(2)Dermoscopic features of JXG cases included: “sunset sign” with central linear and branched blood vessels(15 cases), “sunset sign” with a small yellow globular cloud in the center, dark brown pigmentation, and white fiber strips(23 cases), brownish and yellow cloud-like lesions(2 cases).(3)RCM features of JXG cases included: a large number of irregularly shaped medium refractive cells and a random number of ring-shaped target cells in dermis in 34 cases, a large number of irregularly shaped medium refractive cells with absence of ring-shaped target cells(4 cases), hyperkeratosis, focal incomplete keratosis, and unclear subspinous development(2 cases).(4)The area under ROC curve showed no statistically significant difference between RCM and dermoscopy, while statistically significant difference in the area under ROC curve was found between the combination of the two methods and dermoscopy or RCM alone. Conclusion: Dermoscopy and RCM can be used in early screening of JXG,and the combination of them is more reliable than one method alone.