慢性单纯性苔藓相关性获得性弹性组织变性血管瘤样改变1例国内首报

Acquired Elastotic Hemangioma⁃Like Change Associated with Lichen Simplex Chronicus:the First Case in China

患者男,91岁,左髋部皮疹缓慢增大不伴痛痒4年余。皮肤科情况:左髋部可见一约3 cm×2 cm大暗红色苔藓样斑块,其上有鳞屑,境界较清楚,周围褐色色素沉着,无触压痛。皮损组织病理示:表皮角化过度,偶见角化不全,颗粒层增厚,棘层肥厚,皮突延长,真皮浅层毛细血管呈带状增生,与表皮平行,部分血管内皮细胞呈鞋钉样突出至管腔,未见不典型性,血管周围真皮弹性组织变性,未见含铁血黄素沉积或红细胞外渗;真皮浅层胶原纤维增生,纤维母细胞增多。Verhoeff-Van Gieson染色示:真皮浅层增生血管周围弹力纤维明显减少或缺失,可见断裂、颗粒状碎裂。免疫组织化学显示:真皮浅层增生的毛细血管内皮细胞CD31(+),ERG(+),HHV-8(-),部分管腔内皮细胞D2-40(+)。诊断:慢性单纯性苔藓相关性获得性弹性组织变性血管瘤样改变。

A 91 year⁃old man presented with a skin lesion on the left hip for more than four years with slow enlargement which demonstrated with no pain and itch.Physical examination showed a dark purplish⁃red plaque about 3 cm×2 cm size on the left hip with mossy change and scaly surface which had clear boundary and no tenderness,brown pigmentation around the lesion was observed.The histopathology showed hyperkeratosis of the epidermis,occasionally incomplete keratosis,hypergranulosis,acanthosis,prolonged rete ridges in the epidermis,a bound⁃like proliferation of capillary vessels involved in the superficial dermis which arraged horizontally parallel to the epidermis.There were some endothelial cells extruding towards vessel lumen with hobnail⁃like appearance and no atypia around which were degenerative elastic tissues.No hemosiderin deposition or red blood cell extravasation was observed.Collagen fibers proliferated and fibroblasts increased in the superficial dermis.Verhoeff⁃Van Gieson stain showed that the elastic fibers were reduced or absent in the superficial dermal.Immunohistochemistry results showed that CD31 and ERG were positive in the proliferating blood vessels of the superficial dermis while HHV⁃8 was negative,and D2⁃40 was positive in some luminal endothelial cells.A diagnosis of acquired elastotic hemangioma⁃like change associated with lichen simplex chronicus was made.