摘要
目的:探讨嗜酸性粒细胞增多性血管淋巴样增生(angiolymphoid hyperplasia with eosinophilia,ALHE)的病因、临床表现、病理变化、鉴别诊断、治疗及预后。方法:收集最近3年共15例ALHE患者的临床及病理资料并进行回顾性分析。结果:15例患者中皮损多样,为丘疹、结节、斑块或皮下包块,数目不定;2例出现外周血嗜酸性粒细胞增多,1例Ig E水平升高;组织病理提示13例位于真皮层,2例出现皮下组织变化,血管内皮细胞肿胀并凸向管腔,细胞无异形性及有丝分裂象,血管周围可见广泛的炎性细胞浸润,主要包括淋巴细胞、嗜酸性粒细胞和组织细胞;免疫组化检查示CD34(+),CD20(+),CD3(+),CD1a(-);5例孤立皮损患者手术切除后未复发,10例多发患者外用0.1%他克莫司乳膏2周,4例瘙痒及疼痛症状消失,5例部分丘疹消退,后期经CO_2激光治疗后7例复发。结论:ALHE少见且病因不明,皮损特点及临床症状多样化,实验室检查无特异性,诊断主要依靠组织病理检查,主要病理改变为血管增生,内皮细胞肿胀并凸向管腔形成"墓碑征"及胞质内空泡,伴混合性炎性细胞浸润,免疫组化检查可作为辅助诊断;ALHE患者单发皮损手术效果好,多发皮损经药物及激光治疗缓解后易复发。
Objective： To explore the etiology, clinical manifestation, pathologic changes, differential diagnosis, management and prognosis of angiolymphoid hyperplasia with eosinophilia （ALHE）. Methods： A retrospective analysis of 15 cases with ALHE was performed. Results： Various number of papules, nodules and plaques presented in all 15 cases. Elevated periph- eral blood eosinophil ce11（PBEC） counts were in 2 cases while one patient had high serum IgE level. Pathology showed der- mal changes in 13 cases, and changes in subcutaneous tissue in 2 cases. The swollen endothelial cells protruded into the vascular lumen, with neither atypical cells nor mitotic activity. Perivascular infiltrate of lymphocytes, eosinophils and histio- cytes was evident. Immunohistochemical examination showed CD34（＋）, CD20 （＋）, CD3 （＋）, CDla（-）. 5 cases with solitary lesions did not recur after surgery. Among the 10 patients treated with topical 0.1% tacrolimus ointment for 2 weeks, pruritus and pain disappeared in 4 cases, and lesions partially disappeared in 5 cases. Following treatment with CO2 laser, recurrence occurred in 7 of 11 cases. Conclusions： ALHE is rare with unknown etiology and divergent clinical features. Because of non-specific laboratory findings, diagnosis is mainly relied on histological examination. The main pathological changes are vascular proliferation, cytoplasmic vacuoles swollen endothelial cells protruding into the lumen to form a ＂tombstone＂ appear- ance and perivascular infiltrate of various inflammatory cells. Immunohistochemical staining is helpful for diagnosis. Surgery is a good option for ALHE patients with single lesion, but high tendency of recurrence occurs in patients with multiple lesions after alleviation with drugs and laser therapy.
出处
《临床皮肤科杂志》
CAS
CSCD
北大核心
2016年第1期11-14,共4页
Journal of Clinical Dermatology
