摘要
目的利用反射式共聚焦激光扫描显微镜(RCM)技术对硬化性苔藓的RCM影像学特征进行分析。方法选取在本院就诊的39例临床疑诊硬化性苔藓患者的非生殖器部位典型皮损,先将皮损及皮损周围正常皮肤做RCM扫描,再对该处皮损行组织病理学检查,并将两者结果进行对比研究。结果皮损处RCM影像学特征:表皮-真皮界面模糊,表真皮交界处、真皮浅层可见不等量高折光噬黑色素细胞39例(100%),与组织病理完全吻合;真皮浅层毛细血管扩张34例(87.18%),组织病理改变36例(92.31%);表皮纵向扫描层次较正常皮肤减少,表皮萎缩变薄,基底细胞环缺失,皮突变平37例(94.87%),组织病理38例(97.44%);角质层纵向扫描层次较正常皮肤增加,即角化过度39例(100%),组织病理39例(100%);毛囊漏斗部扩张,内含高折光角化性物质35例(89.74%),组织病理33例(84.62%)。值得注意的是:32例(82.05%)硬化性苔藓患者在表真皮交界处、真皮浅层均可见形态多呈圆形或类圆形的高折光细胞。免疫组织化学显示:Langerin(+)、CD1a(+)、S-100(+),提示此圆形或类圆形的高折光细胞为活化的朗格汉斯细胞。结论结合临床表现、RCM影像学特征可为硬化性苔藓的诊断及鉴别诊断提供强有力的依据。
Objective To analyze the imaging characteristics of lichen sclerosus by reflectance confocal microscopy(RCM).Methods Thirty-nine patients with suspected lichen sclerosus treated in our hospital were enrolled.Typical skin lesions and adjacent normal skin in non-genital area of the patients were scanned with RCM.Pathological examination of the skin lesions was then performed,to compare the results of the two examinations.Results RCM imaging characteristics of lesions were as follows. Epidermis-dermis interface was blurred,and variable numbers of hyperrefractive melanophages were found in epidermis-dermis interface and in dermis of the skin in 39 cases(100%),which were completely consistent with histopathological findings.There was superficial dermal capillary dilation in 34 cases(87.18%)and corresponding histopathological changes in 36 cases(92.31%).Epidermis layers by longitudinal scanning were reduced compared with normal epidermis,which was atrophying and thinning.Basal cell cycle was missing,and skin mutation was flattening in 37 cases(94.87%)as well as 38 cases with histopathological changes.Compared with the normal skin,vertical stratum corneum layers were increased(hyperkeratosis)in 39 cases(100%)and 39 cases(100%)with histopathological changes;hair follicle funnel hyperkeratosis,hair follicle infundibular region was expanding,containing hyperrefractive keratotic material(follicular horn bolus)in 35 cases(89.74%)and 33 cases with histopathological changes(84.62%).It is worth noting that,in 32 patients with lichen sclerosus,round or roundish hyperrefractive cells were found at the epidermis-dermis interface and in the superficial dermis.Immunohistochemistry revealed Langerin(+),CD1a(+),and S-100(+),suggesting that the round or roundish hyperrefractive cells might be the activated Langerhans cells.Conclusion According to clinical manifestations,RCM imaging features can provide a powerful basis for the diagnosis of lichen sclerosus and differential diagnosis.
作者
陈红英
陈柳青
胡彬
马玲
姜倩
何兰
CHEN Hongying;CHEN Liuqing;HU Bin;MA Ling;JIANG Qian;HE Lan(No.1 Hospital of Wuhan,Wuhan 430022,China)
出处
《中国皮肤性病学杂志》
CAS
CSCD
北大核心
2019年第7期776-782,共7页
The Chinese Journal of Dermatovenereology
