CAJ | 학술논문

患者男,41岁.手足反复脓疱和脱屑1年,左足趾肿物4个月.体检:双手拇指、食指为主及掌侧大鱼际肌部位、双足趾及双足跖前1/3处可见不规则淡红色斑片,表面有小片状白色鳞屑,局部红斑基础上见深在性小水疱、脓疱,破溃后形成点状或融合成片状浅糜烂面,表面结黄褐色痂,部分趾指甲增厚、变形明显.左足第4趾掌跖关节前端一约4 cm×3.5 cm×3.5 cm肿物,质稍硬,表面糜烂,伴较多脓性分泌物渗出及新生肉芽组织生长,混合后形成较厚黑色血痂,触痛明显.甲床和足趾肿物组织病理检查:表皮、真皮全层和皮下脂肪弥漫性致密小到中等大淋巴细胞浸润,细胞有异形,其间混杂少量炎性细胞,亲表皮现象明显,见Pautier微脓疡.免疫组化检查:异形淋巴样细胞LCA、波形蛋白、CD3、CD45RO、CD4、Bc1-2均阳性,CD8、CD5、CD10均为散在阳性,Ki-67＞ 80％阳性,CD79a、CD20、CD30、细胞角蛋白、S-100、Bc1-6、间变性淋巴瘤激酶、HMB45、CD1a、P63均为阴性.诊断:掌跖蕈样肉芽肿.
환자남,41세.수족반복농포화탈설1년,좌족지종물4개월.체검:쌍수무지、식지위주급장측대어제기부위、쌍족지급쌍족척전1/3처가견불규칙담홍색반편,표면유소편상백색린설,국부홍반기출상견심재성소수포、농포,파궤후형성점상혹융합성편상천미란면,표면결황갈색가,부분지지갑증후、변형명현.좌족제4지장척관절전단일약4 cm×3.5 cm×3.5 cm종물,질초경,표면미란,반교다농성분비물삼출급신생육아조직생장,혼합후형성교후흑색혈가,촉통명현.갑상화족지종물조직병리검사:표피、진피전층화피하지방미만성치밀소도중등대림파세포침윤,세포유이형,기간혼잡소량염성세포,친표피현상명현,견Pautier미농양.면역조화검사:이형림파양세포LCA、파형단백、CD3、CD45RO、CD4、Bc1-2균양성,CD8、CD5、CD10균위산재양성,Ki-67＞ 80％양성,CD79a、CD20、CD30、세포각단백、S-100、Bc1-6、간변성림파류격매、HMB45、CD1a、P63균위음성.진단:장척심양육아종.
A 41-year-old man presented with recurrent pustules and scales on both hands and feet for 1year and with neoplasm on the left toe for 4 months.On physical examination,there were multiple irregular rufous patches with lamellar white scales on bilateral thumbs,forefingers,thenar eminence,toes,and the onethird anterior part of bilateral soles.Deep-seated pustules and vesicles arising on some erythematous patches were disrupted with the formation of punctiform or patches of erosions covered by yellow brown crusts.Some toenails and fingernails were thickened and deformed.An obviously tender neoplasm measuring 4 cm × 3.5 cm× 3.5 cm was observed in the anterior part of the left fourth toe,which was a little indurated and obviously tender with superficial erosion,large amount of purulent exudates and fresh granulation tissue mixing to form black and thick blood crusts on the surface.Biopsy of the nail bed of the right index finger and neoplasm on the left toe revealed a diffuse,dense,and mixed infiltrate of small- to medium-sized atypical lymphocytes and a few inflammatory cells.Meanwhile,epidermotropism and Pautrier's microabscess were visible.Immunohistochemistry showed that the abnormal lymphocytes were positive for leukocyte common antigen (LCA),Vimentin,CD3,CD45RO,CD4,Bcl-2,partly positive for CD8,CD5,CD10,Ki-67 (＞ 80％ ),but negative for CD79a,CD20,CD30,cytokeratin,S-100,Bc1-6,anaplastic lymphoma kinase (ALK),HMBMS,CD1a or P63.Based on the above findings,a diagnosis of mycosis fungoides palmaris et plantaris was made.