摘要目的 分析皮肤纤维瘤(DF)的组织病理与临床特征,探讨两者的相互联系.方法 回顾分析2017年9月至2018年8月在上海市皮肤病医院病理科经皮肤组织病理检查确诊的150例DF患者的临床和组织病理资料.结果 150例患者中,男65例,女85例,年龄(42±13.8)岁,病程3个月至＞ 30年,部分有伴随症状,主要表现为瘙痒,有自发痛、轻压痛,18例皮损有外伤、虫咬或感染病史.皮损主要位于四肢(107例,71.3％),以单发皮损为主(105例,70％).病理检查前拟诊为“DF”102例,“表皮样囊肿”16例,“色痣”13例,“瘢痕疙瘩”3例,“皮肤肿物”12例,“恶性黑素瘤”1例,“黄色肉芽肿”1例,“结节性痒疹”1例,“神经纤维瘤”1例.在这些患者的169张苏木精-伊红染色切片中,66张(39.1％)为细胞性,36张(21.3％)硬化性,25张(14.8％)表现为动脉瘤样型DF,22张(13.0％)上皮样型.12张切片内可见两种或两种以上亚型并存的现象.还可见少数新的变异型,如DF伴汗腺导管增生(1例)、深在型DF(3例)、上皮样细胞与增生胶原相间的DF(1例)等.动脉瘤样型DF病程长短不一,7个月至＞ 30年,多表现为发生于下肢的皮肤肿物样损害.细胞性DF病程相对较短,常发现数月后就诊,好发于四肢,常伴痒痛.硬化性或萎缩性DF病程长,为数年或数十年,好发于上肢,多无伴随症状.上皮样型DF病程长短不一,临床表现多样,多发于下肢,无伴随症状.结论 DF的临床表现及病理表现均具有多样性,不同的DF皮损可有相似的典型组织病理学表现,不典型的病理表现可干扰疾病诊断.

abstractsObjective To analyze histopathological and clinical features of dermatofibroma,and to explore the relationship between them.Methods Clinical and histopathological data were collected from 150 patients with histopathologically confirmed dermatofibroma in Department of Pathology,Shanghai Skin Disease Hospital from September 2017 to August 2018,and analyzed retrospectively.Results Among the 150 patients,65 were males,and 85 were females.Their age was 42 ± 13.8 years,and the course of disease ranged from 3 months to 30 years.Some of the patients had concomitant symptoms,mainly manifesting as itching,some had spontaneous pain and mild tenderness,and 18 patients had a history of injury,insect bite or infection at lesion sites.Skin lesions mainly occurred on the extremities (107 cases,71.3％),and most were solitary (105 cases,70％).Before pathological examinations,102 cases were clinically diagnosed as dermatofibroma,16 as epidermoid cyst,13 as pigmented nevus,3 as keloid,12 as skin mass,1 as malignant melanoma,1 as xanthogranuloma,1 as prurigo nodularis,and 1 as neurofibroma.Among 169 hematoxylin and eosin (HE)-stained sections,25 (14.8％) appeared to be consistent with aneurysmal dermatofibroma,66 (39.1％)with cellular dermatofibroma,36 (21.3％) with sclerosing dermatofibroma,and 22 (13.0％)with epithelioid dermatofibroma.Coexistence of two or more subtypes could be seen in 12 sections.There were also a few new variants,such as dermatofibroma with hyperplastic sweat duct (1 case),deep dermatofibroma (3 cases),dermatofibroma with epithelioid cells intermingled with hyperplastic collagen (1 case).The duration of aneurysmal dermatofibroma varied from 7 months to 30 years,and most manifested as skin masses on the lower extremities.A relatively short course of disease was observed in patients with cellular dermatofibroma,who often visited a hospital several months after the onset,and cellular dermatofibroma was commonly observed on the extremities and frequently accompanied with itching and pain.The duration of sclerosing or atrophic dermatofibroma was usually long for years or decades,and it commonly occurred on the upper limbs without concomitant symptoms.Epithelioid dermatofibroma of varied durations had various clinical manifestations,frequently occurred on the lower limbs without concomitant symptoms.Conclusions The clinical and pathological manifestations of dermatofibroma are diverse.Different dermatofibroma lesions can share similar typical histopathological manifestations,and atypical pathological features can interfere with the diagnosis of dermatofibroma.