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女,16岁,膝关节囊肿

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 女,16岁,右膝关节皮下囊性肿物。

这个部位,这种内衬上皮诊断什么?

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1 楼    发表于2012-05-04 19:40:21举报|引用
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是发生在髌前还是在腘窝处?

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2 楼    发表于2012-05-04 23:01:46举报|引用
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本帖最后由 病理 于 2012-05-04 23:17:28 编辑

皮肤苗勒囊肿,女性多见,偶发男性,可能是胚胎发育过程异位造成的。

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3 楼    发表于2012-05-07 08:56:21举报|引用
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引用 1 楼 海上明月 在 2012-05-04 19:40:21 的发言:

是发生在髌前还是在腘窝处?


老师您好!打电话询问了是在髌骨上方皮下。

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4 楼    发表于2012-05-07 09:02:50举报|引用
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引用 2 楼 病理 在 2012-05-04 23:01:46 的发言:
本帖最后由 病理 于 2012-05-04 23:17:28 编辑

皮肤苗勒囊肿,女性多见,偶发男性,可能是胚胎发育过程异位造成的。

从囊肿内衬上皮看很像输卵管上皮(有纤毛和透明细胞),还有含炎症细胞的短梭形间质,但是没有查到相关文献。

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5 楼    发表于2012-05-07 23:06:03举报|引用
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引用 4 楼 九天揽月 在 2012-05-07 09:02:50 的发言:
引用 2 楼 病理 在 2012-05-04 23:01:46 的发言:
本帖最后由 病理 于 2012-05-04 23:17:28 编辑

皮肤苗勒囊肿,女性多见,偶发男性,可能是胚胎发育过程异位造成的。

从囊肿内衬上皮看很像输卵管上皮(有纤毛和透明细胞),还有含炎症细胞的短梭形间质,但是没有查到相关文献。

囊肿位于深部真皮或者皮下组织内,囊肿可分为单房或者多房,腔内有乳头状突起,囊壁可类似输卵管上皮,可由立方或者柱状纤毛上皮组成,鳞状上皮化生是其特征,书上肯定有,我忘记那本书了。

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6 楼    发表于2012-05-08 22:48:22举报|引用
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本帖最后由 jianshu322 于 2012-05-08 22:49:05 编辑

皮肤纤毛囊肿  Cutaneous ciliated cyst

1. 临床特征

皮肤纤毛囊肿(皮肤苗勒囊肿)最常用于描述一种发生于年轻女性(12-42岁)在月经初潮后不久在四肢单发的损害。好发于大腿、臀部、小腿和足部(依降次排列)。囊肿位于深部真皮或皮下组织内,常无症状。偶可并发炎症而自觉疼痛,有时可破裂,也有报道皮损发生于腹壁。

偶可发生于男性和其他部位,如背、肩、头皮和颊部等处,但有建议应将其归类于别的类别。

2. 发病机制和组织学特征

两种理论可解释纤毛囊肿的发生。存在于年轻女性四肢上的皮损一般认为是苗勒管(Müllerian,副中肾管)衍生物、它们的存在代表胚胎发育中的迁移异常(异位)。支持这一学说的证据包括副中肾管非常靠近肢体芽、明显的女性发生优势、囊壁上皮和输卵管之间的组织学相似性以及囊壁附近组织缺乏汗腺等。囊肿发生于男性和其他部位,则提示先前存在的汗管衍生囊肿的囊壁可能发生了组织化生,或是囊肿起源于一个完全不同的组织。

囊肿可为单房或多房,腔内有乳头状突起。囊壁类似于正常的输卵管,可有立方至柱状纤毛上皮组成,常可见假复层上皮灶,偶可见间杂的暗细胞。鳞状上皮化生常是其特征。少见黏液分泌细胞。有一两篇报道存在顶泌汗腺样特征。上皮的深部是富含血管的平行排列的胶原纤维束,但平滑肌存在与否不是其特点。

超微结构观察,纤毛有其形态学特征,包括两条中央微管、9组放射状排列的双联微管、基体和纹状小根等。微绒毛有时也较为明显。

囊壁细胞表达角蛋白、上皮细胞膜抗原(EMA),但不表达CEA、肌丝蛋白及平滑肌肌动蛋白(SMA)。有报道1例发生在一男性颊部的皮损有S-100蛋白和SMA呈阳性反应的肌上皮层,但有人认为最好将其归类为伴纤毛化生的汗腺囊瘤。还有1例报道肌丝蛋白表达仅限于纤毛细胞顶端。雌激素和雄激素受体也可为阳性。S-100蛋白偶尔存在。另有1例报道可表达淀粉酶和动力蛋白(dynein)。

3. 鉴别诊断

纤毛上皮细胞也可见于支气管源性囊肿、甲状舌管囊肿、鳃裂囊肿、胸腺囊肿和真性囊性畸胎瘤。

                                                     摘自 《皮肤病理学(下卷)》(第三版)

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7 楼    发表于2012-05-09 17:13:07举报|引用
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非常感谢jianshu322!学习了

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本帖最后由 海上明月 于 2012-05-10 18:10:36 编辑
引用 4 楼 九天揽月 在 2012-05-07 09:02:50 的发言:
引用 2 楼 病理 在 2012-05-04 23:01:46 的发言:
本帖最后由 病理 于 2012-05-04 23:17:28 编辑

皮肤苗勒囊肿,女性多见,偶发男性,可能是胚胎发育过程异位造成的。

从囊肿内衬上皮看很像输卵管上皮(有纤毛和透明细胞),还有含炎症细胞的短梭形间质,但是没有查到相关文献。

请见下文国外文献,也是发生在髌骨上方。哈哈,无独有偶耶。

请读下列原文,或是直接点击文中图片看一看究竟。

J Cutan Aesthet Surg. 2011 May-Aug; 4(2): 158–159.
PMCID: PMC3183730

Cutaneous Ciliated Cyst Over Knee 膝前皮肤纤毛囊肿
Amrut V Ashturkar, Gayatri S Pathak, and Avinash R Joshi
Department of Pathology, Shrimati Kashibai Navale Medical College and General Hospital, Narhe, Pune, India. E-mail: amrutva@yahoo.com
Sir,
Cutaneous ciliated cysts are very unusual benign lesions exclusively occurring on the lower extremity of young females shortly after puberty.[1] They have been widely regarded as Müllerian heterotopias because of the morphological similarity of the cyst lining cells to the epithelium of fallopian tubes.[2] We report a case of an 18-year-old female presented in orthopaedic outpatient department with gradually increasing, painless swelling, over right knee joint since 4 years. On examination, a soft to cystic, solitary, movable, nontender, fluctuant swelling, measuring 4 × 4 cm in size was noted. There was no abnormality of the overlying skin. Ultrasonography confirmed the cystic nature of the lesion. There was no continuation between the cyst and knee joint. Surgical removal of the cyst was carried out under local anaesthesia. Grossly, we received a skin covered, cystic specimen measuring 3.9 × 3.5 × 3.0 cm in size. On cutting open, an uniloculated cyst, measuring 3 cm in diameter was identified, which contained serous fluid. The cyst wall was thin, smooth, and greyish white in colour. Light microscopy revealed a cyst in the deep dermis, which was predominantly lined by single layer of ciliated cuboidal to columnar cells [Figure 1]. At places the lining epithelium showed stratification and squamous metaplasia [Figure 2]. These lining epithelial cells did not contain mucin. The cyst wall was thin, fibrocollagenous without any inflammatory infiltrate. On immunohistochemical staining, the lining epithelial cells showed strong membrane positivity for epithelial membrane antigen and cytoplasmic positivity for cytokeratin (PanCK AE1/AE3) [Figure 3]. Strong nuclear positivity for oestrogen receptor (ER) and progesterone receptor (PR) was noted within the epithelial cells [Figure 4]. Immunohistochemical staining for carcinoembryonic antigen (CEA) and S-100 was negative.
Figure 1
Photomicrograph showing a thin-walled cyst in the deep dermis lined by ciliated cuboidal to columnar cells (H and E, ×40). Inset: closer view of the ciliated epithelium (H and E, ×400)
Figure 2
Focal squamous metaplasia of the lining epithelium of cyst (H and E, ×100)
Figure 3
Lining epithelial cells showing (a) cytoplasmic positivity for cytokeratin (×100) and (b) strong membrane positivity for epithelial membrane antigen
Figure 4
Lining epithelial cells showing nuclear positivity for (a) progesterone receptor and (b) oestrogen receptor (×100)
Cutaneous cysts are rare benign lesions, lined by a simple cuboidal to columnar ciliated epithelium, seen typically on lower extremity in females in the second or third decade of life.[3] One case has been reported in a 51-year-old postmenopausal female patient.[4] Ciliated cutaneous cysts have also been reported at unusual sites, such as abdominal wall and posterior mediastinum.[1,5] Cases of cutaneous ciliated cysts in males in perianal and inguinal area have also been documented in the literature.[6] In our case, the patient was an 18-year-old female with a cyst over right knee joint. Table 1 summarises the previous reports of cutaneous ciliated cysts highlighting the age and sex of the patient with their sites.
Table 1
Table 1
Summary of the previous reports on cutaneous ciliated cysts
On light microscopy, the cysts are uniloculated and are lined by ciliated cuboidal to columnar epithelium without mucous cells, morphologically similar to the epithelium of fallopian tubes.[2] Immunohistochemical staining for PR, ER, cytokeratin, and epithelial membrane antigen were positive, whereas it was negative for CEA, which supports the theory of heterotopia of the ciliated epithelium from the Müllerian epithelium in its histopathogenesis.[12] The positivity of lining epithelium for ER and PR and occurrence of this lesion in second decade after puberty also suggests Müllerian origin. This supports the hypothesis, which suggests that the cells from the fimbrial ends of the fallopian tubes developing from the Müllerian ducts possibly detach and become incorporated into the lateral mesoderm where the lower limb buds arise. These arrested cells then remain dormant until puberty after which, under the influence of ovarian hormone stimulation, the heterotopic Müllerian epithelium produces serous fluid, resulting in cystic formation.[2] Ciliated metaplasia of eccrine or apocrine duct epithelial is another hypothesis documented for histogenesis of ciliated cyst, which explains rare occurrence of cutaneous ciliated cysts in male.[1,4,11] There is marked similarity between the cutaneous ciliated cyst lining and normal salpingeal epithelium in the mode of staining for dynein.[13]
This lesion shares its cutaneous origin with other cutaneous cysts, such as bronchogenic cyst and thyroglossal cyst.[14] However, the location of lower extremity, absence of mucous glands, cartilage and inflammation, positivity for ER and negativity for CEA establishes the diagnosis of cutaneous ciliated cyst.
Surgical removal under local anaesthesia is the recommended treatment for cutaneous ciliated cyst.[4] The recurrence has not been reported in the literature. In the present case also we followed-up the patient for 6 months without any signs of recurrence.
In conclusion, although rare, the possibility of ciliated cutaneous cyst should be considered in a young female presenting with cystic lesion on lower extremity because of its distinct Müllerian histogenesis.
1. Fontaine DG, Lau H, Murray SK, Fraser RB, Wright JR. Cutaneous ciliated cyst of the abdominal wall: A case report with a review of the literature and discussion of pathogenesis. Am J Dermatopathol. 2002;24:63–6. [PubMed]
2. Al-Nafussi AI, Carder P. Cutaneous ciliated cyst: A case report and immunohistochemical comparison with fallopian tube. Histopathology. 1990;16:595–8. [PubMed]
3. Farmer ER, Helwig EB. Cutaneous ciliated cysts. Arch Dermatol. 1978;114:70–3. [PubMed]
4. Torisu-Itakura H, Itakura E, Horiuchi R, Matsumura M, Kiryu H, Takeshita T, et al. Cutaneous ciliated cyst on the leg in a woman of menopausal age. Acta Derm Venereol. 2009;89:323–4. [PubMed]
5. Businger AP, Frick H, Sailer M, Furrer M. A ciliated cyst in the posterior mediastinum compatible with a paravertebral Mullerian cyst. Eur J Cardiothorac Surg. 2008;33:133–6. [PubMed]
6. Ashton MA. Cutaneous ciliated cyst of the lower limb in a male. Histopathology. 1994;26:467–9. [PubMed]
7. Yokozaki H, Yanagawa E, Harada M, Tahara E. Cutaneous ciliated cyst of the right lower leg. Pathol Intl. 1999;49:354–7.
8. Tachibana T, Sakamoto F, Ito M, Ito K, Kaneko Y, Takenuchi T. Cutaneous ciliated cyst: A case report and histochemical, immunohistochemical and ultrastructural study. J Cutan Pathol. 1995;22:33–7. [PubMed]
9. Ohba N, Tsuruta D, Muraoaka M, Haba T, Ishii M. Cutaneous ciliated cyst on the cheek in a male. Intl J Dermatol. 2002;41:48–9.
10. Santos LD, Mendelson G. Perineal cutaneous cyst in a male. Pathology. 2004;36:369–70. [PubMed]
11. Valcárcel PJ, Currás PG, Arca SM, Gómez RI, Escandón A. Cutaneous ciliated cyst of the scrotal skin. A case report with discussion of pathogenesis. Actas Urol Esp. 2008;32:843–6. [PubMed]
12. Chong SJ, Kim SY, Kim HS, Kim GM, Kim SY, Jung JH. Cutaneous ciliated cyst in a 16-year-old girl. J Am Acad Dermatol. 2007;56:159–60. [PubMed]
13. Dini M, Russo GL, Baroni G, Colafranceschi M. Cutaneous ciliated cyst: a case report with immunohistochemical evidence for dynein in ciliated cells. Am J Dermatopathol. 2000;22:519–23. [PubMed]
14. Scott GA. Cutaneous cysts and related lesions. In: Barnhill RL, editor. Textbook of dermatopathology. 2nd ed. New York, NY: McGraw-Hill; 2004. pp. 561–73.


 

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9 楼    发表于2012-05-10 19:59:36举报|引用
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谢谢海上明月老师!学习了

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10 楼    发表于2012-05-12 09:16:25举报|引用
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谢谢老师们,学习了!

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11 楼    发表于2012-05-13 21:25:09举报|引用
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见识了!谢谢!

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12 楼    发表于2012-05-14 12:46:13举报|引用
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学习了!

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13 楼    发表于2012-05-16 14:59:32举报|引用
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好病例,可能这辈子都没有机会看到这样的好病例!

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14 楼    发表于2012-05-17 09:03:19举报|引用
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非常感谢,学习了。

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