中华皮肤科杂志 ›› 2008, Vol. 41 ›› Issue (12): 800-802.

• 论著 • 上一篇    下一篇

朗格汉斯细胞组织细胞增多症伴干燥综合征一例

林尽染 陈明华 陈波斌 黄琼 徐金华   

  1. 复旦大学附属华山医院皮肤科 上海复旦大学附属华山医院皮肤科 上海市复旦大学附属华山医院皮肤科
  • 收稿日期:2008-01-29 修回日期:2008-02-13 发布日期:2008-12-15
  • 通讯作者: 林尽染 E-mail:aminolin@163.com

A case of Langerhans cell histiocytosis and Sjogren′s syndrome

Lin Jin-Ran   

  • Received:2008-01-29 Revised:2008-02-13 Published:2008-12-15
  • Contact: Lin Jin-Ran E-mail:aminolin@163.com

摘要: 患者女,38岁。6年前双侧大阴唇出现红斑、丘疹,偶痒,逐渐融合成斑块,表面糜烂、破溃,渐延及会阴、肛周。半年前右下颌出现直径约为1.5 cm皮下结节,表面皮肤正常,质硬,有酸胀感,渐增大,4个月前左颏部出现直径约0.5 cm皮下硬结。自觉眼干、口干20年余。实验室检查血ANA 1 ∶ 320 颗粒型,SSA抗体阳性。唇腺病理活检:小唾液腺组织内灶性淋巴细胞浸润。右下颌肿块穿刺,见肿瘤细胞。右大阴唇皮损病理活检:真皮内致密组织细胞样细胞浸润,形态不规则,胞质丰富淡染或嗜酸性,少数核分裂;免疫组化S100及CD1a阳性。结合临床表现、实验室检查及组织病理检查,诊断为朗格汉斯细胞组织细胞增多症伴发干燥综合征。经环磷酰胺、长春新碱、糖皮质激素联合依托泊苷化疗后病情好转。

关键词: 组织细胞增多症, 郎格尔汉斯细胞;干燥综合征

Abstract: The patient was a 38-year woman. Six years prior to presentation, she developed erythema and papules with occasional pruritus in both labium majora, which gradually confluenced into plaques with the formation of superficial erosion and ulcer; extension into the vulva and crissum occurred later. Half a year prior to presentation, a subcutaneous firm nodule measuring about 1.5cm in diameter with intact epidermis, developed on the right submaxilla, associated with mild swelling in the area; the nodule enlarged gradually. A subcutaneous induration measuring 0.5 cm in diameter was observed in the left chin 2 months later. She also reported a 20-year history of dry eye and dry mouth. The patient tested postive for antinuclear antibody (granular pattern, with a titer of 1 ∶ 320) and for anti-Sjogren syndrome type A (SSA) antibody. Histologically, there was a focal infiltration of lymphocytes in tissue of minor salivary glands. The pathology of lesions on the right labium majus showed a dense dermal infiltration with S100- and CD1a-positive, irregularly-shaped histiocyte-like cells with abundant eosinophilic cytoplasm and few mitotic figures. Needle biopsy of the right submaxilla area showed tumor cells. A diagnosis of Langerhans cell histiocytosis and Sjogren syndrome was made based on clinical manifestation, laboratory findings and histopathological features. Combination chemotherapy with cyclophosphamide, vincristine, corticosteroids and etoposide resulted in clinical improvement.

Key words: Sjogren's Syndrome