接受阿达木单抗治疗银屑病的隆突性皮肤纤维

病例资料

A34-year-oldCaucasianmanwithahistoryofpsoriasiswastreatedwithadalimumabinjections,subcutaneous40mgevery2weeksforthepast2years.ThepatientwasbornandraisedinNewJersey.Hewasoverweightwithabodymassindexof29butotherwisehealthy.Hismedicalhistorywassignificantonlyforpsoriasisandremovalofanatypicalnevusaboutadecadeearlier.HIVantibodyserologywasnegative.

患者，男，34岁。病史：银屑病，采用阿达木单抗皮下注射剂治疗2年（40mg/2周），10年前去除非典型痣。患者体重超重，体重指数29，整体健康。血清HIV抗体检查呈阴性。

Duringtherapywithadalimumabthepatientdidnottakeanyotheroralmedications.Heusedtopicalagentsincludingclobetasolpropionatespray,lacticacidcream,andhydrocortisonecreamforpsoriaticlesions.

阿达木单抗治疗期间，患者未服用任何口服药物。银屑病皮损的局部用药包括丙酸氯倍他索喷雾，乳酸乳膏和氢化可的松乳膏。

Twoyearsafterstartingtreatmentwithadalimumabthepatientpresentedtohisdermatologistwithamassontheleftupperaspectofhisback.Themasswasfirstnotedbythepatienttheyearbefore,butthepatientnoticedrapidgrowthinthepast2months.Thepatientdidnotrecallanytraumaorburntothisarea.

开始阿达木单抗治疗2年后患者因左上背有一个肿块来院皮肤科。患者1年前注意到该肿块，但在过去2个月内迅速生长。患者表示该部位无创伤或灼伤。

Thephysicalexaminationwasremarkablefora3-to4-cmsoft,rubbery,mobile,subcutaneousmassontheupperaspectoftheback.Theoverlyingskinwasintactandhadnoscar.Theinitialexcisionofthisrevealedanonencapsulatedbutwell-definedtumorthatextendedbeyondtheexpectedclinicalsize.Thehistopathologicexaminationrevealedadenselycellularnonpigmentedspindlecelltumorinthedermisandsubcutaneoustissuenotassociatedwiththeoverlyingepidermis.Thetumorshowedsomeareasofstoriform(cartwheel)arrangement(Fig1)andotherareasshowedelongatedfascicleswithaherringboneappearance(Fig2).Mitoseswereeasilyidentified.LargeareasofthetumorstainedpositivelywithCD34andCD10.PartofthetumorwasnegativeforCD34stain,andthemitoticcountinthatareawashigh.Thehistologicfeaturesweremost







































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