Squamous syringometaplasia associated with docetaxel
Squamous syringometaplasia associated with docetaxel
复制标题
与多西紫杉醇相关的鳞状细胞管化生
DOI：
--
复制
发表时间：
2002
影响因子：
10.3
通讯作者：
A. Tsubura
中科院分区：
文献类型：
--
作者：
I. Kurokawa;S. Nishijima;Kenji Kusumoto;H. Senzaki;N. Shikata;A. Tsubura
小汗腺鳞状上皮化生，一种相对罕见但良性的实体，已报告在癌症患者接受各种化疗方案。它通常被描述为肿胀性斑块、丘疹或水疱，可能局限于四肢或可能是全身性的。多西他赛（泰索帝; Rhone-Poulenc Rennis）是一种合成紫杉烷，由无毒的天然前体10-脱乙酰基浆果赤霉素III制备而成，该前体得自观赏紫杉Taxus baccata L.的叶子。这种药物已在各种类型的癌症，如乳腺癌，肺癌或胃癌中进行了研究，并且先前已经描述了这种药物的皮肤副作用。我们报告了第一例鳞状上皮化生的患者接受多西他赛（泰索帝）治疗转移性食管肿瘤。1999年10月，一名有酒精和烟草滥用史的53岁男子被诊断为食管鳞状细胞癌伴肝转移。患者接受顺铂/氟尿嘧啶一线化疗。疾病进展后，患者接受多西他赛（泰索帝）作为姑息性二线化疗，每21天一次，联合皮质类固醇治疗4天。在开始该方案的第四个疗程后10天，他出现肢端水肿性红斑，伴敏感性水肿性浸润性斑疹，对称分布于腿的下1/3和双手（图1a）。包括皮下组织在内的深部活检组织学显示角质形成细胞坏死与汗管鳞状上皮化生有关。鳞状上皮化生与卷曲的分泌腺坏死有关（图1b）。真皮被炎症相关淋巴细胞、中性粒细胞和嗜酸性粒细胞浸润，无任何血管炎。通过对症治疗，即冷敷和扑热息痛，皮疹逐渐消退，并在7天内消失，伴有严重脱屑，但无疤痕。鳞状上皮化生在组织学上被定义为正常上皮外分泌管（即双层立方细胞和管腔嗜酸性角质层）转化为两层或多层鳞状上皮细胞，其具有类似于棘层的细胞间桥。据报告，它与摄入苯恶洛芬、暴露于四氯二苯并对二恶英、慢性皮肤溃疡和瘢痕、鳞状细胞癌、角化棘皮瘤、小叶脂膜炎和坏疽性脓疡有关。接受化疗的患者出现肢端表皮红斑、斑疹或鳞状上皮化生的丘疹。鳞状上皮化生与化疗药物阿糖胞苷、米托蒽醌、氟尿嘧啶、顺铂、多柔比星、环磷酰胺、依托泊苷、甲氨蝶呤、双硫凡、美法仑、卡莫司汀和塞替派有关。多西他赛的临床试验已在皮肤恶性黑色素瘤患者和人类免疫缺陷病毒阳性的卡波西肉瘤患者中进行。根据Bedikian et al.，当多西他赛用作一线化疗时，12.5%的患者有应答，75%的患者出现皮肤毒性。最常见的表现是指甲呈褐色和斑丘疹伴脱屑。1995年，齐默尔曼等人报告了12名参加I期化疗的患者在前三个疗程中发生的皮肤反应。在这些患者中观察到的最常见皮肤反应的特征是离散的紫色斑块或水肿斑块。图1. (a)手部肢端水肿性红斑伴敏感性渗出性浸润斑;（B）显微照片显示鳞状上皮化生伴卷曲分泌腺坏死。英国皮肤病学杂志2002; 146：524-540。
SIR, Eccrine squamous syringometaplasia, a relatively rare but benign entity, has been reported in cancer patients receiving various chemotherapeutic regimens. It is usually described as erythematous plaques, papules or vesicles, which may be limited to the extremities or may be generalized. Docetaxel (Taxotere; Rhone-Poulenc Rorer) is a synthetic taxoid prepared from a non-toxic natural precursor, 10-deacetyl baccatin III, obtained from the leaves of the ornamental yew Taxus baccata L. This drug has been investigated in various types of cancer such as breast, lung or gastric cancer, and cutaneous side-effects have been previously described with this drug. We report the first case of squamous syringometaplasia in a patient treated with docetaxel (Taxotere) for a metastatic oesophageal neoplasm. In October 1999, a 53-year-old man with a history of alcohol and tobacco abuse was diagnosed as having a squamous cell carcinoma of the oesophagus with liver metastasis. He received first-line chemotherapy with cisplatin ⁄ fluorouracil. Further to progressive disease, he received docetaxel (Taxotere) as palliative second-line chemotherapy every 21 days, in association with 4 days of corticosteroids. Ten days after starting the fourth course of this regimen, he presented with acral oedematous erythema with sensitive erythematous infiltrated macules symmetrically distributed on the lower third of the legs and on both hands (Fig. 1a). Histopathology of a deep biopsy including the hypodermis showed keratinocyte necrosis associated with squamous syringometaplasia of the sweat ducts. The squamous syringometaplasia was associated with necrosis in the coiled secretory glands (Fig. 1b). The dermis was infiltrated by inflammation-associated lymphocytes, neutrophils and eosinophils, without any vasculitis. With symptomatic treatment, i.e. cold compresses and paracetamol, the eruption resolved progressively and disappeared within 7 days with intense desquamation, but without scarring. Squamous syringometaplasia is histologically defined as the transformation of the normal epithelial eccrine duct (i.e. double layer of cuboidal cells and the luminal eosinophilic cuticle) into two or more layers of squamous epithelial cells with intercellular bridges similar to the stratum spinosum. It has been reported in association with ingestion of benoxaprofen, exposure to tetrachloro-dibenzo-p-dioxin, chronic cutaneous ulcers and scars, squamous cell carcinoma, keratoacanthoma, lobular panniculitis and pyoderma gangrenosum. Patients undergoing chemotherapy develop acral epidermal erythema, a macular rash or papulovesicles of squamous syringometaplasia. Squamous syringometaplasia has been described in association with the chemotherapeutic agents cytarabine, mitoxantrone, fluorouracil, cisplatin, doxorubicin, cyclophosphamide, etoposide, methotrexate, bisulfan, melphalan, carmustine and thiotepa. Trials of docetaxel have been conducted in patients with cutaneous malignant melanoma and in human immunodeficiency virus-positive patients with Kaposi’s sarcoma. According to Bedikian et al. when docetaxel was used as first-line chemotherapy, 12Æ5% of the patients responded and 75% showed skin toxicities. Brownish discoloration of nails and a maculopapular rash with desquamation were the most common manifestations. In 1995, Zimmerman et al. reported cutaneous reactions that had occurred over the first three courses of therapy in 12 patients enrolled for phase I chemotherapy. The most common cutaneous reaction seen in these patients was characterized by discrete erythematous to violaceous patches or oedematous plaques. Figure 1. (a) Acral oedematous erythema with sensitive erythematous infiltrated macules on the hand; (b) photomicrograph showing squamous syringometaplasia associated with necrosis in the coiled secretory glands. British Journal of Dermatology 2002; 146: 524–540.
用酚妥拉明进行全身性α-肾上腺素能阻滞：交感神经维持性疼痛的诊断测试。
影响因子：
8.8
作者：
Raja,SN;Treede,RD;Davis,KD;Campbell,JN
通讯作者：
Campbell,JN
DOI：
10.1016/s0889-8588(05)70048-4
发表时间：
1998
期刊：
Hematology/oncology clinics of North America
影响因子：
--
作者：
Thiagarajan,P;Shapiro,SS
通讯作者：
Shapiro,SS