Decreased expression of Fas (APO‐1/CD95) on lesional CD4+ T lymphocytes in cutaneous T cell lymphomas: correlations with blood data
Decreased expression of Fas (APO‐1/CD95) on lesional CD4+ T lymphocytes in cutaneous T cell lymphomas: correlations with blood data
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皮肤 T 细胞淋巴瘤病变 CD4+ T 淋巴细胞上 Fas (APO-1/CD95) 表达降低：与血液数据的相关性
DOI：
10.1046/j.1365-2133.2001.04544.x
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发表时间：
2001
影响因子：
10.3
通讯作者：
J. Guilhou
中科院分区：
文献类型：
--
作者：
O. Dereure;P. Portalès;Jacques Clot;J. Guilhou
先生，鲍温样丘疹病是一种以肉质、通常为色素的丘疹为表现的疾病，累及男女生殖器。在外阴病变中，术语外阴上皮内瘤变(VIN3)也被用来描述同样的情况。组织学检查显示出与原位癌一致的图像，尽管病程似乎是良性的。已证实与致癌性人乳头瘤病毒(HPV16、18、33)有关。在过去，切除手术、电凝、冷冻治疗和5-氟尿嘧啶等治疗方法都取得了不同程度的成功。一位38岁女性因大阴唇皮肤瘙痒性皮损史4年来就诊。她之前曾接受过鬼臼毒素的治疗，但没有任何益处。6/11、16/18、31/33组HPV分型阴道粘膜分子生物学检查均为阴性。然而，在宫颈涂片(杂交捕获II试验)中检测到HPV31/33。以往用Er激光、KTP 532 mm激光和鬼臼蛋白治疗均未成功。检查时，小阴唇、大阴唇、阴蒂及肛周可见红斑和大量小丘疹，每个丘疹直径1±3 mm(图1)。从这些部位采集的几个活检组织的皮肤组织病理学检查显示，鲍温样上皮改变是一致的，因此支持鲍温样丘疹病的临床诊断(图2)。咪喹莫特的治疗方案与推荐的生殖器疣治疗方案不同。将5%的咪喹莫特乳膏隔天涂在受影响的部位，连续10天，直到皮肤明显刺激。这种霜现在每天涂一次，连续10天，但每次2小时后洗掉。这种治疗导致在8周内临床完全缓解(图3)。治疗后1个月、6个月和18个月的组织学检查显示没有任何癌前病变(图4)。治疗后1个月观察到的淋巴组织真皮浸润物在治疗6个月和18个月后的对照组织中密度降低。治疗10个月后进行阴道镜检查，发现阴道门周围有轻微的醋白色区域。宫颈上没有检测到低风险或高风险的HPV材料(杂交捕获II测试)。经过18个多月的治疗后，患者的临床症状继续好转。咪喹莫特是一种局部免疫反应调节剂，目前已登记用于治疗尖锐湿疣。咪喹莫特直接从单核细胞、巨噬细胞和树突状细胞诱导抗病毒和免疫调节细胞因子，如干扰素-a、肿瘤坏死因子-a和不同的白细胞因子。其对先天免疫反应的影响和Th1免疫的激活是其急性发作的原因。
Sir, Bowenoid papulosis is a disease presenting with fleshy, usually pigmented papules involving the genitalia of both sexes. In vulvar lesions, the term vulvar intraepithelial neoplasia (VIN3) is also used to describe the same condition. Histological examination reveals a picture consistent with carcinoma in situ, although the course of the disease appears to be benign. Association with oncogenic human papillomavirus (HPV 16, 18, 33) has been demonstrated. In the past, excisional surgery, electrocoagulation, cryotherapy and 5-fluorouracil have been used in the treatment of the condition with varying degrees of success. A 38-year-old woman was referred to our clinic with a 4-year history of pruritic skin lesions on her labia majora. She had previously been treated with podophyllin without any benefit. The molecular biological examination of the vaginal mucosa had been negative in terms of HPV typing (groups 6/11, 16/18, 31/33). However, HPV 31/33 was detected in the cervical smear (Hybrid Capture II test). Previous treatment with erbium laser, KTP 532 mm laser and podophyllin had been unsuccessful. On examination, erythema and numerous small papules were detectable on the labia minora and majora as well as in the clitoral and perianal area, each papule 1±3 mm in diameter (Fig. 1). The dermatohistopathological examination of several biopsies taken from these sites showed a uniform pattern with bowenoid epithelial changes, thus supporting the clinical diagnosis of bowenoid papulosis (Fig. 2). Treatment with imiquimod was initiated with a regimen different from that recommended for the treatment of genital warts. Imiquimod cream 5% was applied to affected areas on alternate days for 10 days until the skin became visibly irritated. The cream was now applied once daily for another 10 days, but washed off after 2 h each time. This treatment led towards complete clinical resolution within 8 weeks (Fig. 3). Histology performed 1 month, 6 months and 18 months after treatment demonstrated the absence of any precancerous epidermal changes (Fig. 4). The lympho histiocytic dermal infiltrate observed 1 month after treatment decreased in density in the control biopsies taken 6 and 18 months after treatment. Colposcopy performed 10 months after treatment showed minor acetic-white areas around the portio. No low-risk or high-risk HPV material was detected on the cervix (Hybrid Capture II test). More than 18 months after treatment the patient continues to be clinically clear. Imiquimod is a topical immune response modifier so far registered for the treatment of condylomata acuminata. Imiquimod directly induces antiviral and immunomodulating cytokines such as interferon-a, tumour necrosis factor-a and different interleukins from monocytes, macrophages and dendritic cells. Its effect on the innate immune response and the activation of Th1-immunity are responsible for its acute