Neutrophilic hidradenitis induced by chemotherapy involves eccrine and apocrine glands
Neutrophilic hidradenitis induced by chemotherapy involves eccrine and apocrine glands
复制标题
DOI：
10.1097/00000372-199702000-00013
复制
发表时间：
1997-02-01
影响因子：
1.1
通讯作者：
Metze, D
中科院分区：
文献类型：
--
作者：
Brehler, R;Reimann, S;Metze, D
中性粒细胞性汗腺炎是一种主要由化疗药物诱发的自限性炎症性皮肤病。我们报道一例43岁急性髓系白血病患者，接受阿糖胞苷、柔红霉素和硫鸟嘌呤治疗，在化疗第3天双侧腋窝出现疼痛性红色结节。皮损自行愈合无后遗症，再次化疗时又复发。癌胚抗原（CEA）、上皮膜抗原（EMA）和S100的组织学检查及免疫组化染色显示小汗腺和大汗腺坏死。作为继发事件，中性粒细胞、组织细胞以及T细胞和B细胞类型的淋巴细胞浸润腺管。电子显微镜检查证实分泌上皮和卷曲汗腺导管存在严重的细胞变性。超微结构特征以及无缺口末端标记技术标记，符合非凋亡性细胞死亡模式。我们的研究结果强烈提示化疗药物在汗腺分泌上皮积聚产生细胞毒性作用。远端导管和肌上皮细胞保持完整，这可能是化疗停止后腺结构快速再生的原因。鉴于小汗腺和大汗腺均受累，我们建议使用中性粒细胞性汗腺炎这一术语，它是药物相关汗腺反应谱的一部分。
Neutrophilic eccrine hidradenitis is a self-limited inflammatory dermatosis primarily induced by chemotherapeutic agents. We report the case of a 43-year-old patient treated with cytarabine, daunorubicin, and thioguanine for acute myelogenous leukemia who developed painful, red nodules in both axillae on the third day of chemotherapy. The lesions healed spontaneously without sequelae and reappeared once when chemotherapy was readministered.Histologic examination and immunohistochemical staining for carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA), and S100 revealed necrosis of eccrine and apocrine glands. As a secondary event, neutrophils, histiocytes, and lymphocytes of T and B cell types were infiltrating the glandular coils. Electron microscopic examination confirmed the presence of severe cellular degeneration of the secretory epithelia and coiled sweat ducts. Ultrastructural features and absence of labeling with a nick-end labeling technique were consistent with a nonapoptotic mode of cell death.Our findings strongly suggest a cytotoxic effect of chemotherapeutic agents as accumulated in the secretory epithelia of sweat glands. Distal ducts and myoepithelial cells remained intact and may account for rapid regeneration of the glandular structures after discontinuation of chemotherapy. In view of the involvement of both eccrine and apocrine glands, we suggest the term neutrophilic hidradenitis, which is part of the spectrum of drug-associated sweat gland reactions.