The "spade sign" as a pathognomonic histopathologic feature of acne keloidalis: Analysis of 33 cases of cicatricial alopecia.
The "spade sign" as a pathognomonic histopathologic feature of acne keloidalis: Analysis of 33 cases of cicatricial alopecia.
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DOI：
10.1016/j.jaad.2021.06.003
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发表时间：
2022-06
影响因子：
13.8
通讯作者：
Fung, Maxwell A.
中科院分区：
文献类型：
--
作者：
Fernanda Ortega-Springall, Maria;Kiuru, Maija;Fung, Maxwell A.
致编辑：1瘢痕性脱发的组织学特异性诊断在历史上一直是难以捉摸或不可能的。(1)瘢痕性痤疮（AK）是一种原发性瘢痕性脱发，以以滤泡峡部为中心的淋巴细胞和中性粒细胞混合浸润为特征。随着时间的推移，峡部滤泡上皮变薄，最终临床瘢痕形成与滤泡破坏继发的异物肉芽肿反应相关。AK与其他形式的脱发有7个重叠的特征。(2)在最近的AK系列中，Cheng等人提出锹状征象（SS）是一种病理组织学特征。(3)他们将SS定义为由下峡部11的滤泡上皮扩张和变薄形成的黑桃形空间（类似于扑克牌中的黑桃10符号）。他们还创造了“气球标志”（BS）作为一种变体，与12 SS相同，除了它的圆形。毛管角化的必要存在的特征是：肥大的滤泡性角化细胞具有苍白的嗜酸性细胞质，突然的角化形成致密的嗜酸性正角蛋白。为了评估SS在临床相关鉴别诊断中的敏感性和特异性，我们从资深作者（MAF）的教学档案中对18例临床确诊的瘢痕性脱发病例进行了病例对照研究，寻找SS。h&e染色标本的垂直线切片分析是否存在SS/BS。对来自不同患者的33份标本进行了评估。21例诊断包括AK(9)，脱斑状毛囊炎（FD）(6)，中枢性离心性瘢痕性脱发(4)，夹层蜂窝织炎(4)，扁平毛囊苔藓(6)，额纤维化性脱发（FFA）(2)，牵引性脱发(1)，盘状狼疮(1)。3例AK标本中发现SS 24例（3/ 9,33 %）（图1）。其中2例在25个不同的受累卵泡中同时存在SS和BS，而第3例仅显示SS，其他病例未出现SS/BS。与其他瘢痕性脱发比较，SS/BS对AK的敏感性为33%，特异性为100%。1例FFA的28个单一结构被归类为“伪SS”：虽然29个滤泡上皮扩张变薄，但位于表面，30个
To the Editor, 1 Specific diagnosis of cicatricial alopecia by histology alone has historically 2 remained elusive or impossible.(1) Acne keloidalis (AK) is a primary cicatricial 3 alopecia characterized by a mixed (lymphocytic and neutrophilic) infiltrate centered 4 upon the follicular isthmus. With time, there is thinning of isthmic follicular 5 epithelium and, eventually, clinically keloidal scarring associated with a foreign 6 body granulomatous reaction secondary to follicular destruction. AK exhibits 7 overlapping features with other forms of alopecia.(2) In their recent AK series, 8 Cheng, et al, proposed the spade sign (SS) as a pathognomonic histopathologic 9 feature.(3) They defined SS as the spade-shaped space (resembling the spade 10 symbol in playing cards) created by dilated and thinned follicular epithelium in the 11 lower isthmus. They also coined the “balloon sign”(BS) as a variant, identical to 12 SS, except for its round shape. The required presence of trichilemmal 13 keratinization is characterized by isthmic follicular keratinocytes with pale 14 eosinophilic cytoplasm and abrupt keratinization forming compact eosinophilic 15 orthokeratin. 16To evaluate the sensitivity and specificity of SS in a clinically relevant differential 17 diagnosis, we performed a case control study searching for SS in a spectrum of 18 clinically confirmed cases of cicatricial alopecia from the teaching files of the senior 19 author (MAF). Vertical sections of H&E-stained specimens were analyzed for the 20 presence of SS/BS. 33 specimens from different patients were assessed. 21 Diagnoses included AK (9), folliculitis decalvans (FD)(6), central centrifugal 22 cicatricial alopecia (4), dissecting cellulitis (4), lichen planopilaris (6), frontal 23 fibrosing alopecia (FFA)(2), traction alopecia (1), and discoid lupus (1). SS was 24 found in 3 AK specimens (3/9, 33%)(Figure 1). Two specimens had SS and BS in 25 different affected follicles, whereas the third case showed only SS. SS/BS was not 26 present in other cases. Comparing AK against all other cicatricial alopecias, the 27 sensitivity and specificity of the SS/BS for AK were 33% and 100%, respectively. A 28 single structure in one case of FFA was classified as “pseudo SS”: although 29 follicular epithelium was dilated and thinned, it was located superficially and 30
影响因子：
13.8
作者：
Mirmirani, P;Willey, A;Price, VH
通讯作者：
Price, VH
影响因子：
3.1
作者：
Cheng, An-Yu;Lee, Chaw-Ning;Yang, Chao-Chun
通讯作者：
Yang, Chao-Chun