Mutually Exclusive Expression Pattern of Keratin Markers for Differentiation and Proliferation in Circumscribed Palmar Hypokeratosis.
Mutually Exclusive Expression Pattern of Keratin Markers for Differentiation and Proliferation in Circumscribed Palmar Hypokeratosis.
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限制性掌角化不足分化和增殖的角蛋白标记物的互斥表达模式。
DOI：
10.1111/bjd.15407
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Manabe M.
中科院分区：
文献类型：
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作者：
Toyoshima A;Osada SI;Umebayashi Y;Manabe M.
亲爱的编辑， 局限性手掌或足底角化不足 (CPH) 被认为是一种良性克隆性表皮分化或角化障碍。 1-3 CPH 的特征是手掌和足底的鱼际或小鱼际隆起处有界限清楚的环形凹陷性红斑病变。其独特的组织病理学特征是角膜层厚度突然减少和受影响病变的颗粒细胞减少。 2, 4 在此，我们介绍了 CPH 病例，并证明了受影响和未受影响表皮之间分化和增殖的角蛋白标记物的相互排斥的表达模式。患者，64岁，女性，左鱼际肌红斑5年，有刺痛感，逐渐向周围扩展。体格检查发现左侧大鱼际肌上有边界清楚的 3.6 × 9 × 3.0 厘米凹陷红斑（图 1a）。活检标本的显微镜检查显示受影响皮肤病变中的角膜和颗粒层出现“急剧阶梯”状变薄（图 1c），从而诊断为 CPH。据我们所知，我们的案例是文献中第二大的 CPH。 4 不幸的是，多年来局部使用皮质类固醇、类肝素乳膏和他克莫司软膏并没有改善。因此，在征得患者同意接受手术治疗的情况下，在解释可能的风险后，将病灶切除，并从下腹部用全层植皮覆盖（图1b）。术后2年未见复发，令患者满意。随后，我们通过各种角蛋白抗体的免疫染色分析了受影响病灶的增殖和分化之间的平衡。将 10% 福尔马林固定、石蜡包埋的活检标本的脱蜡切片在 10 mmol Là1 柠檬酸盐缓冲溶液（pH 6.0）中于 105°C 高压灭菌 10 分钟，然后根据制造商的方案（Dako，Glostrup，丹麦）使用 EnVision+ 试剂盒进行免疫组织化学染色。受累和未受累皮肤对抗角蛋白（抗 K）1/10 和抗 K5/14 抗体（34bE12；Roche Diagnostics Limited，Burgess Hill，UK）和抗泛角蛋白抗体（AE1/3，Dako）（未显示）的免疫反应性没有显着差异。然而，抗K10抗体（MS-611；Thermo Fisher Scientific Inc.，Waltham，MA，USA）（表皮分化的特异性标志物）的免疫反应性在受影响区域突然下降（图1d）。反之，免疫反应
DEAR EDITOR, Circumscribed palmar or plantar hypokeratosis (CPH) has been regarded as a benign clonal epidermal differentiation or keratinization disorder. 1–3 CPH is characterized by a well-demarcated annular depressed erythematous lesion on the thenar or hypothenar eminences of the palms and sole. Its distinctive histopathological features are an abrupt decrease in the thickness of the corneal layer and hypogranulosis in the affected lesion. 2, 4 Herein we present a case of CPH and also demonstrate a mutually exclusive expression pattern of keratin markers for differentiation and proliferation between the affected and unaffected epidermis. A 64-year-old woman presented with a 5-year history of erythema with a sense of irritation on the left thenar muscle, which gradually extended into the periphery. Physical examination revealed a well-defined, 3.6 9 3.0-cm depressed erythema on the left thenar muscle (Fig. 1a). Microscopic examination of a biopsy specimen showed a ‘sharp step’-like thinning of the corneal and granular layers in the affected skin lesion (Fig. 1c), leading to a diagnosis of CPH. To the best our knowledge, our case was the second largest CPH in the literature. 4 Unfortunately, previous topical administration of corticosteroids, heparinoid cream and tacrolimus ointment for years resulted in no improvement. Therefore, with consent by the patient to undergo surgical treatment, after the possible risk was explained, the lesion was excised and covered with a full-thickness skin graft from the lower abdomen (Fig. 1b). No recurrence was observed 2 years after the surgery, to the patient’s satisfaction.Subsequently, we analysed the balance between proliferation and differentiation in the affected lesions by immunostaining with antibodies to various keratins. Deparaffinized sections of 10% formalin-fixed, paraffin-embedded biopsy specimens were autoclaved in 10 mmol Là1 citrate buffer solution (pH 6.0) at 105 C for 10 min, followed by immunohistochemical staining using the EnVision+ Kit according to the manufacturer’s protocol (Dako, Glostrup, Denmark). There were no marked differences between the involved and uninvolved skin in the immunoreactivity to antikeratin (anti-K) 1/10 and anti-K5/14 antibodies (34bE12; Roche Diagnostics Limited, Burgess Hill, UK) and antipankeratin antibody (AE1/3, Dako)(not shown). However, the immunoreactivity to anti-K10 antibody (MS-611; Thermo Fisher Scientific Inc., Waltham, MA, USA), which is a specific marker for epidermal differentiation, abruptly decreased in the affected area (Fig. 1d). Conversely, the immunoreactivity