【摘要】 患者女,53岁,咽部疼痛40 d,口腔黏膜糜烂1个月,肺癌术后12 d。皮肤科检查:双眼结膜充血;口唇糜烂及结痂,舌黏膜、颊黏膜大片糜烂,分泌物较多;会阴部黏膜可见1个黄豆大溃疡面;左侧胸壁可见3个1 cm大手术瘢痕,躯干四肢未见红斑水疱。皮损组织病理:表皮角质形成细胞坏死,可见水疱形成,疱内有棘层松解细胞,基底细胞局灶性液化变性,真皮弥漫炎性细胞浸润。直接免疫荧光:IgA、IgG、IgM、C3阴性;间接免疫荧光:棘细胞间抗体IgG阳性。肺部术后组织病理:(左下)肺浸润性腺癌(腺泡生长为主型伴微乳头型)。诊断:副肿瘤性天疱疮。更多还原

【Abstract】 A 53-year-old female presented with sore throat for over 40 days, oral mucosal erosions for over 1 month and lung cancer resection 12 days before. Physical examination showed conjunctival congestion in her eyes, erosions on her lips with hemorrhagic crusts on the surface, extensive erosions on her tongue and buccal mucosa with large amount of secretion,an ulcer of soybean size on her mucosa of perineum, three surgical scars of 1 cm in diameter on her left chest wall. No erythema or blister could be detected on her trunk and limbs. Histopathological examination revealed necrosis of epidermal keratinocyte, vesicle formation with acantholytic cells, focal liquefaction degeneration of basal cells and diffuse inflammatory cells infiltration in the dermis. Direct immunofluorescence showed no deposition of IgA, IgG, IgM or C3. Indirect immunofluorescence with rat bladder epithelium as substrate detected intercellular IgG antibody. Histopathological examination of the resected tissue revealed lung invasive adenocarcinoma(acinar growth predominant with micropapillary pattern). A diagnosis of paraneoplastic pemphigus was made.更多还原