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Objective:To analyze the clinical features and reflectance confocal microscopy (RCM) characteristics of vulvar lichen sclerosus (VLS).Methods:RCM examination was carried out in 34 patients who were preliminarily diagnosed as VLS in People's Hospital of Xinjiang Uygur Autonomous Region from January 2018 to June 2019, the results of the various indicators were recorded, and then a histopathological examination was performed at the same site.The RCM image characteristics were analyzed against histopathological manifestations, after that the results were compared and calculated the consistency rate of these image features.Results:The RCM image features of 28 patients with VLS were as follows: the thickness of spinous layer of lesion was thinner than that of surrounding normal skin (epidermis atrophy) in 21 cases (75%); hyper reflectance in basal layer was decreased in 21 cases (75%); In 16 (57.14%)cases, the basal cell ring was absent at the junction of the epidermis, the boundary was blurred, and the infiltration of mononuclear cells and scattered round like large cells in the superficial dermis (liquefaction and degeneration of basal cells); 28 cases (100%) had increased refractive index of superficial dermis (collagen homogenization). The coincidence rates with histopathological examination were 89.29%, 92.86%, 85.71% and 100%, respectively. The sensitivity and specificity of the increase of refractive index in the superficial dermis were the highest, reaching 96.53% and 62.35%. The highest specificity was 92.82% in the presence of epidermal atrophy and the increase of refractive index of superficial dermis.Conclusions:The RCM images of VLS were highly consistent with the histopathological examination.It also has high sensitivity and specificity.Combined with clinical manifestations, it can provide effective help for the diagnosis of vulvar lichen sclerosus and the judgment of therapeutic efficacy.
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Objective To evaluate the application value of confocal laser scanning microscopy(CLSM)in the differentiation between seborrheic keratosis and Bowen′s disease. Methods CLSM was used to observe typical skin lesions in 88 patients clinically diagnosed with seborrheic keratosis and 18 patients clinically diagnosed with Bowen′s disease. Then, tissue specimens were resected from these lesions and subjected to histopathological examination. Results CLSM imaging of seborrheic keratosis lesions showed gyrus?like structures and keratin?filled inclusion cysts in the epidermis with trabecula?like extension of rete ridges in all the 88 cases, basal cells arranged in a cordike or radial pattern in 9 cases, and bright reflective structures in the basal layer and dermis in 6 cases. CLSM imaging of Bowen′s disease lesions revealed disorderly arrangement of large, irregularly shaped atypical cells in some areas in the middle and lower epidermis, and infiltration of scattered mononuclear cells in the superficial dermis. Conclusion CLSM images of seborrheic keratosis are different from those of Bowen′s disease, and CLSM may be helpful for their differential diagnosis.
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Objective To analyze the clonality in Kaposi's sarcoma (KS) lesions by evaluating Xchromosome inactivation pattern in the human androgen receptor (HUMARA) gene.Methods Twenty-five paraffinembedded tissue specimens were collected from female patients with KS (n =15) or cutaneous hemangioma (n =10).DNA was extracted from these specimens,and digested with the methylation-sensitive restriction endonuclease Hpa Ⅱ.PCR was performed to amplify the HUMARA gene,and the amplicons were separated on a 10％ denaturing polyacrylamied gel and stained with ethidium bromide (EB).The loss of heterozygosity of the HUMARA gene was defined as the presence of two DNA fragments before and one fragment after the endonuclease digestion.The clonality in KS lesions was assessed based on the above results.Results Among the 15 patients with KS,13 (86.7％) were heterozygous for the HUMARA gene,of which,92.31％ (12/13) showed loss of heterozygosity of the HUMARA gene on X-chromosome,suggesting a monoclonal origin.Of the 10 patients with hemangioma,9 were heterozygous for the HUMARA gene,and only one lost heterozygosity of the HUMARA gene.The heterozygosity rate for HUMARA gene was significantly different between the patients with KS and hemangioma (P ＜ 0.01).No statistical difference was observed in the clonality status of KS between patients of different nationality,at different stages,or between patients with and without complicated human immunodeficiency virus (HIV) infection (all P ＞ 0.05).Conclusion KS is monoclonal in origin.