每日一题_2023.03.09

A 30-year-old woman presented with a 3-month history of progressive skin lesions on her face. On physical examination, there were hyperpigmented, yellow, papillomatous papules and plaques on the face (left). Hyperpigmented velvety plaques were also seen on the skin of the neck, groin and axillae. She also reported new-onset heartburn, fatigue, and unintentional 15-kg weight loss. A skin biopsy of the facial lesion showed epidermal papillomatosis, acanthosis, hyperkeratosis, and negative staining for human papillomavirus. A computed tomography (CT) of the abdomen and pelvis was performed (right). What is the most likely diagnosis?

患者女，30岁，面部皮损进行性加重3个月。查体:面部色素沉着、黄色、乳头状丘疹和斑块(左)。颈部、腹股沟、腋窝皮肤可见色素沉着的天鹅绒状斑块。患者还报告了新发胃灼热、疲劳和非故意的体重减轻15 kg。面部病变的皮肤活检显示表皮乳头状瘤病、棘层肥厚、角化过度，人乳头瘤病毒染色阴性。进行了腹部和盆腔计算机断层扫描(CT)(右)。最有可能的诊断是什么?

A. Erythrasma 红癣

B. Ichthyosis hystrix 鱼鳞癣

C. Malignant acanthosis nigricans 恶性黑棘皮病

D. Pellagra (Vitamin B3 deficiency) 糙皮病(维生素B3缺乏)

E. Pemphigus vegetans 天疱疮素食者

答案解析：

正确答案是恶性黑棘皮病是一种副肿瘤性皮肤病，涉及皮肤和粘膜表面突然出现天鹅绒般的斑块。 与良性黑棘皮病相比，这些变化更为广泛且恶化速度更快。 腹部和盆腔CT显示胃体增厚，右侧卵巢有实性肿块。 胃活检显示富含粘蛋白的印戒细胞胃腺癌，证实了胃腺癌伴卵巢转移的诊断。

正确答案：C