38-year-old pregnant woman at 30 weeks’ gestation was referred to the dermatology clinic for evaluation of an itchy lesion on her abdomen that had first appeared 9 years earlier and subsequently slowly expanded. The lesion first appeared after the patient had emigrated from Honduras, where she had worked in agriculture. Physical examination of the 15-cm lesion and the histopathological analysis of a skin-biopsy sample are shown. Which of the following is the most likely diagnosis?
一名 38 岁、孕 30 周的孕妇因腹部瘙痒性皮损就诊于皮肤科门诊。该皮损最初出现于 9 年前，此后缓慢扩大。皮损初现时患者刚从洪都拉斯移民至此，她在当地曾从事农业工作。查体可见一处 15 厘米的皮损，皮肤活检样本的组织病理学分析结果如图所示。最可能的诊断是什么？
A. Blastomycosis芽生菌病
B. Chromoblastomycosis着色芽生菌病
C. Cutaneous leishmaniasis皮肤利什曼病
D. Lobomycosis罗博病（瘢痕疙瘩样芽生菌病）
E. Tinea corporis体癣
答案解析：
组织病理学分析显示假上皮瘤样增生，伴真皮内肉芽肿性浸润——符合瘢痕样形态特征；此外可见厚壁、棕色、有隔的孢子，称为砖形细胞（亦称梅德勒小体、硬化小体或铜钱样小体），这是着色芽生菌病的特征性病理表现（pathognomonic）。真菌培养生长出色素性霉菌，镜下可见分隔菌丝，伴有疏松分枝的棒状分生孢子及显著的齿状突起（denticles）。
正确答案：B
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