皮肤环状肉芽肿5例临床病理分析

Granuloma annulare:clinicopathological features in five cases

目的探讨环状肉芽肿的临床病理特征、诊断及鉴别诊断。方法回顾性分析5例环状肉芽肿患者的临床资料,进行病理观察和组织化学染色研究,并复习文献。结果 5例环状肉芽肿患者均为女童,年龄13～39个月。其中局限型4例,穿通型1例。组织病理学表现为中心部凝固性坏死;周边部胶原纤维渐进性坏死;外周部由放射状排列的淋巴细胞、组织细胞围成栅栏状结构。胶原纤维染色(+),黏蛋白染色阳性。结论环状肉芽肿病因尚不明确,临床表现为一个或多个肉色、红色或紫红色的环状结节,组织学改变以栅栏状肉芽肿最常见。组织病理学检查是明确诊断的依据,必要时行组织化学染色检查。

Objective To investigate clinicopathological characteristics,diagnosis and differential diagnosis of the granuloma annulare（GA）.Methods Clinical and pathological features of 5 children patients with GA were analysed and the literatures were reviewed.Results Age of 5 female children ranged from 13 to 39 months.Four cases were the localised GA and another case was the perforating GA.The histopathological analysis showed the characteristics of the palisaded granuloma.The central area of granulomas exhibited the necrotic tissue with degraded collagen and the periphery was formed by radially palisaded lymphoctes and histiocytes.In all cases,van Gieson staining displayed the degenerative necrobiosis of collagen and the alcian-blue（pH 2.5） staining showed positive mucinous materials,which were mainly in the center of the granulomas.The depositional content of mucinous proteins in the GA was positively correlated with the necrotic content of degraded collagen.Conclusions The etiology of GA is unknown.The skin lesion usually is grouped papules of annular shape with color ranging from flesh-colored to erythematous.The most common feature is the palisading granuloma.For differential diagnosis,histochemistry should be performed.