栅栏状嗜中性粒细胞性及肉芽肿性皮炎

Palisaded neutrophilic and granulomatous dermatitis

目的：分析栅栏状嗜中性粒细胞性及肉芽肿性皮炎（PNGD）的临床及组织病理学特点。方法：采用回顾性分析方法对9例PNGD患者的临床表现及组织病理特征进行分析。结果：9例PNGD患者，其中男3例，女6例，年龄4～72岁，平均34．33岁：病程6个月～10年，平均3．44年。皮损多位于四肢及躯干，临床上呈多形性表现，包括暗红色斑块、结节、环形红斑、丘疹及带状硬斑等。该病组织病理表现为胶原变性，周围组织细胞浸润，伴嗜中性粒细胞及核尘、淋巴细胞和多核巨细胞浸润，其中4例并发白细胞碎裂性血管炎，6例并发结缔组织病。结论：PNGD是一个病理诊断，临床表现为多形性皮损，组织病理亦呈谱系改变，包括白细胞碎裂性血管炎、栅栏状肉芽肿伴胶原变性、嗜中性粒细胞及核尘、晚期纤维化。临床上需注意其可能并发的潜在性系统性疾病的背景。

Objective： To analyze the clinical and histopathological characteristics of palisaded neutrophilic and granuloma- tous dermatitis（PNGD）. Methods： The clinical and histopathologic characteristics of 9 cases of PNGD were analyzed retro- spectively. Results： The mean age of 9 cases（3 male and 6 female） was 34.33 years old, ranged from 4 to 72 years. The average course of the disease was 3.44 years （ranged from 6 months to l0 years）. The lesions were mostly located on the limbs and trunk. The skin lesions were polymorphic including dark red plaques, nodules, annular erythema, papules and in- durated bands. The histopathological findings showed areas of collagen degeneration, and inflammation around the lesions which composed of histiocytes, lymphocytes, multinucleated giant cells, neutrophils and nuclear dust. Four cases showed changes of leukocytoclastic vasculitis and six cases had underlying connective tissue diseases. Conclusions： PNGD is a histopathologic diagnosis, which has a wide array of clinical manifestations. Histopathological examination of PNGD shows a spectrum of changes including leukocytoclastic vasculitis, palisaded granulomas with collagen degeneration, neutrophils and nuclear dust, and dermal fibrosis in the late stage. For the clinicians, it is important to identify the association of PNGD with other underlying systemic diseases.