环状肉芽肿81例临床及组织病理分析

目的了解局限型和泛发型环状肉芽肿临床特点、组织学改变及治疗转归情况。方法回顾性分析2010年1月-2016年12月本科收治的81例皮肤环状肉芽肿患者临床资料。结果局限型环状肉芽肿41例,泛发型环状肉芽肿38例(泛发环形21例,播散丘疹型14例,非典型泛发型3例),皮下型1例,穿通型1例。组织病理改变以栅状肉芽肿多见(占69.14%),散在性组织细胞浸润仅占29.63%,上皮样结节型占1.23%。局限型以避光、局部外用糖皮质激素、冷冻等局部治疗为主,泛发型以系统性治疗为主,如糖皮质激素、复方甘草酸苷片、米诺环素、烟酰胺、雷公藤多苷片、羟氯喹、甲氨蝶呤、维甲酸类和窄谱中波紫外线(NB-UVB)照射均可取得满意疗效,但部分患者停药后皮损易复发。结论泛发型环状肉芽肿成人多发,组织病理学改变以栅状肉芽肿最为多见。局限型以局部治疗为主,泛发型以系统治疗为主。     

泛发型穿通性环状肉芽肿

报告1例皮损广泛分布的泛发型穿通性环状肉芽肿。患者男,52岁。腹部、背部、臀部及四肢泛发红色丘疹3个月。组织病理上可见栅栏样肉芽肿及变性的组织经皮穿出。结合临床和组织病理诊断为泛性型穿通性环状肉芽肿。给予羟氯喹200 mg,每日2次口服,配合外用糖皮质激素制剂治疗,皮损略有好转,但治疗效果不理想。     

阿达木单抗治疗泛发型环状肉芽肿一例并文献复习

［摘要］报道一例使用阿达木单抗治疗泛发型环状肉芽肿并复习相关文献。患者，男，76岁。躯干、四肢泛发型环状红斑、丘疹，境界清楚，组织病理示：表皮轻度增生,真皮内见上皮样肉芽肿,中央胶原纤维变性、坏死,肉芽肿周围组织细胞、淋巴细胞浸润,胶原纤维增生，胶原间散在单一核细胞浸润。诊断为泛发型环状肉芽肿。第0周给予阿达木单抗注射液80 mg皮下注射，第1、3、5、7、9周给予阿达木单抗注射液40 mg皮下注射。随访3个月后患者皮损基本消退、遗留少量色素沉着。     

环状肉芽肿43例分析

目的 探讨局限型、泛发型环状肉芽肿诱发因素、临床、组织学改变及治疗情况。方法 回顾性分析24例局限型及19例泛发型环状肉芽肿患者临床资料。结果 两型中尤其是泛发型中部分患者病情与日晒明显相关。局限型皮损常局限于手、颈后、足背，小丘疹排列成环状，直径1～2cm，最大7cm；泛发型皮损较小，0．5～1cm，常泛发。组织学改变以栅状肉芽肿最多见，占61．9％，散在性组织细胞浸润次之，占38．1％．两者均以局限型较泛发型为多。局限型以避光、局部外用糖皮质激素、冷冻、手术切除为主．必要时口服维生素E、烟酰胺、顽固者口服小剂量氯喹可控制病情。泛发型以系统用药为主，氯喹、氨苯砜、糖皮质激素及异维A酸可取得满意疗效，但部分停药后易复发。结论日光照射可能在泛发型环状肉芽肿发病中起着一定的作用；组织学改变以栅状肉芽肿最多见；局限型以局部治疗为主，泛发型以系统治疗为主。     

泛发型环状肉芽肿2例

环状肉芽肿是以环状丘疹或结节性损害为特征的慢性皮肤病,其中泛发型环状肉芽肿临床较少见。本文报道2例女性泛发型环状肉芽肿病例,皮损表现为躯干四肢弥漫的丘疹、环状斑块。甲状腺功能、EB病毒及巨细胞病毒抗体、血糖血脂检查均未见异常。组织病理表现为真皮浅中层栅栏样肉芽肿形成,中央结缔组织变性,周围上皮样细胞,多核巨细胞及淋巴组织细胞浸润。     

播散型环状肉芽肿1例

报告1例泛发性环状肉芽肿。患男性，60岁，全身出现泛发性顶部扁平的红色丘疹，由头面部逐渐泛发全身，丘疹互相融合形成环状红斑。组织病理可见真皮浅层栅栏状肉芽肿改变，周围组织细胞、淋巴细胞浸润，呈栅栏状排列于变性胶原纤维周围。     

类脂质渐进性坏死并发2型糖尿病一例

21岁女性患者,双侧胫前无痛性红褐色斑块4年。空腹血糖14.86mmol/L,尿糖3+,尿酮体1+。皮损组织病理示真皮全层上皮样细胞浸润与变性的胶原纤维交替出现,部分血管周围密集淋巴细胞浸润。诊断:(1)类脂质渐进性坏死;(2) 2型糖尿病。治疗:二甲双胍和降糖片治疗糖尿病;硫酸羟氯喹0.2 g每日1次口服。氟芬那酸丁酯软膏适量外用。随访6个月,血糖控制平稳,皮损明显消退。     

泛发性环状肉芽肿1例

患者女,52岁,躯干、四肢出现红色环状浸润性斑块伴痒痛2年。皮损组织病理示：表皮基本正常,真皮内多处灶性胶原纤维变性,周围有淋巴细胞、组织细胞浸润,呈栅栏状排列,有极少量多核巨细胞浸润。诊断：泛发性环状肉芽肿。     

儿童线状硬皮病伴泛发型环状肉芽肿1例

患儿男,4岁。右侧额部皮肤萎缩凹陷3个月,2个月后全身出现散发丘疹。腹部丘疹组织病理示:真皮血管周围、胶原间散在淋巴细胞、组织细胞浸润,可见多核巨细胞。诊断:线状硬皮病伴泛发型丘疹性环状肉芽肿。     

斑片型环状肉芽肿1例

患者女,35岁。右大腿无症状红色斑片半年。皮损组织病理表现为真皮内组织细胞和淋巴细胞构成的非典型肉芽肿改变,阿申兰染色示胶原纤维间黏蛋白沉积。诊断:斑片型环状肉芽肿。外用糠酸莫米松软膏2个月后皮疹好转。     

成人泛发性环状肉芽肿1例

患者女,57岁。全身出现散在环状或半环状红色浸润性斑块1年。皮损组织病理示:真皮浅层胶原纤维变性及肉芽肿形成;弹力纤维染色示:有少量弹力纤维断裂。阿新蓝染色示:胶原束间见嗜碱性黏液性物质沉积。诊断:泛发性环状肉芽肿。     

Annular Elastolytic Giant Cell Granuloma: Response to Cyclosporin A

A case of annular elastolytic giant cell granuloma with a good response to cyclosporin A is reported. A 62-year-old man developed multiple annular patches on the trunk with elevated and indurated borders. Biopsy specimens from the border showed granulomatous inflammation in the mid dermis with phagocytosis of elastic fibers by giant cells. Biopsy specimens from the center showed dense collagen formation without inflammation. Immunological investigation of perivascular infiltrating cells in the lesions revealed a predominance of CD4+ cells over CD8+ cells. Our case showed a good response to cyclosporin A (5 mg/kg/day) for eight weeks. There were no adverse effects and no recurrences for one month after discontinuation of cyclosporin A.     

The interstitial granulomatous drug reaction: a distinctive clinical and pathological entity

We present 20 patients in whom drug therapy was associated with interstitial histiocytic infiltrates with variable degeneration of collagen and elastic fibers mimicking early lesions of granuloma annulare (GA). Most patients had a reproducible clinical presentation comprising erythematous-to-violaceous, nonpruritic plaques, often with an annular pattern, predominantly involving inner aspects of the arms, medial thighs and intertriginous areas. The most frequent clinical differential diagnoses inchided cutaneous T cell lymphoma, erythema annulare centrifigum (EAC), GA, and lupus erythematosus. A drug reaction was suspected in only 3 cases. The implicated drug classes included calcium channel blockers, angiotensin converting enzyme inhibitors, beta-blockers, lipid-lowering agents, antihistamines, anticonvoilsants and antidepressants. Patients were often on two or more of these drugs; all have been associated with pseudolymphomatotis infiltrates of the skin, the presumptive basis of which is iatrogenic pertubation of immune function. The defining histomorphology was diffuse infiltration of the interstitium by lymphocytes and histiocytes with piecemeal fragmentation of collagen and elastic fibers in concert with a vacuolar interface dermatitis. Ten cases showed intermediate and transformed lymphocytes with hyperchromatic convoluted nuclei disposed interstitially within the dermis or along the dermoepidermal junction with variable epidermotropism. In the 15 patients who discontinued the implicated drug, lesional resolution occurred. We propose the designations interstitial granulomatous drug reaction for this novel cutaneous reaction pattern.     

Annular elastolytic giant cell granuloma

We treated a 13-year-old girl who had annular erythematous lesions with central atrophic areas, which had been present on her trunk and limbs for 4 months. Histological examination revealed patchy dermal lymphohistocytic infiltration with multinucleated giant cells which were phagocytosing elastic fibers, causing them to disappear. The active border of the lesions regressed after intradermal injection of corticosteroids. The classification of the disease and its differential diagnosis from the usual granuloma annulare, inflammatory anetoderma, O'Brien's actinic granuloma, and Convit's disease are discussed.     

Treatment of generalized granuloma annulare – a systematic review

Granuloma annulare (GA) is a benign inflammatory skin disease. Localized GA is likely to resolve spontaneously, while generalized GA (GGA) is rare and may persist for decades. GGA usually is resistant to a variety of therapeutic modalities and takes a chronic course. The objective of this study was to summarize all reported treatments of generalized granuloma annulare. This is a systematic review based on MEDLINE, Embase and Cochrane Central Register search of articles in English and German and a manual search, between 1980 and 2013, to summarize the treatment of generalized granuloma annulare. Most medical literature on treatment of GGA is limited to individual case reports and small series of patients treated without a control group. Randomized controlled clinical studies are missing. Multiple treatment modalities for GGA were reported including topical and systemic steroids, PUVA, isotretinoin, dapsone, pentoxifylline, hydroxychloroquine, cyclosporine, IFN‐γ, potassium iodide, nicotinamide, niacinamide, salicylic acid, dipyridamole, PDT, fumaric acid ester, etanercept, infliximab, adalimumab. While there are numerous case reports of successful treatments in the literature including surgical, medical and phototherapy options, well‐designed, randomized, controlled clinical trials are required for an evidence‐based treatment of GGA.     

Generalized elastophagocytic granuloma.

The case of an eighty-three-year-old woman with the sudden onset of a generalized pruritic eruption is reported. The skin lesions resembled disseminated subacute lupus erythematosus on clinical examination, but actinic granuloma or annular elastolytic giant cell granuloma was seen in biopsy specimens of the lesions. Our case was differentiated from generalized granuloma annulare by the distinct zoning of elastolysis and the distribution of giant cells.