A comparative histopathologic study of generalized and localized granuloma annulare

We have reviewed the morphologic findings in 41 histologic slides of granuloma annulare (GA), 15 from localized (LGA) and 26 from generalized granuloma annulare (GGA). The most common pattern was the histiocytic infiltrative type, more so in cases with LGA than with GGA. The palisading granuloma pattern was present in 21.9% of patients and its prevalence was almost equal in both clinical types. The least prevalent histologic type in all patients taken together was the epithelioid nodule type. However, the prevalence of this type in LGA was equal to that of the palisading type, in contrast to that in GGA where it accounted for only 11.5%. In addition, a mixed histologic pattern was found in greater than 25% of sections from GGA and in only one section from LGA. Periodic acid-Schiff stain revealed hyalinized capillary basement membrane in most of GGA and only in approximately 50% of LGA sections. The variation in prevalence of the different histologic patterns between sections from LGA and GGA, and the difference between our findings and those observed in other series, are discussed.     

Comparative ultrastructural study of generalized and localized granuloma annulare

The dermal changes in four cases of generalized granuloma annulare (GGA) and in four of localized granuloma annulare (LGA) were studied ultrastructurally, and the findings in the two groups were compared. The basic alterations were similar in both types, and showed varied stages of development. The cellular infiltrate was composed mostly of histiocytes. Cell debris was found in all lesions. The degenerative changes affected the collagen fibers, the elastic fibers, and the cellular infiltrate. Of special interest are the following findings in GGA: First, masses of intercellular fibrin material were seen only in the lesions of GGA. Second, thick and multilayered basal lamina around capillaries was apparently more common in the generalized form. These changes may suggest that a more pronounced immune reaction is responsible for the development of the generalized form of the disease.     

HLA antigen frequency in granuloma annulare

The frequency of HLA-A and -B antigens in fifty-nine patients with localized granuloma annulare was compared with the frequency in 200 blood donors. The frequencies of HLA-A29, -B14 and -B15 were increased significantly in the patient group, the increase of HLA-A29 remaining significant after correction for the number of antigens compared.     

HLA antigens in localized granuloma annulare.

HLA antigen frequencies were studied in 46 patients with localized granuloma annulare. The results do not support the hypothesis of an association between this condition and insulin-dependent diabetes mellitus.     

Serum lysozyme in patients with localized and generalized granuloma annulare

Serum lysozyme (Muramidase) levels in patients with localized and generalized granuloma annulare were measured by a turbidometric method. More lysozyme is present in the serum samples of patients with generalized granuloma annulare than patients with the localized form or normal controls. The mean level of patients with generalized disease was 9.27 mg/L compared with 5.96 mg/L for patients with localized disease and 6.8 mg/L for controls.     

泛发型环状肉芽肿1例

1临床资料患者,男,56岁,因全身散发丘疹及环状斑块2月,于2006年2月就诊。患者于2月前发现背部出现淡红色皮疹,呈环形,逐渐增多至躯干和四肢,无     

Erythematous generalized granuloma annulare

Two elderly patients had a distinctive generalized, erythematous form of granuloma annulare. The granulomatous changes were shown to be located superficially in the dermis. One patient had diabetes mellitus and carcinoma of the breast. Both patients had pulmonary emphysema.     

泛发性丘疹型环状肉芽肿一例

患者男,55岁。一年前于背部发现散在正常肤色丘疹,无明显自觉症状,此后, 皮疹逐渐增多,累及整个躯干及四肢。当地医院曾诊断为湿疹、汗管瘤等,给予口服抗组胺药及外用糖皮质激素等治疗无明显疗效。患者有糖尿病史11年,间断用二甲双胍和胰岛素控制血糖,另患高甘油三脂血症8年,未正规治疗。无手术、外伤、食物、药物过敏史,无肝、肾疾病,无结核,无关节肿痛和晨僵,无家族遗传病史。体检：各系统检查未见明显异常,全身浅表淋巴结未触及肿大……     

Photochemotherapy of generalized granuloma annulare

Various forms of treatment for generalized granuloma annulare have been employed with little success. The results of treatment with topical and intralesional corticosteroids, as well as systemic therapy with corticosteroids, salicylates, aspirin, niacinamide, and chloroquine, have been generally disappointing. We describe five patients with generalized granuloma annulare of several years' duration who were treated with oral psoralen plus ultraviolet A irradiation. Lesions were present on the extremities, buttocks, and trunk in the form of macules, papules, and plaques. One patient also had perforating lesions on her thighs. Flattening of the lesions with decreased erythema and pigmentation was noted as early as 1 month after initiation of treatment. Complete clearance was achieved in all patients. Maintenance therapy has been required, resulting in prolonged disease-free intervals. Although the mechanism of action of oral psoralen plus ultraviolet A irradiation in granuloma annulare is unclear, one possibility is selective elimination of the cells that are responsible for initiating the disease.     

Pustular generalized perforating granuloma annulare

We report a 84-year-old man with a 13-year history of recurrent generalized asymptomatic pustular lesions. Histology revealed areas of necrobiosis surrounded by palisading granulomas and transepidermal and follicular elimination of the necrobiotic material. A dense infiltrate of neutrophils was also found. Although 26% of patients with generalized perforating granuloma annulare have some yellow pustule-like papules, these correspond histologically to the yellow viscous necrobiotic material extruding through the epidermis and not to a real neutrophilic infiltrate. This is the first case report of perforating granuloma annulare with recurrent generalized pustular lesions with a dense infiltrate of neutrophils.     

Intracellular elastin in generalized granuloma annulare

This report reviews thirteen cases of generalized granuloma annulare. The light and electron microscopic appearance of intracellular elastin particles in eleven of these cases is described. These bodies were also noted in deep granuloma annulare, elastosis perforans serpiginosa, and a small percentage of localized granuloma annulare. They were not found in necrobiosis lipoidica.     

Elastic tissue changes in generalized granuloma annulare

The histological picture in granuloma annulare (GA) is well defined. The types of infiltrate and the changes in collagen and elastic tissue have been repeatedly described. This is a preliminary study focused on the elastic tissue changes in lesions of generalized GA. Biopsies from four patients were studied. Specimens of involved and uninvolved skin from both exposed and unexposed parts of the body were compared. Changes of actinic elastosis in the papillary dermis in each patient in different stages were observed only in the exposed skin. The typical GA infiltrate was located beneath, in the upper mid-dermis. In the zone of the infiltrate in all specimens--exposed and unexposed--with no regard to the severity of actinic elastotic changes, absence or a marked reduction of elastic material was noted with engulfment of elastic remnants in giant cells. Giant cells with phagocytosis of elastotic material were mostly located on the periphery of the granuloma in the upper as well as in the deeper portion, where elastic fibers were still present. This might support the suggestion that degenerating elastic fibers promote the granulomatous reaction that leads to the formation of granuloma annulare.     

Neutrophil migration in granuloma annulare: comparative study between localized and generalized types and between active and regressive states

In vitro neutrophilic leukocyte (NL) chemotaxis was studied in patients with granuloma annulare (GA). Chemotaxis of NL from patients with the generalized form of the disease (GGA) was compared to that from patients with the localized form (LGA). A similar comparison was also made between patients in the active state of the disease versus those in regression. No significant differences were observed between any of the GA patients' values and a matched control group, nor were the observed differences statistically significant when NL migration was compared in patients with GGA versus LGA or in patients having the active form of the disease as compared to those in regression. In an attempt to detect eventual effects of control sera on patients' NL or of patients' sera on control NL, the sera and leukocytes were cross-reacted in chemotactic assays. The results did not show any effect of crossing sera and cells. Taken together, these data fail to indicate any possible role for NL chemotactic activity in GA.     

Histological and immunohistochemical study of granuloma annulare and subcutaneous granuloma annulare in children

Background:  The aim of this study was to investigate the histological and immunohistochemical features of granuloma annulare (GA) in comparison to deep granuloma annulare (DGA) and granulomatous dermatoses (GDs).
Methods:  Our material comprised 13 GA, 8 DGA and 1 atypical granuloma annulare (AGA) in a child with primary immunodeficiency, 10 cases of nonspecific GDs and 1 case of sarcoidosis with cutaneous involvement. The immunohistochemical streptavidin-biotin-Horseradish peroxidase (HRP) analysis was performed on paraffin sections for the detection of CD68/KP-1, CD68/anti-human CD68 clone PGM1 (PGM1), lysozyme, S-100 protein, CD1a, CD3, CD20/L-26, CD4 and CD8.
Results:  All 13 GA were characterized by typical palisading and interstitial granulomas. In 6 cases, the lesion extended to the subcutaneous fat, while a considerable perivascular lymphocytic infiltrate without any signs of vasculitis was observed in 10 cases. The DGA were located to the deep dermis and subcutaneous fat, showing palisading granulomas with central necrobiosis. Immunohistochemistry revealed a broad intense expression of CD68/PGM1 in the histiocytic population in all cases, a constant but fainter detection of CD68/KP-1 and a variable one of lysozyme. T-cell markers (CD3, CD4 and CD8) were mainly detected in the perivascular lymphocytic infiltrate of GA and DGA, with CD4+ T lymphocytes predominating over CD8+ in GA and DGA, while CD8+ T lymphocytes was the predominant population in AGA.
Conclusions:  CD68/PGM1 is a sensitive and reliable histiocytic marker in confirming the histiocytic nature of equivocal GA and DGA, but the histiocytic immunoprofile is of no particular usefulness in differentiating GA from other GD.