穿通性环状肉芽肿1例

临床资料 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，病变主要发生于真皮和皮下组织，病理示灶状胶原变性和栅栏状肉芽肿形成。穿通性环状肉芽肿是环状肉芽肿中一种特殊类型，较少见。我科遇到1例报道如下。     

皮下型环状肉芽肿并发斑片型环状肉芽肿1例

皮下型环状肉芽肿(subcutaneous granuloma annulare,SGA)又称深在型环状肉芽肿、假性类风湿结节、渐进性坏死性环状肉芽肿、皮下型栅栏状肉芽肿[1],是一种自限性炎症性皮肤病,好发于儿童,临床少见,且易误诊,并发斑片型环状肉芽肿(patch-type granuloma annulare,PGA)更罕见,现报告我院诊治的1 例如下.     

Disseminated papular granuloma annulare

报告1例播散性丘疹型环状肉芽肿.患者男,61岁.因躯干、四肢起大量粟粒大、无症状的丘疹3年余就诊.组织病理检查显示真皮浅层栅栏状肉芽肿形成,中央有局灶性胶原纤维变性,周围可见组织细胞和淋巴细胞浸润.阿新蓝染色示肉芽肿的中央有阳性物质沉积.该病需与毛囊性扁平苔藓、丘疹型结节病、发疹性汗管瘤、光泽苔藓和毛囊性蕈样肉芽肿等病鉴别.     

脐窝状丘疹性环状肉芽肿4例

环状肉芽肿是以皮内丘疹排列呈环形损害为特征的一种常见皮肤病。各种变异型包括播散型环状肉芽肿,皮下结节型环状肉芽肿,穿通型环状肉芽肿已有报道。本文报道4例脐窝状丘疹性环状肉芽肿。患者为5—9岁的男孩。临床表现为正常肤色脐窝状丘疹,局限于双手背,手指伸侧,组织病理     

环状肉芽肿伴色素减退

报告1例环状肉芽肿伴色素减退。患者女,51岁。双前臂及胸部环状丘疹1年余。皮肤科检查:双上肢前臂、双手背及胸部可见淡红色或褐色环状丘疹及斑块,表面光滑,界限清楚,中央稍凹陷,部分皮损中央可见色素减退斑。皮损组织病理检查:真皮浅层可见灶状胶原坏死灶,周围淋巴组织细胞栅栏状浸润。诊断:环状肉芽肿伴色素减退。     

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。     

非感染性肉芽肿

962631 环状肉芽肿的组织研究/吕玲…//中华皮肤科杂志。-1996,29(1)。-51～52 35例临床和病理检查确诊为环状肉芽肿的组织学研究进一步支持其组织学改变是可变的这一观点。其组织学构型显示由浸润至渐进性坏死乃至肉样瘤样炎症病谱。本组病例中,栅状肉芽肿型多见,占48.6％,此型在局限型环状肉芽肿(LGA)中较泛发型环状肉芽肿(GGA)中为多。本组中未见到上皮样结节型。散在性组织细胞浸润型仅次于栅状肉芽肿型,占40％,在LGA中较GGA中为多。混合型为5.7％,均     

环状肉芽肿

报告1例环状肉芽肿。患者女,79岁。双侧腰、腹部红斑5年。皮肤科检查:双侧腰、腹部可见片状环形大小不等的红色斑疹,界限清楚,部分融合成片状。皮损组织病理检查:表皮角化过度,轻度棘层肥厚,真皮浅中层肉芽肿性炎症呈栅栏状排列,中央可见胶原纤维增粗、变性,真皮内血管周围少量慢性炎性细胞浸润。诊断:环状肉芽肿。     

播散型环状肉芽肿1例

报告播散型环状肉芽肿1例。患者男,54岁。以全身皮肤弥漫性丘疹1年余就诊。全身对称分布环状排列的数个圆滑群集小丘疹,中央皮肤稍凹陷,圆形,米粒大小,孤立或者融合。皮损组织病理示:真皮浅层不规则胶原纤维变性,周围组织细胞和淋巴细胞浸润,呈栅栏状排列在变性胶原纤维周围。诊断:播散型环状肉芽肿。     

儿童泛发型环状弹性组织溶解性巨细胞肉芽肿

报告1例儿童泛发型环状弹性组织溶解性巨细胞肉芽肿.患儿男,13岁.全身红色斑块3年,微痒,日晒后加重,皮损呈环状逐渐向外离心性扩展.皮肤科检查:躯干及四肢泛发指头至双手掌大的不规则环状斑块,边缘红肿隆起,中央萎缩,面部可见散在黄豆至蚕豆大虫蚀状萎缩性斑块.皮损组织病理检查:真皮全层弥漫性以组织细胞、多核巨细胞为主的肉芽肿浸润.弹性纤维染色示肉芽肿浸润部位弹性纤维缺失或仅有少量碎片.诊断:环状弹性纤维组织溶解性巨细胞肉芽肿.     

Eosinophils in the cellular infiltrate of granuloma annulare

Eosinophils have been described in the infiltrates of granuloma annulare, but their frequency, distribution and extent are not well documented. We found eosinophils in 18/45 (40%) cases of granuloma annulare, without significant variation relating to histologic sub-pattern. Eosinophils were seen in over half the cases of deep granuloma annulare and in over one-third of the cases of superficial granuloma annulare. This study demonstrates the lack of specificity of eosinophils in differentiating superficial granuloma annulare from deep granuloma annulare, granuloma annulare from necrobiosis lipoidica, and granuloma annulare from occasional clinical simulants which histologically show eosinophils, such as arthropod bite reactions.     

Granuloma annulare following BCG vaccination

BACKGROUND: Granuloma annulare following BCG vaccination or tuberculin skin tests is rarely reported in the literature. We describe three cases occurring in patients under the age of 6 years. CASE REPORTS: In the first two cases, granuloma annulare was initially localized at the vaccinal site, then generalized. In the third case, diagnosis was deep granuloma annulare localized far from the initial vaccination site, with recurrence following tuberculin test. In the three cases, diagnosis was made on the basis of clinical and histological elements. DISCUSSION: The relationship between granuloma annulare and BCG may seem evident when the eruption occurs at the vaccinal site, but remains difficult to prove. Diagnosis essentially relies on the absence of other classical etiologies and a compatible delay. When a vaccination such as BCG appears to be the cause of granuloma annulare, a possible cause would be injection trauma or a cell-mediated-delayed-hypersensitivity reaction to a specific antigen contained in the vaccine, leading to development of skin disorders such as granuloma annulare in predisposed subjects. Reports of granuloma annulare following BCG are uncommon but the incidence may be underestimated. In practice, diagnosis of granuloma annulare following BCG or tuberculin skin test cannot be established until BCG dissemination infection is ruled out, a necessary clinical and paraclinical step required in all cases of eruptions following this vaccination. Granuloma annulare is a benign complication requiring no treatment and does not constitute a contraindication for other usual vaccinations.     

The granuloma annulare phenotype and tuberculosis

At one time it was believed that granuloma annulare was associated with or even caused by tuberculosis. In the past 50 years, that idea has seemed to be of little more than historic importance. A case is reported of chronic, inadequately treated tuberculosis with erythema induratum in which clinical and histologic lesions compatible with granuloma annulare occurred. Specific antituberculosis therapy caused clearing of the skin lesions. The previous reported cases of granuloma annulare and tuberculosis are summarized. Other systemic diseases reportedly associated with granuloma annulare are noted to emphasize the many possible etiologic relationships. Granuloma annulare may be viewed not as a disease sui generis but as a phenotypic macrophage-granulomatous response to multiple etiologic disease patterns.     

Resolution of disseminated granuloma annulare following isotretinoin therapy

Disseminated granuloma annulare is often a chronic disorder that may prove refractory to treatment and lead to prolonged cosmetic disfigurement. In a patient with disseminated granuloma annulare that was unresponsive to multiple therapeutic regimens, administration of isotretinoin resulted in rapid clearing of nearly all lesions. To our knowledge this is the first reported case in which this agent was used to treat disseminated granuloma annulare.     

Generalized granuloma annulare and drug-induced immunodeficiency

BACKGROUND: Granuloma have already been described in the context of immunosuppression. We report six cases of widespread granuloma annulare occurring in patients with drug-induced immunosuppression. CASE REPORTS: There were four women and two men, with mean age of 61 years (35-76). Three patients were treated with chemotherapy for breast (2 cases) and liver cancer. One woman was given chemotherapy for Hodgkin's disease. One had undergone liver transplantation and was given cyclosporine, another was treated with systemic steroids for polyarthritis. All had generalized non-photoexposed granuloma annulare, composed of multiple erythematous papules, sometimes with annular pattern. The lesions were localized on the trunk, legs and arms. Histopathology revealed granuloma annulare in each patient. DISCUSSION: These six cases suggest a relationship between drug-induced immunodeficiency and generalized granuloma annulare. The immune dysregulation induced by the drugs may have been responsible for the formation of granuloma annulare.     

Granuloma annulare of the photoexposed areas in two liver transplant recipients

BACKGROUND: We report two cases of generalized granuloma annulare occurring in photoexposed areas in two liver transplant recipients. CASE REPORTS: Case 1 was a 65-year-old man who had undergone liver transplantation in 1992. He was given immunosuppressive and antihypertensive therapy. Within 18 months of transplantation, he developed a confluent rash with maculae on sun-exposed areas (neck opening, nape, arms) and sparing the undershirt area. Clinical examination was normal. Skin biopsy revealed a palissade infiltrate located in the middle and upper derma, suggestive of granuloma annulare, with elastophagocytosis patterns (orcein stain and ultrastructure study). Photoexposure granuloma was diagnosed. Case 2 was a 59-year-old man who had undergone liver tranplantation in 1994. He was given immunosuppressive and antihypertensive therapy and developed within 4 months a dark rash on the neck opening and nape, sparing photoprotected areas. Histopathology revealed granuloma annulare. Elastophagocytosis was disclosed by orcein stain and the ultrastructure study. DISCUSSION: This clinical presentation of granuloma annulare in two liver transplant recipients is unusual. We discuss the clinical and histopathological patterns observed in our two cases and the relationships between granuloma annulare and immunosuppression.     

Increased plasma fibronectin in diabetes mellitus, necrobiosis lipoidica and widespread granuloma annulare

The plasma level of fibronectin was measured in patients with granuloma annulare, necrobiosis lipoidica and diabetes mellitus and compared with levels in healthy controls. A significant increase was observed in necrobiosis lipoidica, generalised granuloma annulare and diabetes but not in patients with solitary lesions of granuloma annulare. The possible role of fibronectin in the development of micro-angiopathy is discussed.