Knöss M, Krukemeyer M G, Gehrke T, Otto C, Meyer-Scholten C, Otto M, Kriegsmann J
Institut für Pathologie, Trier.
Pathologe. 2006 Nov;27(6):409-15. doi: 10.1007/s00292-006-0865-7.
Rheumatoid granuloma (RG) is histomorphologically defined as a subcutaneous palisading granuloma with central fibrinoid necrosis. Clinically, it presents as a nodule typically localized at pressure points near the joints. From the rheumatic pathological point of view, the main diagnostic challenge is the differentiation of RG from granuloma anulare, especially if clinical information on the site of removal, known diseases, duration of illness, medication and existing American College of Rheumatology (ACR) criteria are missing. Other granulomatous lesions, such as mycobacterial infections, foreign body granulomas, necrobiosis lipoidica or sarcoidosis, can be differentiated from RG by histopathological criteria or by additional examinations such as pathogen specification or PCR. An immunohistochemical marker for the differential diagnosis of granulomas is not yet available. Diagnosis is based on conventional H-E staining, alcian blue-PAS staining, polarizing analysis or PCR. In the following article, the most important granulomatous entities in the differential diagnosis of RG are introduced and the main diagnostic characteristics are discussed.
类风湿性肉芽肿（RG）在组织形态学上被定义为一种伴有中央纤维蛋白样坏死的皮下栅栏状肉芽肿。临床上，它表现为通常位于关节附近压力点的结节。从风湿性病理学角度来看，主要的诊断挑战是将RG与环状肉芽肿区分开来，尤其是在缺少关于切除部位、已知疾病、病程、用药情况以及现有的美国风湿病学会（ACR）标准等临床信息时。其他肉芽肿性病变，如分枝杆菌感染、异物肉芽肿、类脂质渐进性坏死或结节病，可以通过组织病理学标准或通过诸如病原体鉴定或聚合酶链反应（PCR）等额外检查与RG区分开来。目前尚无用于肉芽肿鉴别诊断的免疫组化标志物。诊断基于传统的苏木精-伊红（H-E）染色、阿尔辛蓝-过碘酸雪夫（AB-PAS）染色、偏振分析或PCR。在接下来的文章中，将介绍RG鉴别诊断中最重要的肉芽肿性实体，并讨论其主要诊断特征。
