Ziemer Mirjana, Koehler Martin Johannes, Weyers Wolfgang
Department of Dermatology, Venereology, and Allergology, University Hospital of Leipzig, Leipzig, Germany.
J Cutan Pathol. 2011 Nov;38(11):876-83. doi: 10.1111/j.1600-0560.2011.01760.x. Epub 2011 Aug 23.
As the sequential inflammatory changes are the same in erythema elevatum diutinum (EED) and granuloma faciale (GF), histopathologic distinction may be difficult.
All available cases from 1998 to 2009 with the diagnosis of EED and GF were collected and reviewed, both clinically and histopathologically. Nine cases of EED and 41 cases of GF were reviewed in a blinded fashion using a checklist of 26 histopathologic criteria.
Only four of the evaluated criteria showed differences between GF and EED. High density of the infiltrate was noted in 97% of cases of GF but only in 56% of cases of EED. Eosinophils were the predominant cell type in 59% of cases of GF but in none of the cases of EED. Plasma cells were more frequent in GF (64%) than in EED (22%), and granulomas were never found in GF but in 22% of EED. A zone of perijunctional sparing (Grenz zone) was observed in about three quarters of the cases in both the groups.
The histopathology of GF and EED is very similar and overlapping. The presence of a Grenz zone and patterned fibrosis does not distinguish the two diseases. However, granulomatous nodules are only seen in EED, and a predominance of eosinophils in the infiltrate favors a diagnosis of GF.
持久性隆起性红斑（EED）和面部肉芽肿（GF）的系列炎症变化相同，组织病理学鉴别可能困难。
收集并回顾1998年至2009年所有诊断为EED和GF的病例，进行临床和组织病理学检查。采用包含26项组织病理学标准的清单，以盲法回顾了9例EED和41例GF病例。
仅4项评估标准显示GF和EED之间存在差异。97%的GF病例可见高密度浸润，但EED病例中仅56%可见。59%的GF病例中嗜酸性粒细胞为主要细胞类型，而EED病例中均未发现。GF中浆细胞更常见（64%），而EED中为22%，GF中从未发现肉芽肿，而EED中有22%可见。两组中约四分之三的病例观察到交界周缘保留区（无浸润带）。
GF和EED的组织病理学非常相似且有重叠。无浸润带和模式化纤维化的存在并不能区分这两种疾病。然而，肉芽肿性结节仅见于EED，浸润中嗜酸性粒细胞占优势有利于GF的诊断。
