Patterson J W
Department of Pathology, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298.
Am J Dermatopathol. 1988 Feb;10(1):1-8. doi: 10.1097/00000372-198802000-00001.
We performed histologic and selected histochemical and immunohistochemical studies on rheumatoid nodules (RN) from 12 patients and lesions of subcutaneous granuloma annulare (SGA) from nine patients. The mean age for patients with RN was 56 years, while that for SGA patients was 19 years. In contrast to those with RN, none of the patients with SGA had arthritis. RN tended to show homogeneous, eosinophilic necrobiosis, giant cells within palisaded foci, and significant stromal fibrosis; while lesions of SGA showed pale, edematous necrobiosis, an absence of giant cells, and lesser degrees of fibrosis. The single most helpful histochemical method was alcian blue, which stained necrobiotic foci in all cases of SGA but in only one case of RN. Epithelioid cells in both disorders stained positively for muramidase. IgM was found in vessel walls in two cases of RN. While the mechanisms of these disorders are not entirely clear, it appears that RN can usually be reliably distinguished from SGA on histologic grounds alone.
我们对12例患者的类风湿结节（RN）以及9例患者的皮下环状肉芽肿（SGA）病变进行了组织学、部分组织化学和免疫组织化学研究。RN患者的平均年龄为56岁，而SGA患者的平均年龄为19岁。与RN患者不同，SGA患者均无关节炎。RN倾向于表现为均匀的嗜酸性坏死、栅栏状病灶内的巨细胞以及显著的间质纤维化；而SGA病变表现为淡染、水肿性坏死、无巨细胞以及较轻程度的纤维化。最有用的单一组织化学方法是阿尔辛蓝，它在所有SGA病例中均能染色坏死病灶，但仅在1例RN中能染色。两种疾病中的上皮样细胞对溶菌酶染色均呈阳性。在2例RN的血管壁中发现了IgM。虽然这些疾病的机制尚不完全清楚，但似乎仅从组织学角度就能可靠地区分RN和SGA。
