Coutinho Inês, Pereira Neide, Gouveia Miguel, Cardoso José Carlos, Tellechea Oscar
Department of Dermatology, Coimbra University Hospital, Coimbra, Portugal.
Am J Dermatopathol. 2015 Aug;37(8):614-9. doi: 10.1097/DAD.0000000000000288.
Interstitial granulomatous dermatitis (IGD) is an uncommon granulomatous dermatitis occurring in the setting of highly reactive immune states, with a polymorphic clinical presentation. Because there is overlap with other entities [namely palisading neutrophilic granulomatous dermatitis (PNGD)], controversy exists regarding its classification.
To understand if there are features allowing clear-cut distinction between IGD and PNGD.
Retrospective analysis of 10 cases previously diagnosed as IGD or PNGD, from 2000 to 2013, with review of the histopathologic findings and clinical correlation.
Six females and 4 males presented mostly with erythematous papules/nodules (n = 7) but also with erythematous annular plaques (n = 3). In 2 patients, the lesions coexisted. They were mostly distributed symmetrically on the limbs. Associated disease was observed in 6 patients. Regarding histopathology, an inflammatory infiltrate occupying the superficial and mid dermis was present in 40% of cases, with an interstitial component in all biopsies and a palisaded arrangement in 60%. Neutrophils and mononuclear cells were present in all cases in varying proportions. Necrobiosis was found in 70%, and leukocytoclasia was observed in 80% of biopsies.
Coexistence of the interstitial and palisaded inflammatory patterns occurred in 90% of cases, with no correlation between tissue neutrophilia and the predominant pattern of the infiltrate. There was also no clear-cut correlation between the infiltrate pattern and semiologic aspect of the lesions. Therefore, the features described in our study suggest that IGD and PNGD belong to the same clinicopathological spectrum.
间质性肉芽肿性皮炎（IGD）是一种罕见的肉芽肿性皮炎，发生于高反应性免疫状态下，临床表现多样。由于它与其他疾病实体（即栅栏状中性粒细胞肉芽肿性皮炎（PNGD））存在重叠，其分类存在争议。
了解是否存在能够明确区分IGD和PNGD的特征。
对2000年至2013年期间先前诊断为IGD或PNGD的10例病例进行回顾性分析，复习组织病理学结果并进行临床相关性分析。
6例女性和4例男性主要表现为红斑丘疹/结节（n = 7），但也有红斑环状斑块（n = 3）。2例患者病变共存。病变大多对称分布于四肢。6例患者观察到相关疾病。关于组织病理学，40%的病例存在占据真皮浅层和中层的炎性浸润，所有活检标本均有间质成分，60%呈栅栏状排列。所有病例均有不同比例的中性粒细胞和单核细胞。70%的病例发现有渐进性坏死，80%的活检标本观察到核尘。
90%的病例存在间质和栅栏状炎症模式共存，组织嗜中性粒细胞增多与浸润的主要模式之间无相关性。浸润模式与病变的症状学方面也无明确相关性。因此，我们研究中描述的特征表明IGD和PNGD属于同一临床病理谱系。
