Friedman-Birnbaum R, Weltfriend S, Kerner H, Lichtig C
Department of Dermatology, Rambam Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa.
Am J Dermatopathol. 1989 Oct;11(5):429-33.
The histological picture in granuloma annulare (GA) is well defined. The types of infiltrate and the changes in collagen and elastic tissue have been repeatedly described. This is a preliminary study focused on the elastic tissue changes in lesions of generalized GA. Biopsies from four patients were studied. Specimens of involved and uninvolved skin from both exposed and unexposed parts of the body were compared. Changes of actinic elastosis in the papillary dermis in each patient in different stages were observed only in the exposed skin. The typical GA infiltrate was located beneath, in the upper mid-dermis. In the zone of the infiltrate in all specimens--exposed and unexposed--with no regard to the severity of actinic elastotic changes, absence or a marked reduction of elastic material was noted with engulfment of elastic remnants in giant cells. Giant cells with phagocytosis of elastotic material were mostly located on the periphery of the granuloma in the upper as well as in the deeper portion, where elastic fibers were still present. This might support the suggestion that degenerating elastic fibers promote the granulomatous reaction that leads to the formation of granuloma annulare.
环状肉芽肿（GA）的组织学表现明确。浸润类型以及胶原和弹性组织的变化已被多次描述。这是一项初步研究，重点关注泛发性GA病变中的弹性组织变化。对4例患者的活检标本进行了研究。比较了身体暴露部位和非暴露部位受累皮肤与未受累皮肤的标本。仅在暴露皮肤中观察到每位患者不同阶段乳头层真皮中光化性弹性组织变性的变化。典型的GA浸润位于真皮中上部下方。在所有标本（无论暴露与否）的浸润区域，无论光化性弹性组织变性的严重程度如何，均可见弹性物质缺失或显著减少，同时巨细胞吞噬弹性残余物。吞噬弹性组织物质的巨细胞大多位于肉芽肿的外周，在较浅和较深部位，此处仍有弹性纤维存在。这可能支持以下观点，即退化的弹性纤维促进了导致环状肉芽肿形成的肉芽肿反应。
