Gibson L E, Reizner G T, Winkelmann R K
Department of Dermatology, Mayo Clinic, Rochester, MN 55905.
J Cutan Pathol. 1988 Feb;15(1):18-21. doi: 10.1111/j.1600-0560.1988.tb00509.x.
The histopathologic findings in 331 cases of necrobiosis lipoidica diabeticorum seen during a 50-year period were reviewed. Three cases showing cholesterol cleft formation were found. All 3 cases were associated with severe diabetes mellitus. The differential diagnosis of importance is necrobiotic xanthogranuloma. Common features included extensive hyaline necrobiosis and foreign-body giant cells. Atypical and Touton-type giant cells are more common in necrobiotic xanthogranuloma. Vascular changes in necrobiotic xanthogranuloma may include granulomatous involvement of muscular walls with thrombosis. Explanations for cholesterol cleft formation are offered. When cholesterol clefts are seen in biopsy specimens of necrobiosis, necrobiotic xanthogranuloma must be ruled out. In addition, when found in necrobiosis lipoidica diabeticorum, these clefts may imply diabetes mellitus with complications.
回顾了50年间所见的331例糖尿病性类脂质渐进性坏死的组织病理学发现。发现3例有胆固醇裂隙形成。所有3例均与严重糖尿病相关。重要的鉴别诊断是渐进性坏死性黄色肉芽肿。共同特征包括广泛的透明样渐进性坏死和异物巨细胞。非典型和图顿型巨细胞在渐进性坏死性黄色肉芽肿中更常见。渐进性坏死性黄色肉芽肿的血管变化可能包括肌壁的肉芽肿性累及伴血栓形成。对胆固醇裂隙形成的原因进行了探讨。当在渐进性坏死的活检标本中见到胆固醇裂隙时，必须排除渐进性坏死性黄色肉芽肿。此外，当在糖尿病性类脂质渐进性坏死中发现这些裂隙时，可能意味着糖尿病伴有并发症。
