Lupton G P, Kao G F, Johnson F B, Graham J H, Helwig E B
J Am Acad Dermatol. 1985 Feb;12(2 Pt 1):296-303.
Cutaneous mercury granulomas are rarely encountered. Clinically they pose difficulty in diagnosis when there is no clear history of penetrating injury by objects containing metallic mercury. Histologic, chemical, and scanning electron microscopic studies of such cutaneous lesions were performed on four cases from the Armed Forces Institute of Pathology files. Reported cases from the literature were reviewed. Metallic mercury in tissue sections appears as dark, opaque globules, usually spherical in shape and of varying sizes and numbers. A zone of collagen necrosis often surrounds the mercury globules. A granulomatous foreign body-giant cell reaction and a mixed inflammatory cellular infiltrate composed of neutrophils, lymphocytes, histiocytes, plasma cells, and occasional eosinophils are usually present. Epidermal and dermal necrosis, with or without ulceration or pseudoepitheliomatous hyperplasia, is also a common finding. The gold lysis test and energy-dispersive x-ray analysis confirmed the presence of metallic mercury in the tissue. Following cutaneous injury from mercury, systemic toxicity may develop and death may even occur. An approach to clinical management is discussed.
皮肤汞肉芽肿很少见。临床上，当没有明确的含金属汞物体穿透伤病史时，它们在诊断上存在困难。对武装部队病理研究所档案中的4例此类皮肤病变进行了组织学、化学和扫描电子显微镜研究。对文献报道的病例进行了回顾。组织切片中的金属汞表现为深色、不透明的球体，通常呈球形，大小和数量各异。汞球周围常出现胶原坏死区。通常存在肉芽肿性异物巨细胞反应以及由中性粒细胞、淋巴细胞、组织细胞、浆细胞和偶尔的嗜酸性粒细胞组成的混合性炎症细胞浸润。表皮和真皮坏死，伴有或不伴有溃疡或假上皮瘤样增生，也是常见表现。金溶解试验和能量色散X射线分析证实了组织中存在金属汞。汞导致皮肤损伤后，可能会出现全身毒性，甚至可能导致死亡。本文讨论了临床处理方法。
