Burnstine M A, Headington J T, Reifler D M, Oestreicher J H, Elner V M
Department of Ophthalmology, W. K. Kellogg Eye Center.
Arch Ophthalmol. 1994 Dec;112(12):1590-3. doi: 10.1001/archopht.1994.01090240096032.
We describe the two oldest individuals with nodular granuloma annulare (pseudorheumatoid nodules) in the ophthalmologic literature and propose a unified classification scheme that recognizes pseudorheumatoid nodules to be granuloma annulare, nodular type. All lesions in both cases revealed so-called necrobiotic granulomas, characterized by an acellular central area containing mucin (hyaluronic acid) surrounded by palisading histiocytes (macrophages), diagnostic of granuloma annulare. These features are identical to those reported in the ophthalmologic and older general pathology literature as pseudorheumatoid nodules and the contemporary general and dermatologic pathology literature as granuloma annulare. We believe the diagnosis of nodular granuloma annulare should be employed for necrobiotic lesions displaying distinctive clinicopathologic features to unite the ophthalmologic, general, and dermatologic pathology literature. Granuloma annulare, nodular type, must also be considered in the differential diagnosis of ocular and periocular lesions at any age.
我们描述了眼科文献中两名患有结节性环状肉芽肿（假类风湿结节）的年龄最大的患者，并提出了一种统一的分类方案，该方案将假类风湿结节认定为结节型环状肉芽肿。两例患者的所有病变均显示出所谓的坏死性肉芽肿，其特征为无细胞的中央区域含有粘蛋白（透明质酸），周围有栅栏状组织细胞（巨噬细胞），这是环状肉芽肿的诊断依据。这些特征与眼科及早期普通病理学文献中报道的假类风湿结节以及当代普通病理学和皮肤病理学文献中报道的环状肉芽肿相同。我们认为，对于具有独特临床病理特征的坏死性病变，应采用结节性环状肉芽肿这一诊断名称，以统一眼科、普通病理学和皮肤病理学文献。在任何年龄段的眼部和眼周病变的鉴别诊断中，也必须考虑结节型环状肉芽肿。
