Somach S C, Helm T N, Lawlor K B, Bergfeld W F, Bass J
Department of Dermatology, Cleveland Clinic Foundation, Ohio.
Arch Dermatol. 1993 Sep;129(9):1152-6. doi: 10.1001/archderm.129.9.1152.
We identified several patients with a histologic diagnosis of pretibial myxedema in whom thyroid disease was not found. The purpose of this study was to investigate if histologic characteristics can distinguish between pretibial mucinosis secondary to Graves' disease and that unassociated with thyroid disease.
Biopsy specimens interpreted as compatible with pretibial myxedema were reviewed; these included 12 cases of pretibial mucinosis with documented Graves' disease, and six cases of pretibial mucinosis without evidence of Graves' disease. Ten specimens interpreted as compatible with stasis dermatitis were also evaluated for histologic characteristics, including the possible presence of mucin.
Features that distinguish between pretibial mucinosis associated with Graves' disease and pretibial mucinosis without Graves' disease included preservation of a zone of normal-appearing collagen in the superficial papillary dermis (12/12 with Graves' disease, 0/6 without), mucin deposition in the reticular dermis (12/12 with Graves' disease, 0/6 without), lack of mucin deposition in the superficial papillary dermis (11/12 with Graves' disease, 1/6 without), angioplasia (2/12 with Graves' disease, 6/6 without), and the presence of hemosiderin (2/12 with Graves' disease, 6/6 without). Mucin deposition in the papillary dermis was found in six of 10 specimens interpreted as stasis dermatitis.
There are patients with pretibial mucinosis in whom there is no thyroid disease. Specimens from patients without Graves' disease have features of stasis dermatitis in addition to mucinosis. We conclude that pretibial mucinosis may result from stasis or Graves' disease and that histologic differences allow for accurate differentiation.
我们发现了几例组织学诊断为胫前黏液性水肿但未发现甲状腺疾病的患者。本研究的目的是调查组织学特征是否能够区分格雷夫斯病继发的胫前黏液性水肿和与甲状腺疾病无关的胫前黏液性水肿。
对经解释与胫前黏液性水肿相符的活检标本进行回顾性分析；其中包括12例有记录的格雷夫斯病相关性胫前黏液性水肿病例，以及6例无格雷夫斯病证据的胫前黏液性水肿病例。还对10例经解释与淤积性皮炎相符的标本进行了组织学特征评估，包括是否可能存在黏液。
区分格雷夫斯病相关性胫前黏液性水肿和无格雷夫斯病的胫前黏液性水肿的特征包括：浅表乳头层真皮中保留外观正常的胶原带（格雷夫斯病患者中有12/12例，无格雷夫斯病患者中0/6例）、网状真皮中有黏液沉积（格雷夫斯病患者中有12/12例，无格雷夫斯病患者中0/6例）、浅表乳头层真皮中无黏液沉积（格雷夫斯病患者中有11/12例，无格雷夫斯病患者中1/6例）、血管形成（格雷夫斯病患者中有2/12例，无格雷夫斯病患者中6/6例）以及含铁血黄素的存在（格雷夫斯病患者中有2/12例，无格雷夫斯病患者中6/6例）。在10例经解释为淤积性皮炎的标本中，有6例在乳头层真皮中有黏液沉积。
存在无甲状腺疾病的胫前黏液性水肿患者。无格雷夫斯病患者的标本除黏液性水肿外还具有淤积性皮炎的特征。我们得出结论，胫前黏液性水肿可能由淤积或格雷夫斯病引起，并且组织学差异有助于准确鉴别。
