背景:环状肉芽肿(GA)临床表现多样,多个亚型,病因和发病机制不明。关于儿童GA的现有研究很少。
目的:探讨儿童GA的临床表现与组织病理学的相关性。
方法:收集2017-2022年昆明市儿童医院收治的39例18岁以下临床和病理诊断均为GA的患者。查阅了他们的医疗记录,记录和总结患儿的临床资料,包括性别,年龄,疾病部位,等。检索儿童皮肤病变标本的现有蜡块和病理胶片进行进一步研究和相关组织学检查,包括苏木精-伊红,阿尔辛蓝,弹性纤维(维多利亚蓝-利钦红法),和抗酸染色。最后,儿童的临床表现,组织病理学结果,并对特殊染色特性进行了分析。
结果:儿童环状肉芽肿的临床表现多样:11例表现为单个病灶,25例多发性病变,和3个全身病变。病理分型包括组织细胞浸润,栅栏状肉芽肿,上皮样结节,4、11、9和15例混合类型,分别。39例抗酸染色阴性。Alcian蓝染色阳性率为92.3%,弹性纤维染色为100%。弹性纤维溶解程度与环状肉芽肿病理分型呈正相关(r=0.432,P<0.05)。儿童环状肉芽肿的临床表现与组织病理学分型之间没有相关性。在环状肉芽肿的病理诊断中,弹性纤维染色阳性率高于阿尔辛蓝染色。发现弹性纤维溶解程度与组织病理学分期之间存在相关性。然而,病理分期的差异可能与不同时期环状肉芽肿的病理表现有关。
结论:弹性纤维降解可能是小儿环状肉芽肿发病的关键步骤。这也是针对儿童环状肉芽肿的首批研究之一。
BACKGROUND: Granuloma annulare (GA) has diverse clinical manifestations, multiple subtypes, and unknown etiology and pathogenesis. Existing studies regarding GA in children are scarce.
OBJECTIVE: To examine the correlation between clinical manifestation and histopathology of pediatric GA.
METHODS: A total of 39 patients under 18 years of age with both a clinical and pathological diagnosis of GA at Kunming Children\'s Hospital from 2017 to 2022 were retrieved. Their medical records were consulted, and clinical data of the children were recorded and summarized, including gender, age, disease site, etc. Existing wax blocks of skin lesion specimens of children and pathological films were retrieved for further study and relevant histology, including hematoxylin-eosin, Alcian blue, elastic fiber (Victoria blue-Lichon red method), and antacid staining. Finally, the children\'s clinical manifestations, histopathological results, and special staining characteristics were analyzed.
RESULTS: The clinical manifestations of granuloma annulare in children were diverse: 11 cases presented with a single lesion, 25 with multiple lesions, and 3 with generalized lesions. The pathological typing comprised histiocytic infiltration, palisading granuloma, epithelioid nodular, and mixed types in 4, 11, 9, and 15 cases, respectively. Thirty-nine cases were negative for antacid staining. The positive rate of Alcian blue staining was 92.3%, and that of elastic fiber staining was 100%. The degree of elastic fiber dissolution and granuloma annulare histopathological typing were positively correlated (r = 0.432, P < 0.05). No correlation was found between clinical presentation and histopathological typing of the granuloma annulare in children. In the pathological diagnosis of granuloma annulare, the positive elastic fiber staining rate was higher than that of Alcian blue staining. A correlation was found between elastic fiber dissolution degree and histopathological staging. However, the differences in pathological staging may have been related to the pathological manifestation of granuloma annulare at different periods.
CONCLUSIONS: Elastic fiber degradation may be a critical step in the pathogenesis of pediatric granuloma annulare. This is also one of the first studies focused on granuloma annulare in children.