【医学生物课件】高雄长庚医院皮肤科.ppt

医术是一切技术中最美和最高尚的。 ------希波克拉底 专业分享●▂●敬请收藏 Actinic Granuloma(Annular Elastolytic Giant Cell Granuloma) -Report of A Case- 高雄長庚醫院皮膚科 陳毅書 郭宏文 何宜承 Case Report A 53 y/o male patient, with multiple erythematous to brownish , annular shaped plaques Site: forehead, neck, v-chest, bil dorsal hands (sun-exposure area) Size: about 3?5cm in diameter Number: total 8 ?10 Combined S/S: (-) Case Report Clinical Impression R/O Granuloma annulare , R/O sarcoidosis, R/O leprosy Skin biopsy (89/04/12) HE stain , Verhoeff-van Gieson stain Diagnosis Actinic Granuloma (Annular Elastolytic Giant Cell Granuloma) Discussion Actinic Granuloma (Annular Elastolytic Giant Cell Granuloma) History 1967 Dowling et al : atypical (annular) necrobiosis lipoidica of the face and scalp 1973 Mehregan et al : Miescher’s granuloma of the face 1975 O’Brien : Actinic Granuloma 1979 Hanke et al : Annular Elastolytic Giant Cell Granuloma Clinical Features Sex : female predominant Age of onset: middle to old age ( 30 ?40y/o) Etiology: unknown, may be due to the “ cell-mediated immune response to weakly antigenic determinants on actinically altered elastotic fibers” Clinical Features (Skin lesion) Single or multiple, asymptomatic, erythematous to brownish , annular to serpinginous plaques, with slowly centrifugal progression Size: millimeters to centimeters Site: sun-exposure area : forehead, neck, v-chest, extensor site of extremities covered area: abdomen, back (case report) Histopathological Findings Elevated border: granulomatous infiltration , histiocytes in a palisade of interstitual pattern. multinucleated giant cell , elastotic fibers adjacent to and within the giant cells. Asteroid body Mucin : (-) Histopathological Findings Central Zone: near or total absence of elastic fibers (Verhoef-van Gieson stain) collagen: scarlike appearance, slightly The zone peripheral to the annulus: increase amount of thick elastotic metarial with the staining properties of elastic tissue Differential Di