非感染性肉芽腫性皮膚疾患の臨床像と組織学的特徴

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1 非 感 染 性 肉 芽 腫 性 皮 膚 疾 患 の 臨 床 像 と 組 織 学 的 特 徴 要 旨 Annular elastolytic giant cell granuloma ( ) キーワード: Annular elastolytic giant cell granuloma Clinical and Histological Features of Noninfectious Cutaneous Granulomatous Diseases Hiroyuki Okamoto ABSTRACT Abstract. Clinical and histological features of noninfectious cutaneous granulomatous diseases are reviewed, and their relationship with sarcoidosis is discussed.granuloma annulare, necrobiosis lipoidica and rheumatoid nodules are histologically characterized by palisading granulomas. Granuloma annulare and necrobiosis lipoidica are considered to be associated with diabetes mellitus. There have been reports of cases complicating these two palisading granulomas and sarcoidosis, although the pathological relationship is unknown. Annular elastolytic giant cell granuloma is expressed by annular skin lesions on sunexposed areas and histological phagocytosis of elastic fibers within giant cells in the dermis. It has been reported that the disease is complicated with sarcoidosis or seems to be in a spectrum of epithelioid cell granulomatous diseases including sarcoidosis in some cases. Since epithelioid cell granulomas with caseous necrosis was observed in lupus miliaris disseminatus faciei(lmdf), the disorder was originally described as tuberculide. However, LMDF is now considered to be a variant of rosacea. There are cases of LMDF that are difficult to be clinically and microscopically discriminated from cutaneous sarcoidosis. keywords ; Granuloma annulare, Palisading granuloma, Diabetes mellitus, Necrobiosis lipoidica, Annular elastolytic giant cell granuloma, Lupus miliaris disseminatus faciei 関 西 医 科 大 学 皮 膚 科 著 者 連 絡 先 : 岡 本 祐 之 大 阪 府 守 口 市 文 園 町 TEL (3301) FAX Department of Dermatology, Kansai Medical University 15

2 日 サ 会 誌 2000,20(1) 1 はじめに 1) Figure 3 3) 2 環 状 肉 芽 腫 Granuloma Annulare Figure 1 Figure 2 2) a) a) 他 臓 器 病 変 の 皮 膚 表 現 :それによって 悪 性 腫 瘍 や 内 臓 疾 患 の 存 在 を 示 唆 する 皮 膚 症 状 Figure 1 Figure 2 Granuloma annulare showing annularly-arranged eruptions on left hand. Granuloma annulare with a large annular lesion on right forearm. 16

3 3 リポイド 類 壊 死 症 Necrobiosis Lipoidica Figure 3 Histological features of granuloma annulare showing palisading granuloma. Necrobiotic lesion (*) surrounded by epithelioid cells, lymphocytes and multinucleated giant cells (arrowheads). Umbert & Winkelmann 4) 59 BHL Ehrich 5) Harrison & Shuster 6) Kato 7) 8) BHL Figure 4 Umbert & Winkelmann 4) Figure 5 9) 10) Figure 6 Figure 4 Granuloma annulare (arrows) in a patient with sarcoidosis. Figure 5 Necrobiosis lipoidica with multiple brownish plaques on left leg. Figure 6 Necrobiosis lipoidica in a patient with past history of sarcoidosis. 17

4 日 サ 会 誌 2000,20(1) 4 肉 芽 腫 性 口 唇 炎 Cheilitis Granulomatosa, メルカーソン ローゼンタール 症 候 群 Melkersson-Rosenthal Syndrome Figure 7 11) Wiesenfeld 12) 60 Bourgeois-Droin 13) veim 14) 15) 16) Crohn 5 Annular Elastolytic Giant Cell Granuloma Figure 8 actinic granuloma Miescher s granuloma of the face 17) Figure 9 18) Hanke 19) Terui 20) Annular Elastolytic Giant Cell Granuloma Figure 7 Cheilitis granulomatosa with diffuse swelling on perioral areas. Figure 8 Annular elastolytic giant cell granuloma with multiple annular lesions on V region of the chest. 18

5 6 顔 面 播 種 状 粟 粒 性 狼 瘡 Lupus Miliaris Disseminatus Faciei Figure 10 Darouti & Zaher 21) 20% 22) p. acnes 7 その 他 Figure 9 Histological features of annular elastolytic giant cell granuloma. Elastic fibers within a multinucleated giant cell (arrows). Figure 10 Lupus miliaris disseminatus faciei with multiple papules and pustules on periorbital areas. 引 用 文 献 1) Magro CM, Crowson AN, Regauer S : Granuloma annulare and necrobiosis lipoidica tissue reactions as a manifestation of systemic disease. Hum Pathol 1996; 27: ) Okamoto H, Mizuno K, Danno K et al:intraepidermal multinucleated giant cell in sarcoidosis. Acta Dermato- Kyoto 1995; 90: ) 岡 本 祐 之 : 環 状 肉 芽 腫 皮 膚 科 診 療 プラクティス: 皮 膚 病 理 を 読 む 熊 切 正 信 編, 文 光 堂, 東 京 1999; ) Umbert P, Winkelmann RK : Granuloma annulare and sarcoidosis. Br J Dermatol 1977; 97: ) Ehrich EW, McGuire JL, Kim YH : Association of granuloma annulare with sarcoidosis. Arch Dermatol 1992; 128: ) Harrison P, Shuster S : Granuloma annulare and sarcoidosis. Br J Dermatol 1979; 100: ) Kato H, Fujieda Y, Kitajima Y et al : A case of granuloma annulare and sarcoidosis. J Dermatol 1985; 12: ) 藤 田 優, 小 林 まさ 子, 長 尾 啓 一 :サルコイドーシスに 合 併 した 環 状 肉 芽 腫 皮 膚 臨 床 1992; 34;

6 日 サ 会 誌 2000,20(1) 9) 岡 本 祐 之 : 脂 肪 性 類 壊 死 皮 膚 科 診 療 プラクティス: 皮 膚 病 理 を 読 む 熊 切 正 信 編, 文 光 堂, 東 京 1999; ) Gudmundsen K, Smith O, Dervan P et al : Necrobiosis lipoidica and sarcoidosis. Clin Exp Dermatol 1991; 16: ) 岡 野 弘 子, 河 合 修 三, 岡 本 祐 之 : 肉 芽 腫 性 口 唇 炎 の1 例, 倉 敷 中 央 病 院 年 報 1991; 60: ) Wiesenfeld D, Ferguson MM, Mitchell DN et al : Oro-facial granulomatosis--a clinical and pathological analysis. Q J Med 1985; 54: ) Bourgeois-Droin C, Havard S, Granier F et al : Granulomatous cheilitis in two children with sarcoidosis. J Am Acad Dermatol 1993; 29 : ) Shehade SA, Foulds IS : Granulomatous cheilitis and a positive Kveim test. Br J Dermatol 1986; 115: ) Lindelof B, Eklund A, Liden S : Kveim test reactivity in Melkersson-Rosenthal syndrome (cheilitis granulomatosa). Acta Derm Venereol 1985 ; 65 : ) 西 岡 昭 二, 津 田 眞 五, 田 中 克 己 他 :サルコイドーシスにみ られた 肉 芽 腫 性 口 唇 炎. 臨 皮 1995; 49: ) Morita K, Okamoto H, Miyachi Y:Papular elastolytic giant cell granuloma: a clinical variant of annular elastolytic giant cell granuloma or generalized granuloma annulare? Eur J Dermatol 1999; 9: ) Kurose N, Nakagawa H, Iozumi K et al : Systemic elastolytic granulomatosis with cutaneous, ocular, lymph nodal, and intestinal involvement. Spectrum of annular elastolytic giant cell granuloma and sarcoidosis. J Am Acad Dermatol 1992 ; 26: ) Hanke CW, Bailin PL, Roenigk HH Jr : Annular elastolytic giant cell granuloma. A clinicopathologic study of five cases and a review of similar entities. J Am Acad Dermatol 1979; 1: ) Terui T, Tagami H : Annular elastolytic sarcoidosis of the face. Eur J Dermatol 1998; 8: ) El Darouti M, Zaher H : Lupus miliaris disseminatus faciei-- pathologic study of early, fully developed, and late lesions. Int J Dermatol 1993; 32: ) 田 村 智 恵 子, 三 浦 隆 : 皮 膚 サルコイド 結 節 の 形 で 発 症 した 顔 面 播 種 状 粟 粒 性 狼 瘡 の1 例 臨 皮 1996; 50:

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