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경결홍반과 결절홍반의 임상 및 병리학적 비교 연구

Other Titles
 (The) clinical and histopathological study of erythema induratum and erythema nodosum 
Issue Date
1990
Description
의학과/석사
Abstract
[한글] 경결홍반과 결절홍반은 하지에 염증성 결절이 나타나는 질환으로 임상소견이 각기 다른 특징을 갖는다. 그러나 병변이 두질환 모두 주로 하지에 결절로 나타나고 임상적 변형이 있으며, 병리조직학적 소견상 두 질환 모두 급성, 아급성 흑은 만성 지방층염의 양상을 나타내고, 병의 진행 정도와 조직생검 부위에 따라 각 질환의 병리학적 변화도 다양하게 나타나므로 감별진단이 어려운 경우가 많다. 이에 본 연구자는 두 질환의 감별점을 규명하기 위해, 경결홍반 환자 30명과 결절홍반 환자 38명의 임상 및 병리조직학적 소견을 관 찰하여 다음과 같은 결과를 얻었다. 1. 임상적 소견 가. 남녀비는 경결홍반 1:5, 결절홍반 1:4.4로 두 질환 모두 여성에서 호발하였다. 나.발생연령은 경결홍반의 80%가 11세부터 40세까지, 결절홍반의 68%가 21세부터 40세까지 분포하였다. 다. 두 질환의 호발부위는 하지, 상지 순서이며 하지 중 정강이와 장딴지의 발생 빈도는 차이가 없었으며, 모두 병변이 다발성, 대칭으로 발생하였고, 궤양은 경결홍반의 8예(27%)에서있었고 결절홍반에서는 없었다. 결핵과 관련된 경우는 경결홍반 13예중 1예(8%)에서 있었고 결절홍반에서 결핵과 연관된 예는 없었다. 2. 병리조직학적 소견 가. 경결홍반은 소엽성 지방층염과 소엽 및 격벽성 지방층염이 각각 17예(57%), 13예(43%)였고 격벽성 지방층염은 관찰되지 않는 반면, 결절홍반은 격벽성 지방층염이 25예(66%), 소엽성지방층염은 5예(13%), 소엽 및 격벽성 지방층염이 8예(21%)였다. 나. 경결홍반은 30예(100%) 모두 다양한 괴사를 보였고 육아종은 24예(80%)에서 관찰되었으나, 결절홍반에서 괴사는 발견되지 않았고 육아종이 17예(45%)에서 관찰되었다. 다. 진피의 변화는 경결홍반 7예(23%)에서 관찰되었는데 이들은 책상 육아종(palisading granuloma) 소견을 보인 괴사성 육아종이 3예(10%), 육아종만 보인 경우가 2예(7%), 괴사만 보인 경우가 2예(7%)였으며, 이에 반하여 결절홍반에서는 진피내 육아종이나 괴사는 관찰되지 않았다. 라. 지방층의 변화 중 경결홍반의 특징적인 소견은 소엽의 괴사성육아종 24예(80%)로 그 중 책상 육아종이 7예(23%), 지방식 육아종 5예(17%), 결핵결절 6예(20%)였으며, 결절홍반의 가장 특징적인 소견은 염증세포의 침윤을 동반한 격벽 비후 37예(97%)였고, 육아종 17예(45%) 중 지방식 육아종 4예(11%),결핵결절 4예(11%)가 관찰되었다. 마. 혈관의 변화를 관찰한 결과 경결홍반에서 -유두진피내의 모세혈관 증식이 18예(60%)였고 지방층에서 괴사성 혈관염이 20예(67%) 관찰되었는데 , 전 예에서 괴사가 있는 부위에 국한하여 나타났고, 정맥염이 6예(20%) 관찰되었으며, 결절홍반에서는 지방층에서 정맥염이 10예(26%) 관찰되었고 괴사성 혈관염은 관찰되지 않았다. 이상의 결과로 보아 경결홍반과 결절홍반의 감별은 임상적으로는 궤양의 유무가 중요하나 궤양이 동반되지 않은 경우에는 임상적 감별진단이 어렵다. 조직학적으로 경결홍반은 괴사와 괴사성 혈관염을 동반한 소엽성 또는 소엽 및 격벽성 지방층염인 반면 결절홍반은 주로 격벽성 지방층염으로 괴사와 괴사성 혈관염은 동반하지 않는 것이 특징이다. 이에 괴사와 괴사성 혈관염의 소견 여부가 두 질환의 감별진단에 유의한것으로 사료된다. The clinical and histopathological study of erythema induratum and erythema nodosum Un Sun Choi, M.D. Department of Medical Science The Graduate School Yonsei University (Directed by Assistant Professor Soo Ⅱ Chun, M.D.) There are different characteristics in the clinical manifestations of erythema induratum and erythema nodosum which are represented as inflammatory nodules of the panniculus. Their differential diagnosis is often difficult because there are clinical variations, and the histopathologic findings of both show acute, subacute, or chronic panniculitis and vary according to degree of the progression and. the site of biopsy. We investigated the clinical and histopathologic features of 30cases of erythema induratum and 38 cases of erythema nodosum for the purpose of defining the differential findings between them. The results are as follows. A. Clinical features 1. The male to female ratio was 1:5 in erythema induratum and 1:4.4 in erythema nodosum. Both diseases occurred more of ten in females than in males. 2. Eighty percent of erythema induratum patients were between 11 years and 40 years of age, and 68 percent of erythema nodosum patients between 21 years and 40 years. 3. The predilection sites of both diseases were the lower and upper extremities, in that order. No significant difference of incidence was present between the shin and calf. Both diseases were presented as multiple as well as bilateral. Ulcer was observed in eight(27%) cases of erythema induratum but none observed in erythema nodosum. One case(8%) of erythema induratum was associated with pulmonary tuberculosis but none of erythema nodosum was associated wish it. B. Histopathologic findings 1. Erythema induratum showed 17 cases(57%) of lobular panniculitis, 13 cases(43%) of lobular and septal panniculitis and no septal panniculitis. Erythema nodosum showed 5 cases(13%),8 cases(21%) and 25 cases(60%), respectively. 2. Varying degrees of necroses of panniculus were observed in all 30 cases of erythema induratum but not in erythema nodosum. Granulomas were present in 24 cases(8D%) of erythema induratum and 17 cases(45%) of erythema nodosum. 3. Dermal changes were observed in 7 cases(23%) of erythema induratum. Three(10%) of them showed palisading granuloma and necrosis, while two cases(7%) showed only granuloma and two cases(7%) showed only necrosis. There was no dermal change in erythema nodosum. 4. The lobular granuloma and necrosis which was the most common finding of erythema induratum was observed in 24 cases(80%). Among them, seven cases(23%) showed palisading granuloma, five cases(17%) lipophagic granuloma and six cases(20%) tubercle. The most common finding of erythema nodosum was the septal inflammation and thickening which was observed in 37 cases(97%). Among them, four cases(11%) showed lipophagic granuloma and four cases(11%) tubercle. 5. Vascular changes of erythema induraturm affected 18 cases(60%) of capillary proliferation in the papillary dermis, 20 cases(67%) of necrotizing vasculitis located only in severe necrosis and 6 cases(20%) of phlebitis. Erythema nodosum showed 10 cases(26%) of phlebitis and no necrotizing vasculitis, Summarizing the above results, the ulcer is clinically important in differential diagnosis of erythema induratum from erythema nodosum. But in the case where there is no ulcer, it is difficult. Histopathologic findings of erythema induratum are characterized by lobular panniculitis or lobuloseptal panniculitis, necrosis and necrotizing vasculitis and erythema nodosum is characterized by septal panniculitis without necrosis and necrotizing vasculitis. It is suggested that necrosis and necrotizing vasculitis are significant findings to differentiate erythema induratum from erythema nodosum.
[영문] There are different characteristics in the clinical manifestations of erythema induratum and erythema nodosum which are represented as inflammatory nodules of the panniculus. Their differential diagnosis is often difficult because there are clinical variations, and the histopathologic findings of both show acute, subacute, or chronic panniculitis and vary according to degree of the progression and. the site of biopsy. We investigated the clinical and histopathologic features of 30cases of erythema induratum and 38 cases of erythema nodosum for the purpose of defining the differential findings between them. The results are as follows. A. Clinical features 1. The male to female ratio was 1:5 in erythema induratum and 1:4.4 in erythema nodosum. Both diseases occurred more of ten in females than in males. 2. Eighty percent of erythema induratum patients were between 11 years and 40 years of age, and 68 percent of erythema nodosum patients between 21 years and 40 years. 3. The predilection sites of both diseases were the lower and upper extremities, in that order. No significant difference of incidence was present between the shin and calf. Both diseases were presented as multiple as well as bilateral. Ulcer was observed in eight(27%) cases of erythema induratum but none observed in erythema nodosum. One case(8%) of erythema induratum was associated with pulmonary tuberculosis but none of erythema nodosum was associated wish it. B. Histopathologic findings 1. Erythema induratum showed 17 cases(57%) of lobular panniculitis, 13 cases(43%) of lobular and septal panniculitis and no septal panniculitis. Erythema nodosum showed 5 cases(13%),8 cases(21%) and 25 cases(60%), respectively. 2. Varying degrees of necroses of panniculus were observed in all 30 cases of erythema induratum but not in erythema nodosum. Granulomas were present in 24 cases(8D%) of erythema induratum and 17 cases(45%) of erythema nodosum. 3. Dermal changes were observed in 7 cases(23%) of erythema induratum. Three(10%) of them showed palisading granuloma and necrosis, while two cases(7%) showed only granuloma and two cases(7%) showed only necrosis. There was no dermal change in erythema nodosum. 4. The lobular granuloma and necrosis which was the most common finding of erythema induratum was observed in 24 cases(80%). Among them, seven cases(23%) showed palisading granuloma, five cases(17%) lipophagic granuloma and six cases(20%) tubercle. The most common finding of erythema nodosum was the septal inflammation and thickening which was observed in 37 cases(97%). Among them, four cases(11%) showed lipophagic granuloma and four cases(11%) tubercle. 5. Vascular changes of erythema induraturm affected 18 cases(60%) of capillary proliferation in the papillary dermis, 20 cases(67%) of necrotizing vasculitis located only in severe necrosis and 6 cases(20%) of phlebitis. Erythema nodosum showed 10 cases(26%) of phlebitis and no necrotizing vasculitis, Summarizing the above results, the ulcer is clinically important in differential diagnosis of erythema induratum from erythema nodosum. But in the case where there is no ulcer, it is difficult. Histopathologic findings of erythema induratum are characterized by lobular panniculitis or lobuloseptal panniculitis, necrosis and necrotizing vasculitis and erythema nodosum is characterized by septal panniculitis without necrosis and necrotizing vasculitis. It is suggested that necrosis and necrotizing vasculitis are significant findings to differentiate erythema induratum from erythema nodosum.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/117224
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2. 학위논문 > 1. College of Medicine (의과대학) > 석사
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