Lipodermatosclerosis: a clinicopathologic study of 17 cases and differential diagnosis from erythema nodosum
Lipodermatosclerosis: a clinicopathologic study of 17 cases and differential diagnosis from erythema nodosum
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DOI：
10.1111/j.1600-0560.2008.01049.x
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发表时间：
2009-04-01
影响因子：
1.7
通讯作者：
Lee, Julia Y-Y.
中科院分区：
文献类型：
--
作者：
Huang, Tsung-Mao;Lee, Julia Y-Y.
背景：脂皮硬化症(LDS)的临床表现类似蜂窝织炎和各种脂膜炎。方法：回顾分析26例经病理证实的腰椎管瘤的临床病理资料，以更好地描述腰椎管瘤的病理改变。根据临床病理对照，17例确诊为腰椎间盘突出症。由于部分病例表现为结节性红斑样病变，本文对14例结节性红斑样病变的鉴别诊断特征进行了分析。结果：镜下急性LDS病变表现为斑片状出血、脂肪小叶内有脂噬细胞的缺血性脂肪坏死或玻璃化。随着疾病进展到亚急性期和慢性期，真皮的脂膜或膜囊性脂肪坏死、隔膜纤维化和背景静脉淤积变得更加明显。相反，EN表现为轻微的静脉淤滞和膜囊性脂肪坏死。结论：腰椎间盘突出症可能表现为EN样病变。因此，LDS应纳入EN的鉴别诊断。临床病理对照对诊断具有重要意义。急性腰椎间盘突出症与早期肠易激综合征的鉴别比较困难。间隔/小叶脂膜炎、皮下组织出血、脂肪小叶脂噬细胞和/或缺血性脂肪坏死的综合征象有助于急性腰椎病的诊断。脂肪硬化症：17例临床病理研究及与结节性红斑的鉴别诊断.皮肤病理学杂志，2009；36：453-460.(C)2008年布莱克韦尔·芒克斯加德。
Background: The clinical manifestations of lipodermatosclerosis (LDS) may mimic cellulitis and various panniculitides. Methods: To better characterize the histopathologic changes of LDS, we reviewed the clinicopathologic findings of 26 cases with a pathologic diagnosis consistent with LDS. A final diagnosis of LDS was made in 17 cases based on the clinicopathological correlation. As some cases manifested erythema nodosum (EN)-like lesions, 14 specimens of EN were reviewed to identify features for differential diagnosis. Results: Microscopically, the acute LDS lesions were characterized by patchy hemorrhage, ischemic fat necrosis with lipophages or hyalinization in the fat lobules. As the disease progressed to the subacute and chronic stages, lipomembranous or membranocystic fat necrosis, septal fibrosis and background venous stasis in the dermis became more pronounced. In contrast, EN typically displayed minimal venous stasis and membranocystic fat necrosis. Conclusions: LDS may manifest as EN-like lesions. Therefore LDS should be included in the differential diagnosis of EN. Clinicopathologic correlation is essential for diagnosis. Differentiating the acute LDS from the early EN is more difficult. A constellation of the findings of septal/lobular panniculitis, hemorrhage in the subcutaneous tissue, and lipophages and/or ischemic fat necrosis in the fat lobules favors the diagnosis of acute LDS.Huang T-M, Lee JY-Y. Lipodermatosclerosis: a clinicopathologic study of 17 cases and differential diagnosis from erythema nodosum.J Cutan Pathol 2009; 36: 453-460. (C) 2008 Blackwell Munksgaard.