Lipodermatosclerosis: a clinicopathologic correlation
Lipodermatosclerosis: a clinicopathologic correlation
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DOI：
10.1111/ijd.12856
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发表时间：
2016-03-01
影响因子：
3.6
通讯作者：
Julanon, Narachai
中科院分区：
文献类型：
--
作者：
Choonhakarn, Charoen;Chaowattanapanit, Suteeraporn;Julanon, Narachai
背景：脂质皮肤硬化（LDS）是一种与静脉功能不全相关的慢性纤维化性血管炎。虽然LDS通常是一种临床诊断，但它可能与其他全脂肽混淆。因此，显微镜检查是必要的，以支持诊断在这种情况下。然而，组织病理学改变尚未得到广泛的定义。本研究的目的是表征该疾病与临床表现相关的组织病理学谱。方法回顾性分析25例患者的临床资料和病理组织学表现。结果25例患者中，男女比例为4:1。平均年龄54岁（31 ~ 74岁）。临床表现为急性8例（32%），亚急性12例（48%），慢性5例（20%）。显微镜下的研究大多显示不同程度的血管瘀滞变化，这取决于病变的年龄。早期病变主要表现为脂肪细胞坏死、间隔增厚、红细胞外渗和淋巴细胞浸润。慢性病变主要表现为脂膜性脂肪坏死伴微囊肿形成、皮下组织血管淤积改变和室间隔纤维化。亚急性期和慢性期所有标本均可见铁沉积或含铁血黄素延伸至皮下。结论LDS的诊断仍需临床病理对照。室间隔纤维化、脂膜性脂肪坏死、血管淤积明显改变和红细胞外渗等一系列表现可用于组织病理学定义LDS。有趣的是，对于这种慢性疾病，皮下组织中的铁沉积是一个有用的发现。
BackgroundLipodermatosclerosis (LDS) is a chronic fibrosing panniculitis associated with venous insufficiency. Although LDS is often a clinical diagnosis, it can be confused with other panniculitides. Microscopic examination is therefore essential to support the diagnosis in this condition. Histopathologic changes, however, have not been extensively defined. The purpose of this study was to characterize the histopathologic spectrum of this condition correlated with clinical manifestation.MethodsA total of 25 cases were collected retrospectively, and the clinical information and histopathologic findings were reviewed.ResultsOf 25 patients, the female to male ratio was 4 : 1. The mean age was 54years (range, 31-74years). Clinical features were acute in eight (32%), subacute in 12 (48%), and chronic in five (20%). The microscopic study mostly demonstrated vascular stasis changes of varying degrees depending on the age of the lesion. Adipocyte necrosis with thickened septa, extravasation of erythrocytes, and lymphocytic infiltration were major findings in the early lesions. In the chronic lesion, lipomembranous fat necrosis with microcyst formation, vascular stasis changes in subcutaneous tissue, and septal fibrosis were predominant features. Iron deposition or hemosiderin extending to the subcutaneous layer was always seen in all specimens at the subacute and chronic stages.ConclusionThe diagnosis of LDS still needs clinicopathologic correlation. The constellation of findings including septal fibrosis, lipomembranous fat necrosis, prominent vascular changes of stasis, and erythrocytic extravasation can be used to define LDS histopathologically. Interestingly, iron deposition in the subcutaneous tissue is a useful finding for this chronic condition.