Grover Disease: A Reappraisal of Histopathological Diagnostic Criteria in 120 Cases
Grover Disease: A Reappraisal of Histopathological Diagnostic Criteria in 120 Cases
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DOI：
10.1097/dad.0b013e3181c80cf9
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发表时间：
2010-08-01
影响因子：
1.1
通讯作者：
Ariza, Aurelio
中科院分区：
文献类型：
--
作者：
Fernandez-Figueras, Maria-Teresa;Puig, Luis;Ariza, Aurelio
格罗弗病（GD）是一种相当常见的丘疹性瘙痒性皮肤病，可以是短暂的，持续的，或无症状。临床疑似病变的显微诊断可能具有挑战性，因为GD可以采用不同的模式，并且通常承认受累的区域大多是灶性的。该疾病的组织病理学特征是棘层溶解，常合并角化不良，使病变外观类似于Darier病、Hailey-Hailey病或天疱疮。湿疹的特征也可以观察到。在对连续120例GD的研究中，我们发现性别和年龄的发病率与之前描述的相似，没有明显的季节影响，但仔细评估其显微镜特征表明，GD的组织病理学诊断标准应该扩大。具体来说，除了常见的GD表现外，我们还发现了角化不全的角化孔样斜柱状病变，病灶呈网状或透镜状轮廓，表皮内水疱病变，基底空泡化和角化不良的地衣样改变，以及角化细胞异型性的不成熟灶。此外，真皮浸润不仅由淋巴细胞和嗜酸性粒细胞混合组成，而且还由中性粒细胞组成。在许多病例中，毛细血管显示血管损伤的迹象，包括由于细胞浆水肿和红细胞外渗引起的内皮肿胀。最后，由于超过50%的病例的受累区域大于2mm，我们应该假设GD病变并不总是像通常声称的那样小。了解本文新描述的模式对于避免GD的漏诊可能是重要的，并且可能有助于了解这种棘层溶解性疾病的发病机制。
Grover disease (GD) is a rather common papular pruritic dermatosis that can be transient, persistent, or asymptomatic. The microscopic diagnosis of clinically suspected lesions can be challenging because GD can adopt different patterns, and involved areas are generally admitted to be mostly focal. The histopathologic hallmark of the disease is acantholysis, frequently combined with dyskeratosis, which confers the lesions an appearance similar to Darier disease, Hailey-Hailey disease, or pemphigus. Eczematous features can be observed as well. In this study of 120 consecutive cases of GD, we have found a sex and age incidence similar to what has been previously described, with no obvious seasonal influence, but careful evaluation of their microscopic features suggests that the histopathological diagnostic criteria of GD should be expanded. Specifically, in addition to the commonly described GD findings, we have detected cases with porokeratosis-like oblique columns of parakeratosis, lesions showing a nevoid or lentiginous silhouette, intraepidermal vesicular lesions, lichenoid changes with basal vacuolization and dyskeratosis, and dysmaturative foci with keratinocyte atypia. Moreover, quite often the dermal infiltrate was composed not only of lymphocytes intermingled with eosinophils, but also of neutrophils. In many cases, the capillary vessels showed hints of vascular damage including endothelial tumefaction due to cyto-plasmatic edema and erythrocyte extravasation. Finally, because involved areas were larger than 2 mm in more than 50% of our cases, we should assume that GD lesions are not always as small as commonly claimed. Awareness of the patterns newly described herein may be important to avoid underdiagnosis of GD and may contribute to understand the pathogenesis of this acantholytic disease.