Sabato 27 ottobre 2012 - Pacini Editore

COmuNiCaziONi ORali
references
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epithelial and melanocytic populations: a case series and review of
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2 Weedon D. Weedon’s skin pathology. 3rd ed.
3 Cornejo KM, Deng AC. Malignant melanoma within squamous cell
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Granuloma faciale: a possible member of IgG4associated
sclerosing diseases
A.M. Cesinaro, S. Lonardi * , F. Facchetti *
Department of Anatomic Pathology, Azienda Ospedaliero-Universitaria
Policlinico, Modena, Italy, and * Department of Anatomic Pathology, University
of Brescia, Brescia, Italy
Introduction. The pathogenesis of Granuloma Faciale (GF),
an entity framed in the group of cutaneous chronic vasculitides
characterized by mixed inflammatory infiltrate with eosinophils
and plasma cells and perivascular concentric fibrosis 1 , is poorly
understood. The present study investigated whether GF might be
part of the spectrum of IgG4-related sclerosing diseases (IgG4-
RSD) 2 . Cases of Erythema Elevatum Diutinum (EED), a disease
retained to belong to the same group of cutaneous disorders of
GF, were also studied for comparison.
Material and Methods. Thirty-one cases of GF from 18 males
(age range 36 to 80 yrs, mean 53.05), and 7 females (39 to 85
yrs, mean 56.7) (M:F = 2.5:1), and 5 cases of EED (4 females
and 1 male, 38-82 yrs, mean 48.8) were analyzed by immunohistochemistry
for the expression of IgG and IgG4. In addition, the
distribution of Th1, T regulatory and Th2 T-cell subsets, respectively
identified by anti-T-Bet, -FoxP3 and -GATA-3 antibodies,
was also evaluated.
Results. Eight out of 31 biopsies (25.8%) from 6/25 patients
(24%) with GF, fulfilled the criteria for IgG4-RSD. Interestingly,
all these cases were from males (6/18; 33.3%) and four of them
showed recurrent and/or multiple lesions. In additional six cases,
the IgG4/IgG ratio was higher than 40%, but the absolute number
of IgG4/HPF was lower than 50. None of the 5 EED cases
fulfilled the criteria for IgG4-RSD, but in one case the IgG4+
plasma cells were 50/HPF. The distribution of the T-cell subsets
expressing T-bet, FoxP3 and GATA-3 was quite variable, in
general the GATA-3+ lymphocytes were more abundant, but no
relationship with the number of IgG4+ plasma cells was found.
Discussion. GF shares with IgG4-RSD histological and immunohistochemical
features. A pathogenesis related to IgG4+ immunoglobulins
is possible at least in a subset of patients, particularly
males with multiple/recurrent lesions.
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Fig. 1. Histological and immunohistochemical features in a case of Gf
with high content of igG4+ plasma cells. On haematoxylin and eosin (a
and b) a dense nodular inflammatory infiltrate, involving the dermis,
is composed by polymorphonuclear neutrophils and eosinophils,
lymphocytes and plasma cells, and shows focal fibrosis. immunostains
for igG4+ (c) and igG (d) show a high content and percentage of igG4+
plasma cells; the th2, t-reg and th1 t-cell subsets, respectively expressing
Gata-3 (e), foxp3 (f) and t-bet (g) are differently distributed
within the infiltrate, with a moderate prevalence of the Gata-3+ cells.
references
1 LeBoit PE. Granuloma faciale: a diagnosis deserving of dignity. The
American Journal of dermatopathology 2002;24:440-3.
2 Cheuk W, Chan JK. IgG4-related sclerosing disease: a critical appraisal
of an evolving clinicopathologic entity. Advances in anatomic
pathology 2010;17:303-32.