{"id":8213,"date":"2020-04-27T15:50:27","date_gmt":"2020-04-27T18:50:27","guid":{"rendered":"https:\/\/doctorhoogstra.com\/es\/wiki\/patologia-del-granuloma-anular\/"},"modified":"2020-04-30T21:27:55","modified_gmt":"2020-05-01T00:27:55","slug":"pathologie-du-granulome-annulaire","status":"publish","type":"wiki","link":"https:\/\/doctorhoogstra.com\/fr\/wiki\/patologia-del-granuloma-anular\/","title":{"rendered":"Pathologie du granulome annulaire"},"content":{"rendered":"<p><\/p><div id=\"ez-toc-container\" class=\"ez-toc-v2_0_88 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Contenu<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Basculer la table des mati\u00e8res\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Basculer<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewbox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewbox=\"0 0 24 24\" version=\"1.2\" baseprofile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 eztoc-toggle-hide-by-default' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/doctorhoogstra.com\/fr\/wiki\/patologia-del-granuloma-anular\/#Histologia-de-granuloma-anular\" >Histologie du granulome annulaire<\/a><ul class='ez-toc-list-level-5' ><li class='ez-toc-heading-level-5'><ul class='ez-toc-list-level-5' ><li class='ez-toc-heading-level-5'><ul class='ez-toc-list-level-5' ><li class='ez-toc-heading-level-5'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/doctorhoogstra.com\/fr\/wiki\/patologia-del-granuloma-anular\/#Patologia-del-granuloma-anular\" >Pathologie du granulome annulaire<\/a><\/li><\/ul><\/li><\/ul><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/doctorhoogstra.com\/fr\/wiki\/patologia-del-granuloma-anular\/#Histologico-variantes-del-granuloma-anular\" >Variantes histologiques du granulome annulaire<\/a><ul class='ez-toc-list-level-5' ><li class='ez-toc-heading-level-5'><ul class='ez-toc-list-level-5' ><li class='ez-toc-heading-level-5'><ul class='ez-toc-list-level-5' ><li class='ez-toc-heading-level-5'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/doctorhoogstra.com\/fr\/wiki\/patologia-del-granuloma-anular\/#Patologia-del-granuloma-anular-subcutaneo\" >Pathologie du granulome annulaire sous-cutan\u00e9<\/a><\/li><\/ul><\/li><\/ul><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/doctorhoogstra.com\/fr\/wiki\/patologia-del-granuloma-anular\/#Manchas-especiales-en-granuloma-anular\" >Taches sp\u00e9ciales dans le granulome annulaire<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/doctorhoogstra.com\/fr\/wiki\/patologia-del-granuloma-anular\/#Diagnostico-diferencial-de-granuloma-anular\" >Diagnostic diff\u00e9rentiel du granulome annulaire<\/a><\/li><\/ul><\/nav><\/div>\n\n<section class=\"textBlock\">\n<h2><span class=\"ez-toc-section\" id=\"Histologia-de-granuloma-anular\"><\/span>\n<span class=\"term\" data-term-id=\"128\">Histologie<\/span> de <span class=\"term\" data-term-id=\"113\">granulome<\/span> Annuler<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>La vue num\u00e9ris\u00e9e de l&#039;histologie du granulome annulaire montre un <span class=\"term\" data-term-id=\"1076\">granulomateux<\/span> <span class=\"term\" data-term-id=\"490\">inflammatoire<\/span> motif situ\u00e9 dans les parties superficielle et moyenne <span class=\"term\" data-term-id=\"61\">derme<\/span>.<\/p>\n<ul>\n<li>Figure 1. Une inspection plus approfondie r\u00e9v\u00e8le une palissade <span class=\"term\" data-term-id=\"858\">histiocytes<\/span> autour d&#039;un foyer <span class=\"term\" data-term-id=\"194\">n\u00e9crobiose<\/span> et augment\u00e9 <span class=\"term\" data-term-id=\"1636\">mucine<\/span> <span class=\"term\" data-term-id=\"370\">d\u00e9claration<\/span>.<\/li>\n<li>Figure 2, Figure 3. Le derme interm\u00e9diaire semble normal. <span class=\"term\" data-term-id=\"736\">Multinucl\u00e9\u00e9<\/span> <span class=\"term\" data-term-id=\"739\">cellules g\u00e9antes<\/span> On les voit fr\u00e9quemment.<\/li>\n<li>Figure 4. Un l\u00e9ger <span class=\"term\" data-term-id=\"228\">p\u00e9rivasculaire<\/span> et <span class=\"term\" data-term-id=\"750\">interstitiel<\/span> <span class=\"term\" data-term-id=\"422\">lymphocytaire<\/span> <span class=\"term\" data-term-id=\"541\">infiltrer<\/span> peut \u00eatre vu dans le derme environnant avec des <span class=\"term\" data-term-id=\"196\"><span class=\"term\" data-term-id=\"442\">neutrophiles<\/span><\/span>  et <span class=\"term\" data-term-id=\"448\">\u00e9osinophiles<\/span>. <span class=\"term\" data-term-id=\"1513\">Plasma<\/span> Les cellules sont rares.<\/li>\n<li>Associ\u00e9 <span class=\"term\" data-term-id=\"753\">vasculaire<\/span> <span class=\"term\" data-term-id=\"850\">fibrine<\/span> d\u00e9p\u00f4t et <span class=\"term\" data-term-id=\"1612\">nucl\u00e9aire<\/span> poussi\u00e8re \u00e9voquant <span class=\"term\" data-term-id=\"1091\">vascularite<\/span> Cela semble \u00eatre une trouvaille rare.<\/li>\n<\/ul>\n<section class=\"textBlock imageLinkBlockTitle\">\n<h5 class=\"colour--primary\"><span class=\"ez-toc-section\" id=\"Patologia-del-granuloma-anular\"><\/span>Pathologie du granulome annulaire<span class=\"ez-toc-section-end\"><\/span><\/h5>\n<\/section>\n<section class=\"imageLinkBlock\">\n<div class=\"flex\">\n<div class=\"imageLinkBlock__item__image\">\n<p>                        <img alt='granulome-annulare1__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingilde0xq-5329658-9821659' src='https:\/\/doctorhoogstra.com\/wp-content\/uploads\/2020\/04\/granuloma-annulare1__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsIngiLDE0XQ-5329658.jpg'>\n<\/div>\n<p class=\"p-small\">Figure 1<\/p>\n<div class=\"imageLinkBlock__item__image\">\n<p>                        <img alt='granulome-annulare2__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-4565482-6872438' src='https:\/\/doctorhoogstra.com\/wp-content\/uploads\/2020\/04\/granuloma-annulare2__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsIngiLDFd-4565482.jpg'>\n<\/div>\n<p class=\"p-small\">Figure 2<\/p>\n<div class=\"imageLinkBlock__item__image\">\n<p>                        <img alt='granulome-annulare3__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-9563710-5436435' src='https:\/\/doctorhoogstra.com\/wp-content\/uploads\/2020\/04\/granuloma-annulare3__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsIngiLDFd-9563710.jpg'>\n<\/div>\n<p class=\"p-small\">figure 3<\/p>\n<div class=\"imageLinkBlock__item__image\">\n<p>                        <img alt='granulome-annulare4__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-1285090-3303108' src='https:\/\/doctorhoogstra.com\/wp-content\/uploads\/2020\/04\/granuloma-annulare4__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsIngiLDFd-1285090.jpg'>\n<\/div>\n<p class=\"p-small\">Figure 4<\/p>\n<\/p><\/div>\n<\/section>\n<div class=\"clearfix imageLinkBlock\"><\/div>\n<h2><span class=\"ez-toc-section\" id=\"Histologico-variantes-del-granuloma-anular\"><\/span>\n<span class=\"term\" data-term-id=\"474\">Histologique<\/span> variantes de granulome annulaire<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><span class=\"term\" data-term-id=\"900\">Sous-cutan\u00e9e<\/span> GA : Dans cette variante, l&#039;infiltrat inflammatoire se situe majoritairement dans le derme profond et s&#039;\u00e9tend dans le tissu sous-cutan\u00e9 (Figure 5, 6). De vastes zones de n\u00e9crobiose peuvent \u00eatre observ\u00e9es ainsi qu&#039;un nombre accru d&#039;\u00e9osinophiles (Figures 7, 8, 9).<\/p>\n<section class=\"textBlock imageLinkBlockTitle\">\n<h5 class=\"colour--primary\"><span class=\"ez-toc-section\" id=\"Patologia-del-granuloma-anular-subcutaneo\"><\/span>Pathologie du granulome annulaire sous-cutan\u00e9<span class=\"ez-toc-section-end\"><\/span><\/h5>\n<\/section>\n<section class=\"imageLinkBlock\">\n<div class=\"flex\">\n<div class=\"imageLinkBlock__item__image\">\n<p>                        <img alt='deepgafigure5__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisinkildi3of0-6816347-9218965' src='https:\/\/doctorhoogstra.com\/wp-content\/uploads\/2020\/04\/DeepGAFigure5__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsInkiLDI3OF0-6816347.jpg'>\n<\/div>\n<p class=\"p-small\">Figure 5<\/p>\n<div class=\"imageLinkBlock__item__image\">\n<p>                        <img alt='deepgafigure6__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-4087218-9120443' src='https:\/\/doctorhoogstra.com\/wp-content\/uploads\/2020\/04\/DeepGAFigure6__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsIngiLDFd-4087218.jpg'>\n<\/div>\n<p class=\"p-small\">Figure 6<\/p>\n<div class=\"imageLinkBlock__item__image\">\n<p>                        <img alt='deepgafigure7__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-4080129-3781180' src='https:\/\/doctorhoogstra.com\/wp-content\/uploads\/2020\/04\/DeepGAFigure7__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsIngiLDFd-4080129.jpg'>\n<\/div>\n<p class=\"p-small\">Figure 7<\/p>\n<div class=\"imageLinkBlock__item__image\">\n<p>                        <img alt='deepgafigure8__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-5765437-4559173' src='https:\/\/doctorhoogstra.com\/wp-content\/uploads\/2020\/04\/DeepGAFigure8__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsIngiLDFd-5765437.jpg'>\n<\/div>\n<p class=\"p-small\">Figure 8<\/p>\n<div class=\"imageLinkBlock__item__image\">\n<p>                        <img alt='deepgafigure9__protectwyjqcm90zwn0il0_focusfillwzi5ncwymjisingildfd-4265961-2141960' src='https:\/\/doctorhoogstra.com\/wp-content\/uploads\/2020\/04\/DeepGAFigure9__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsIngiLDFd-4265961.jpg'>\n<\/div>\n<p class=\"p-small\">Figure 9<\/p>\n<\/p><\/div>\n<\/section>\n<div class=\"clearfix imageLinkBlock\"><\/div>\n<p>Variante mitotiquement active\u00a0: bien que l&#039;activit\u00e9 mitotique typique soit faible, une variante mitotiquement active est reconnue qui pourrait autrement soulever des inqui\u00e9tudes quant \u00e0 un <span class=\"term\" data-term-id=\"895\">prolif\u00e9rative<\/span> <span class=\"term\" data-term-id=\"164\">blessure<\/span>. La prudence est recommand\u00e9e dans ces cas pour exclure <span class=\"term\" data-term-id=\"1667\">\u00e9pith\u00e9lio\u00efde<\/span> <span class=\"term\" data-term-id=\"1665\">sarcome<\/span> comme discut\u00e9 ci-dessous.<\/p>\n<p>GA perforante : on voit ici que l&#039;infiltrat inflammatoire est \u00e9vacu\u00e9 par la <span class=\"term\" data-term-id=\"85\">\u00e9piderme<\/span> \u00e0 travers un canal form\u00e9 entre <span class=\"term\" data-term-id=\"846\">\u00e9pidermique<\/span> descentes.<\/p>\n<p><span class=\"term\" data-term-id=\"67\">Diffus\u00e9<\/span> GA\u00a0: Bien que l&#039;histologie puisse \u00eatre identique \u00e0 celle d&#039;un GA typique, l&#039;infiltrat peut \u00eatre clairsem\u00e9 et retenu dans le <span class=\"term\" data-term-id=\"214\">derme papillaire<\/span>. Le lichen nitidus est parfois \u00e9voqu\u00e9 dans ces cas.<\/p>\n<p>GA interstitiel\u00a0: le mod\u00e8le de faible puissance est diff\u00e9rent, montrant un \u00ab derme occup\u00e9 \u00bb et d\u00e9pourvu de foyers n\u00e9crobiotiques et mucineux. Une puissance \u00e9lev\u00e9e r\u00e9v\u00e8le l&#039;infiltration interstitielle de <span class=\"term\" data-term-id=\"22\">b\u00e9nin<\/span> apparition d&#039;histiocytes. Bien que moins visible, une augmentation de la mucine est souvent observ\u00e9e autour de l&#039;infiltrat inflammatoire. En pr\u00e9sence de nombreux \u00e9osinophiles et de modifications de l&#039;interface, une r\u00e9action m\u00e9dicamenteuse granulomateuse interstitielle doit \u00eatre envisag\u00e9e.<\/p>\n<div id=\"square-placement-country-holder\" class=\"country-dependent advert\">\n<div class=\"box-placement square-placement\">\n<div class=\"advert__frame\">\n<div id=\"dermnet-dermnet-mobbox\">\n<\/div><\/div><\/div><\/div>\n<h2><span class=\"ez-toc-section\" id=\"Manchas-especiales-en-granuloma-anular\"><\/span>Taches sp\u00e9ciales dans le granulome annulaire<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Les taches de mucine telles que le fer collo\u00efdal et le bleu alcian peuvent \u00eatre utilis\u00e9es pour mettre en \u00e9vidence l&#039;augmentation <span class=\"term\" data-term-id=\"43\">tissu conjonctif<\/span> mucines<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Diagnostico-diferencial-de-granuloma-anular\"><\/span>\n<span class=\"term\" data-term-id=\"813\">Diagnostic diff\u00e9rentiel<\/span> granulome annulaire<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>N\u00e9crobiose lipo\u00efde : en couches avec foyers n\u00e9crobiotiques ouverts. Il manque de mucine. Un nombre plus \u00e9lev\u00e9 de plasmocytes peut \u00eatre un indice.<\/p>\n<p>Rhumato\u00efde <span class=\"term\" data-term-id=\"198\">nodule<\/span>: Les changements observ\u00e9s ici ressemblent davantage \u00e0 la variante sous-cutan\u00e9e de l&#039;AG. Les caract\u00e9ristiques discriminatoires observ\u00e9es dans les nodules rhumato\u00efdes comprennent la pr\u00e9sence de zones de <span class=\"term\" data-term-id=\"449\">\u00e9osinophile<\/span> n\u00e9crobiose et absence de d\u00e9p\u00f4t de mucine. Les ant\u00e9c\u00e9dents m\u00e9dicaux sont g\u00e9n\u00e9ralement informatifs.<\/p>\n<p>Sarcome \u00e9pith\u00e9lio\u00efde\u00a0: r\u00e9fl\u00e9chissez toujours \u00e0 deux fois avant de diagnostiquer une AG dans le <span class=\"term\" data-term-id=\"1268\">chiffres<\/span>. Bien que le mod\u00e8le de faible puissance puisse \u00eatre similaire en raison des zones \u00e9osinophiles de <span class=\"term\" data-term-id=\"403\">n\u00e9crose<\/span>, une inspection plus approfondie r\u00e9v\u00e9lera toujours un <span class=\"term\" data-term-id=\"1395\">atypique<\/span> infiltrer. <span class=\"term\" data-term-id=\"1421\">Immunohistochimie<\/span> Elle est d\u00e9finitive dans les l\u00e9sions difficiles qui montrent <span class=\"term\" data-term-id=\"847\">\u00c9pith\u00e9lium<\/span> membrane <span class=\"term\" data-term-id=\"410\">antig\u00e8ne<\/span> (EMA) et <span class=\"term\" data-term-id=\"1614\">Cytokeratin<\/span> (CK) positivit\u00e9.<\/p>\n<\/section>","protected":false},"excerpt":{"rendered":"<p>Histolog\u00eda de granuloma anular La vista de exploraci\u00f3n de la histolog\u00eda del granuloma anular muestra un granulomatoso inflamatorio patr\u00f3n situado dentro de lo superficial y medio dermis. Figura 1. Una&#8230;<\/p>","protected":false},"author":8,"featured_media":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","format":"standard","meta":{"footnotes":""},"categories":[204],"tags":[205],"class_list":["post-8213","wiki","type-wiki","status-publish","format-standard","category-glosario-definiciones","tag-patologia"],"_links":{"self":[{"href":"https:\/\/doctorhoogstra.com\/fr\/wp-json\/wp\/v2\/wiki\/8213","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/doctorhoogstra.com\/fr\/wp-json\/wp\/v2\/wiki"}],"about":[{"href":"https:\/\/doctorhoogstra.com\/fr\/wp-json\/wp\/v2\/types\/wiki"}],"author":[{"embeddable":true,"href":"https:\/\/doctorhoogstra.com\/fr\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/doctorhoogstra.com\/fr\/wp-json\/wp\/v2\/comments?post=8213"}],"version-history":[{"count":0,"href":"https:\/\/doctorhoogstra.com\/fr\/wp-json\/wp\/v2\/wiki\/8213\/revisions"}],"wp:attachment":[{"href":"https:\/\/doctorhoogstra.com\/fr\/wp-json\/wp\/v2\/media?parent=8213"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/doctorhoogstra.com\/fr\/wp-json\/wp\/v2\/categories?post=8213"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/doctorhoogstra.com\/fr\/wp-json\/wp\/v2\/tags?post=8213"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}