Inguinal granuloma
Introduction
Introduction to inguinal granuloma Granulomainguinale (granulomainguinale) is a chronic, mildly contagious sexually transmitted disease caused by Clostridium granulomatosis, which appears as a small round body in the mononuclear cells of infected tissues. Donoyanbody, this disease is also called Donovanosis. It is a chronic infectious disease characterized by granulation tissue hyperplasia plaques, anal and vulva at the site of good hair, forming painless ulcers, and can be inoculated by itself. basic knowledge The proportion of illness: 0.03% Susceptible people: more common men Mode of infection: non-infectious Complications: squamous cell carcinoma
Cause
Inguinal granulomatosis
Pathogen infection (98%)
In addition to sexual intercourse, it can also be transmitted by yin, so it is a chronic infectious disease. In addition to the genitals and thighs, it can also invade the face and back. It is worthy of vigilance.
Pathogenesis
Clostridium granulomatosis is only pathogenic to humans. Pathogens first form a slow-moving papule or subcutaneous nodule at the site of invasion, and then form ulcers, involving surrounding tissues. The pathological basis is the infiltration of a large number of inflammatory cells.
Prevention
Inguinal granuloma prevention
Adhere to regular treatment, avoid halfway, when the treatment is completed, go to the hospital for review or evaluation. If symptoms persist or recur, you should go to the hospital immediately, avoid sexual contact before using the patient and his sexual partner, and use condoms. Contraceptive tools, the patient's sexual partner should also insist on examination and treatment.
1) A sexual partner of a patient with inguinal granulomatosis should be examined and treated if they have had sexual contact with the patient within 60 days of the patient's symptoms.
2) Prevent unfair sexual behavior and avoid unclean sexual intercourse.
Complication
Inguinal granulomatous complications Complications squamous cell carcinoma
After-effects: due to lymphatic blockage, external genitalia such as labia, clitoris, penis, scrotum, etc. may be pseudo-skin disease, or may cause urethra, vagina, anus, etc. due to scars and adhesions, and may also cause cancer and cause genital mutilation. As a result of scar formation, it can lead to obstruction of the lymphatic vessels, causing elephantiasis of the penis, scrotum and female genitals. It can also cause urethral, vaginal, rectal or anal stenosis due to scar formation and tissue adhesion, due to ulcers and fistula scars, etc. Long-term unhealed, can be complicated by squamous cell carcinoma.
Symptom
Inguinal granulomatosis symptoms Common symptoms Papular lymph nodes enlargement pigmentation purulent discharge subcutaneous nodular granuloma
1. Incidence: more common in men, male to female ratio of 2 to 3:1, more common in sexually active ages of 20 to 45 years old.
2. Incubation period: It can cause transmission due to repeated contact, so the incubation period is uncertain, which is 8 to 80 days.
3. The predilection site: the damage is mostly in the external genital area. Men are more common in the foreskin, coronary sulcus, ligament, glans and penis. Women are more common in large, labia minora, ligament, perineum, cervix, etc. Visible in the perianal area, homosexuals are particularly common, through the blood and lymphatic pathways can also be to the nose, lips, oropharynx, limbs, chest, abdomen, buttocks, internal organs such as the colon, liver, kidney, etc., epididymis, bone marrow, bones, Joints such as the eyelids, the tibia, the clavicle, and the ankle joint spread.
4. Characteristics of skin lesions: The initial damage is painless in the external genital area, dark red moist small papules, gradually develop into subcutaneous nodules about 0.5cm in diameter, and the nodules can be ulcerated to form ulcers, such as mixed with fusiform Infection, the tissue can rapidly develop necrosis, the ulcer continues to develop, the base can form a proliferative beef red velvet granulation tissue, the quality is hard, the edge is uplifted, it is sputum-like, the bleeding is easy to touch, the surface is serous and purulent secretion There is stench, such as neglecting treatment, ulcers increase and deepen over a long period of time, can affect the urethra, anus, etc., severe destruction of the tissue can form a fistula, prolonged unhealed, and finally due to fibrous tissue hyperplasia, the formation of hypertrophic scar-like bulge However, it has not healed, and the pathogens can be found in the pigmentation, ulcers, granulation tissue and scar tissue. Due to self-inoculation, there may be scattered small satellite-like ulcers around the lesion.
5. Whole body dissemination: About 6% of patients spread to other parts of the body through blood or lymphatic channels, such as the skin of the face, mouth, chest, lower abdomen and buttocks, and can also spread to the liver, colon or epididymis and other organs.
6. Complications: due to scar formation, it can lead to obstruction of lymphatic vessels, causing elephantiasis of the penis, scrotum and female genital area. It can also cause urethral, vaginal, rectal or anal stenosis due to scar formation and tissue adhesion. Ulcers and fistula scars and other long-term unhealed, can be complicated by squamous cell carcinoma.
7. False diaphragm: occurs in the lower part of the inguinal skin granuloma local swelling, but non-lymph node enlargement, it is called pseudobubo (pseudobubo), can also develop into granulomatous ulcer, long-term unhealed.
8. Course of disease: The disease is slow, can be extended for several years or even ten years, can not self-heal, rapid development during pregnancy, a small number of advanced patients can be malignant, squamous cell carcinoma.
Examine
Inspection of inguinal granuloma
1. Histopathological examination: It is a reliable method for diagnosing this disease. From the edge of active lesions, HE staining shows that the epidermis is keratinized, the granular layer disappears, the acanthosis is thick, the sponge forms and the pseudoepithelial neoplasia, There may be atrophy and/or ulceration in the central area of the lesion. Polymorphonuclear leukocytes move outward in the acanthite hypertrophy area, forming a focal small abscess. The characteristic histological changes are diffuse in the dermal papilla and upper dermis. And high-density cell infiltration, edema, abundant vascular and vascular endothelium hyperplasia, infiltrating cells including more plasma cells, tissue cells, unequal red blood cell overflow, sometimes lymphocytes and epithelioid cells or Langhans giant The most characteristic of cells is that Giemsa staining can identify enlarged tissue cells (20-90 m) with multiple compartments, each with 1 to 20 Dunofan bodies, small bodies. It is 1~2m in size and is blue-black and has a pin-like shape.
2. Cytological examination: Take about 1mm3 of debris from the biopsy tissue, clamp it in two slides, rotate it in the forward and reverse directions, make a cell pellet, compress it in air and fix it with methanol. Giemsa staining, microscopic Dunofan bodies in mononuclear cells (sometimes also seen outside the cell).
3. Bacterial culture: The tissue fragments obtained from the above slides were emulsified with sterile saline, inoculated into chicken embryo yolk sac of 5 days old, and incubated at 37 ° C for 72 h. The granuloma granulosa will be in the yolk sac fluid. Medium growth, stained to show pin-shaped pathogens.
4. Serological examination: There is no practical serological method. The complement-binding test can only detect the antibody with meaningful titer in the serum of patients with disease of more than 3 months, and it is associated with Klebsiella pneumoniae. And the nasal induration of Klebsiella has cross-reactivity.
Histopathology: the central part of the lesion is ulcer, the margin of the spine is thickened or pseudoepithelial neoplasia, the epidermis of the ulcer has pseudoepithelial neoplasia, the acanthosis is hypertrophy, the nail process is prolonged, the dermis has dense tissue cells, plasma cells and A small amount of lymphocytes infiltrated, with polymorphonuclear leukocyte microabscess, stained with Gram, scattered tissue cells were seen in the lesion, the cytoplasm was multi-vesicle-separated vacuoles, of which 1 to 20, 1 ~ 2m diameter oval The corpuscle (Donovan body) has diagnostic value.
Diagnosis
Diagnosis and diagnosis of inguinal granuloma
diagnosis
According to the history of sexual contact, clinical manifestations (such as the initial occurrence of external genital nodules, specific edge bulge, beef red painless granulomatous ulcer) and laboratory examination confirmed, silver staining can find Donovan body in the pathological tissue section, However, it is best to use the tissue smear to find the Donovan body, that is, puncture the biopsy at the edge of the lesion, or take a small piece of tissue in the deep section, crush the specimen with two slides, dry naturally, fix the formaldehyde, and then Using Wright or Giemsa staining microscopy, Donovan bodies were found in the cystic space of large mononuclear cytoplasm, which was round or egg-shaped, 1-2 m in size, and its capsule was stained with bacteria. The eosinophilic dense zone, because chromatin is concentrated at the poles, looks like a closed pin. The characteristic monocytes are 25-90 m in diameter and contain many cystic regions containing Donovan bodies.
It is easy to identify this disease in popular areas, according to the age of sexual activity, genital and its vicinity, there is no pain, odor, clear boundaries, high edge curling, beef red, proliferative granulomatous ulcers Damage, biopsy or cytology, and detection of Dunofan body can be diagnosed.
Differential diagnosis
Early genital ulcer and anal disease damage should be differentiated from soft chancre and syphilis with hard squat and flat wet sputum: chronic ulcer or scar lesions should be differentiated from sexually ill lymphogranuloma.
1. Hard chancreous like early inguinal granuloma, can be distinguished according to dark field microscopy and syphilis serum test.
2. The difference between sexually transmitted lymphogranuloma and inguinal granuloma is that the sexually transmitted lymphogranuloma mainly shows painful transverse sputum, and its pathogen is Chlamydia trachomatis.
3. The soft chancre, the lower sputum is acute, the incubation period is 2 to 5 days, often multiple, ulcer pain, painful groin in the groin, short course, the pathogen is Haemophilus ducrei, can be cultured and identified.
4. Genital herpes is different from inguinal granuloma. Genital herpes starts with multiple small blisters. It quickly becomes a superficial erosion or ulcer, and local lymph nodes can be enlarged. The pathogen is herpes simplex virus.
5. Condyloma acuminata inguinal granuloma can be misdiagnosed as condyloma acuminata, but the tissue smear can be diagnosed when Dunofan body is found.
6. Penis, vulva, cervical cancer generally biopsy or postoperative histological examination can be identified, pay attention to inguinal granuloma with high density of dermal cells infiltration, formation of small abscesses, more plasma cells, and duno in macrophages Where the characteristics of the body and other factors, the identification of difficult to identify inguinal granuloma treatment.
7. Dermal leishmaniasis (Oriental sputum) When the inguinal granuloma occurs outside the genitalia, it needs to be differentiated from the oriental sputum. The latter can ulcerate and form a ulcer, and the healing is slow. The pathogen is tropical Leishmania, histopathology. Check that the larger round or elliptical Leishman-Dunofan body (LD body) is visible inside and outside the cell, and should be distinguished from the pin-shaped Dunofan body.
8. Inguinal granuloma and HIV-infected inguinal granuloma is a genital ulcer-forming disease that increases the risk of HIV transmission. Several large-scale studies have shown that this disease is closely related to syphilis and HIV infection. In the infected patients, the clinical and drug treatment effects have not changed, a survey has shown that global programs to eliminate inguinal granulomas can delay the spread of HIV infection.
