nodule
Introduction
Introduction The nodule lesion is more rash, the papule damage is large and deep, and it penetrates deep into the deep dermis, and the heavy one can reach the subcutaneous tissue. The surface is semi-circular and smoother. The surface of the inflammatory nodules is red, painful and angular pain, and the diameter is 0.5~5cm. In the late stage, there are often ruptures, such as late syphilis nodular lesions, and skin tuberculous nodules are debilitating. The histopathological changes of the nodules are deeper in the deep dermis and can invade the subcutaneous fat layer, so it can be associated with changes in lipid membranes and blood vessels. The pathological changes of the superficial dermis were mild, and the pathological changes of the rash and papules were different in the epidermis and dermis. According to the different causes, the nodules can be limited, the disease is asymmetrical, and the number is small; it can also be systemic, symmetric, and the number is small or sparse. Nodular dermatosis generally has mild systemic symptoms, slow onset, and relatively long course of disease, such as skin tuberculosis, syphilis, and chronic erythema. Therefore, it is clinically different from rash and papular skin diseases. The nodules are divided into inflammatory and non-inflammatory.
Cause
Cause
First, non-inflammatory nodules
(1) Rheumatoid nodules, which are autoimmune diseases.
(B) late syphilis near joint nodules, for the hard tough end fibrosis nodules, no red tumors.
(3) Skin porcine cysticercosis nodules, human ingestion of mites eggs through the stomach and the ten-fat intestine hatching six hooks, cattle into the intestinal wall through the blood, lymph into the skin to form a large peanut, round nodules.
(4) Gout nodules, gout is a source of metabolic disorders. Serum uric acid is elevated, and uric acid is deposited in the form of crystals in the form of gout stones. Occurs in the toe joints.
(5) Nodular xanthoma, caused by disorder of lipid metabolism and high p-lipoproteinemia. The dermis has diffuse foam cell infiltration.
(6) Nodular calcareous deposition, more common in children with dermatomyositis, mostly in the onset of bone and joint.
(7) Pneumococcal nodules, often infected with paragonimiasis.
(8) Chronic nodular chondruff dermatitis of the ear, mostly caused by traumatic frostbite.
(9) Skin kala-azar, which is caused by the Leishmania corpuscle invading the skin membrane. It can be secondary or secondary to visceral infection.
Second, inflammatory nodules
(a) microorganisms
1. bacterial
(1) Tumor-type leprosy: The pathogen is Mycobacterium leprae, positive for acid-fast staining, and positive for Gram stain. The tumor type and the boundary type leprosy nasal film have the highest rate of bacteria. 200 million pieces of bacteria are sterilized every day. Therefore, the respiratory tract is the main route of infection.
(2) skin tuberculosis: the pathogen is Mycobacterium tuberculosis, acid-fast staining, skin tuberculosis is reinfection, and common is lupus vulgaris. It is often invaded by the skin trauma.
(3) Hard erythema: often caused by tuberculosis or lymph node tuberculosis, is a tuberculosis type.
(4) Tuberculous nodular phlebitis: often invade the lower leg, the foot, and the erythema nodules consistent with the vein, forming a strip.
(5) Nasal induration: caused by infection with Klebsiella pneumoniae. Caused by Gram-negative Brevibacterium, initially rhinitis, followed by nasopharynx, soft palate, and nose to form a tough, purplish red nodule.
(6) Swimming pool granuloma: infected by swimming pool mycobacteria, mostly due to bruises and infections, prone to elbows, knees, hands and feet and lower legs, producing brown nodules or plaques.
(7) Mycobacterial ulcer: The pathogen is ulcerative mycobacteria, which is a saprophytic bacteria in tropical soil, which occurs in the calf and forearm and is a painless solid nodule that can be ulcerated and crusted.
(8) Late nodular skin syphilis rash: the lesion consists of a ring-shaped nodule, often ruptured.
(9) Late skin syphilis rubber swelling: occurs in the joint surface susceptible to trauma and soft palate, the size of the finger is large to large walnut, hard and tough, asymptomatic, but easy to ulcerate to form a kidney shape and horseshoe shape.
(10) Facial miliary lupus: In the past, it was considered to be tuberculosis. Although there were tuberculosis changes in histology, tuberculin was negative and no tuberculosis was present. It is currently considered to be unrelated to tuberculosis.
(11) Inguinal granuloma: The pathogen is granulomatous Klebsiella-negative Brevibacterium, which is oval in the mononuclear cells, namely Donovan bodies. More in the perineum, genitals, perianal hard nodules, rupture edge bulge is papillary-like hyperplasia. Attribute-borne disease.
(12) Acute febrile neutrophilic disease: The cause may be vasculitis caused by a bacterial or fungal antigen and a corresponding antibody forming a rabbit plague complex.
(13) nodular erythema: mostly caused by streptococcus, tuberculosis infection, also seen in leprosy out of BehCet disease and drugs.
2. Viral
(1) Milking pox: caused by the burdock virus, which occurs mostly in the fingers of the milking or slaughtering workers and the forearm injuries.
(2) Nodular polyarteritis: a rabbit with a compound small arteritis, associated with hepatitis B virus, with high Y globulinemia, mostly in middle-aged men.
3. Fungal, such as pool filariasis, caused by S. sinensis. It is divided into fixed type and lymphatic type, and it is a string of purple-red painless nodules along the lymphatic vessels.
4. Parasitic acne nodules, which are transmitted by human sputum, and the toxins in the stratum corneum of the skin cause severe itching. In the male scrotum, the penis forms a red nodule itchy.
(2) Physical factors
1. Cold panniculitis. Occurs in infants and young children, poor peripheral blood circulation, plus cold factors, damage caused by subcutaneous fat.
2. Traumatic fat necrosis. Caused by trauma, common in women, may be caused by vascular injury.
3. Subcutaneous fat necrosis in newborns. May be caused by trauma and cold at birth. More than 1 to 6 weeks after birth.
4. Light linear granulomas are chronic granulomas that are often caused by exposure to sunlight.
5. Foreign body edema. Various foreign objects such as paraffin and quartz. Metal quilts, lead, etc., and silk and nylon threads can cause foreign body reactions and granuloma.
(three) immune allergic
1. Allergic skin vasculitis. An allergic reaction caused by bacteria, viruses, proteins, drugs. Leukocyte-fragmented vasculitis caused by immune complexes is a dish-type allergic reaction.
2. Facial eosinophilic buds have single or multiple red nodules on the face, which is an allergic vasculitis immune complex deposition.
3. Allergic to granuloma is granuloma-forming necrotizing vasculitis. It is characterized by increased asthma and eosinophils, up to 0.20~0.30.
4. Giant cell arteritis This disease is granulomatous arteritis, which invades the branches of the aorta. Many of the symptoms are caused by vascular occlusion, which is red painful nodules.
5. The majority of patients with nodular pruritus are caused by mosquito bites, and the two legs are stretched to the side. The red papules are initially itchy, and the thickening and keratinization are nodules after grasping.
6. Deep lupus erythematosus is also known as lupus fat paste. Skin lesions are characterized by deep subcutaneous nodules or plaques that are tough and can be applied to any area. The vascular wall of the fat layer has immunoglobulin deposition.
(4) Other or unexplained reasons
1. Nodular vasculitis. Most occur in women aged 30-50, with larger nodules, located on the back side of the calf, without rupture. Resolved hard fibrotic nodules.
2. The cause of sarcoidosis is unknown, and it can be manifested in various forms, such as small nodule type and large nodule type. However, its pathological features are epithelioid cell granuloma, which is common in giant cells.
3. The cause of nodular febrile non-suppurative panniculitis is unknown. It is common in young and middle-aged women and occurs in the thighs and buttocks. It is a painful nodule and plaque, about 1-10 cm in diameter.
4. Proliferative nodular pityria can cause proliferative brown-purple nodules due to the mixture and iodine, and naturally disappear after stopping the drug.
5. After corticosteroids in the long-term use of corticosteroids, the drug is discontinued for 1-30 days, which is more common in children. The lesion was red solid subcutaneous nodules.
6. The cause of subacute nodular migratory panniculitis is unknown. Of the 11 cases reported by Perry in 1964, 9 had a history of tonsillitis before onset.
7. The cause of subcutaneous nodular granuloma is unknown. More common in children. Occurs in the lower limbs or arms and is a purple red nodule.
8. Nodularity? Peripheral inflammation is an immune phenomenon, which can be high Y globulinemia, rheumatoid factor positive, may have low complementemia, the pathogenesis is immune complexes, and recently discovered This disease can occur in hepatitis B virus. The skin lesions are mostly in the calf.
Examine
an examination
Diseases with nodules as the primary lesions have deeper lesions, mostly in the lower layer of the dermis, and affect the subcutaneous tissue and fat layer. And often form a granulomatous infiltration. Because of the invasion of the fat layer. And often form a granulomatous infiltration. It causes panniculitis and vasculitis due to invasion of fat. The palpation damage is deep and hard, often with redness and tenderness. Most of them are semi-circular flat ridges, with less upward protrusion and deeper downward infiltration. The general course of disease is longer, the onset is slower, and the acute inflammatory reaction is less. There are few acute symptoms of high fever. These features provide a diagnostic idea. For example, lupus vulgaris, its initial damage is tuberculous nodules, infiltrated by epithelioid cells, peripheral lymphocytes, Langhans cells and cheese necrosis. Because of necrosis and ulceration, it is more scarred.
The skin sclerosing nodules of the third-stage syphilis also manifested as subcutaneous granulomatous infiltration, giant cells, cheese necrosis and infiltration of lymphocytes, plasma cells and epithelioid cells, which resembled tuberculous nodules. Also nodular erythema, pathological manifestations of interstitial panniculitis, and small and medium vasculitis. Nodular xanthoma is a disorder of lipid metabolism, and tissue cells phagocytose a large number of lipid granules to form a foam cell granuloma. And Touton giant cells, and multinucleated giant cells, we often have granulomatous infiltration from nodular lesions, and often accompanied by multinucleated giant cells. Such as Mycobacterium tuberculosis, leprosy, treponema pallidum infection, advanced nodule damage, foreign body granuloma. Followed by nodules caused by common vasculitis. The wall of the tube and its surroundings also have granulomatous infiltration, followed by nodular panniculitis and non-inflammatory parasitic infections, and metabolic disorders of nodular lesions. Therefore, the examination of histopathology for diseases with nodular lesions is of great significance for diagnosis.
Diagnosis
Differential diagnosis
The diagnosis should be differentiated from the following symptoms:
1. Itchy, nodular nodules. Nodular pruritus is a variant of localized neurodermatitis, which is characterized by a sickle-like nodule with acute itching.
2. Thermal nodules: Radioactive development of nodule absorption is higher than surrounding thyroid tissue. Such nodules are generally more functional nodules, and patients often have hyperthyroidism. Hot nodules are generally not cancerous.
3. Cold nodular thyroid adenoma: mostly single, slow growth, asymptomatic. The thyroid scan is a "warm nodule." If it is a toxic adenoma, it shows "hot nodules." Adenomas can also develop hemorrhage, necrosis and liquefaction as "cold nodules."
