Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2023; 11(17): 4019-4025
Published online Jun 16, 2023. doi: 10.12998/wjcc.v11.i17.4019
Elastic fiber degradation in the development of pediatric granuloma annulare: Report of 39 cases
Dong-Yuan Zhang, Li Zhang, Qin-Yan Yang, Yu-Cheng Xie, Hong-Chao Jiang, Jia-Zheng Li, Hong Shu
Dong-Yuan Zhang, Li Zhang, Hong Shu, Department of Dermatology, Kunming Children’s Hospital, Kunming 650000, Yunnan Province, China
Qin-Yan Yang, Department of Human Resource, Kunming Children’s Hospital, Kunming 650000, Yunnan Province, China
Yu-Cheng Xie, Department of Pathology, Kunming Children’s Hospital, Kunming 650000, Yunnan Province, China
Hong-Chao Jiang, Institute of Pediatric Disease Research in Yunnan, Kunming Children’s Hospital, Kunming 650000, Yunnan Province, China
Jia-Zheng Li, Department of Emergency, The Cooperation of Chinese and Western Medicine Hospital of Yunnan Province, Kunming 650000, Yunnan Province, China
Author contributions: Zhang DY and Zhang L substantial contribution to the conception and design of the work; Zhang DY, Zhang L, Xie YC, Li JZ, and Yang QY contribution to the acquisition, analysis, interpretation of data for the work; Zhang DY contributions to article writing and revising; Jiang HC and Shu H contribution to critical manuscript revisions for project design; Yang QY agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; Shu H contributions to final approval of the version to be published; All authors have read and approve the final manuscript; Zhang DY and Zhang L contributed equally to this work; They are substantial contribution to the conception and design of the work.
Supported by Spring City Project Famous Doctor Special.
Institutional review board statement: The study protocol was reviewed and approved by Kunming Children’s Hospital Medicine Ethics Committee, approval number 2022-03-325-K01.
Informed consent statement: Kunming Children’s Hospital Medicine Ethics Committee concluded that this study was ethical and determined that written informed consent was not required.
Conflict-of-interest statement: All the authors have no conflicts of interest to declare.
Data sharing statement: The data that support the findings of this study are not publicly available due to their containing information that could compromise the privacy of research participants but are available from the corresponding author Shu Hong upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong Shu, BMed, Doctor, Chief Doctor, Chief Physician, MHSc, Professor, Senior Consultant Dermatologist, Staff Physician, Department of Dermatology, Kunming Children’s Hospital, No. 288 Qianxing Road, Xishan District, Kunming 650000, Yunnan Province, China. etyyshuhong@sina.com
Received: February 3, 2023
Peer-review started: February 3, 2023
First decision: April 10, 2023
Revised: April 23, 2023
Accepted: May 6, 2023
Article in press: May 6, 2023
Published online: June 16, 2023
Abstract
BACKGROUND

Granuloma annulare (GA) has diverse clinical manifestations, multiple subtypes, and unknown etiology and pathogenesis. Existing studies regarding GA in children are scarce.

AIM

To examine the correlation between clinical manifestation and histopathology of pediatric GA.

METHODS

A total of 39 patients under 18 years of age with both a clinical and pathological diagnosis of GA at Kunming Children's Hospital from 2017 to 2022 were retrieved. Their medical records were consulted, and clinical data of the children were recorded and summarized, including gender, age, disease site, etc. Existing wax blocks of skin lesion specimens of children and pathological films were retrieved for further study and relevant histology, including hematoxylin-eosin, Alcian blue, elastic fiber (Victoria blue-Lichon red method), and antacid staining. Finally, the children’s clinical manifestations, histopathological results, and special staining characteristics were analyzed.

RESULTS

The clinical manifestations of granuloma annulare in children were diverse: 11 cases presented with a single lesion, 25 with multiple lesions, and 3 with generalized lesions. The pathological typing comprised histiocytic infiltration, palisading granuloma, epithelioid nodular, and mixed types in 4, 11, 9, and 15 cases, respectively. Thirty-nine cases were negative for antacid staining. The positive rate of Alcian blue staining was 92.3%, and that of elastic fiber staining was 100%. The degree of elastic fiber dissolution and granuloma annulare histopathological typing were positively correlated (r = 0.432, P < 0.05). No correlation was found between clinical presentation and histopathological typing of the granuloma annulare in children. In the pathological diagnosis of granuloma annulare, the positive elastic fiber staining rate was higher than that of Alcian blue staining. A correlation was found between elastic fiber dissolution degree and histopathological staging. However, the differences in pathological staging may have been related to the pathological manifestation of granuloma annulare at different periods.

CONCLUSION

Elastic fiber degradation may be a critical step in the pathogenesis of pediatric granuloma annulare. This is also one of the first studies focused on granuloma annulare in children.

Keywords: Pediatric, Granuloma annulare, Histopathology, Elastic fibers, Mucin, Case report

Core Tip: This study examined the correlation between clinical manifestation and histopathology of pediatric granuloma annulare. We performed a retrospective analysis of thirty-nine cases of granuloma annulare in children and demonstrated a correlation between histopathological staining and elastic fiber dissolution. Different pathological staging may reflect the pathological manifestation of granuloma annulare at different periods. Our study demonstrates that elastic fiber degradation may be a critical step in the pathogenesis of pediatric granuloma annulare. Moreover, it is one of the first studies on granuloma annulare in children.