김유찬 김윤전 2006-02 1131 https://aurora.ajou.ac.kr/handle/2018.oak/16775 학위논문(석사)--아주대학교 일반대학원 :의학과,2006. 2 연구 목적 : 백반증의 진단은 대개 임상 양상과 우드등 검사로 이루어지지만, 때로 임상 양상만으로 백반증과 다른 저색소 질환을 감별하기는 어렵다. 따라서 백반증의 조직학적 소견에 관한 연구가 필요하나 아직 이에 대한 연구는 미비한 실정이다. 따라서 본 연구에서는 백반증을 진단, 혹은 감별 진단할 때에 중요한 병리조직학적 소견을 알고자 하였다. 재료 및 방법 : 100명의 백반증 환자와 30명의 탈색모반 환자의 정상 및 병변 부위의 조직 검체를 대상으로 Fontana-Masson, S-100 단백, NKI/beteb, MART-1염색을 시행하였다. 염증이 있는 경우 CD3, CD20, CD68, CD1a염색을 추가로 시행하였다. 결 과 : 일반 염색에서 백반증 조직은 인접 정상 조직에 비해 진피의 염증 소견과 기저막의 탈색 소견을 더 많이 나타내었다. 탈색 모반 조직도 주변의 정상 조직에 비해 기저막의 탈색 소견을 보였으나 그 빈도가 백반증보다 훨씬 적었다. 백반증 조직의 16%에서 멜라닌이 남아있었으며 이 때 색소가 있는 면적은 전체 표피 면적의 0.06%를 차지하였다. 면역조직화학 염색을 한 결과 NKI/beteb 염색은 12%의 백반증 조직에서 양성 소견을 보였으며 mm2당 7.68개의 색소세포가 존재하여 인접 정상의 384.36/mm2 개보다 유의하게 적었다. 탈색모반에서도 색소 세포 숫자는 병변에서 243.86/mm2 개가 측정되어 인접 정상에서 412.65/mm2 개와 차이를 보였으나 그 차이는 백반증 조직보다 작았다. MART-1염색에서도 백반증 조직의 13% 에서 양성 소견을 보였고 mm2당 95.75 개의 색소세포가 관찰되어 NKI/beteb staining과 비슷한 소견을 보였다. 그러나 S-100에 양성을 나타내는 세포는 모든 백반증 조직에 존재하였으며 그 숫자도 175.36/mm2 개로 NKI/beteb염색이나 MART-1염색보다 훨씬 많았다. ABSTRACT i TABLE OF CONTENTS iii LIST OF FIGURES v LIST OF TABLES vi I. INTRODUCTION 1 II. MATERIAL AND METHODS 3 A. Subjects 3 B. Methods 3 1. Biopsies 3 2. Stain 4 3. Immunohistochemistry 4 4. Image Analysis 6 5. Statistical Analysis 7 6. Electron microscopic evaluation 8 III. RESULTS 9 A. H&E staining 9 B. Special staining for melanin 11 C. Immunohistochemical staining for melanocytes 13 1. Melanocytes remaining in vitiliginous skin 13 2. Relationship between duration of vitiligo and the number of melanocytes 16 3. Relationship between the presence of inflammation and the number of melanocytes 17 D. Immunohistochemical staining for Langerhans cells 20 E. Immunohistochemical staining for dermal inflammatory cells 22 F. Ultrastructural changes of vitiligo 24 IV. DISCUSSION 26 V. CONCLUSION 30 REFERENCES 33 |Fig. 1. Melanin pigment in the vitiligo lesional, perilesional normal skin and nevus depigmentosus 12 Fig. 2. Melanocytes in the vitiligo lesional, perilesional normal skin and nevus depigmentosus skin 15 Fig. 3. Melanocytes between vitiligo with inflammation and vitiligo without inflammation 19 Fig. 4. Comparison of Langerhans cells in the epidermis of inflammatory vitiligo and non-inflammatory vitiligo 21 Fig. 5. The component of the dermal inflammatory infiltrate in vitiligo 23 Fig. 6. Remaining melanocyte in vitiligo lesional skin 25 Fig. 7. The migration of melanocyte to upper layer of the epidermis 25 |Table 1. Antibodies used, and their working dilutions 6 Table 2. Comparison of histologic features of lesional and perilesional normal skin in vittiligo and nevus depigmentosus 10 Table 3. Quantitative analysis of melanin pigment of lesional and perilesional normal skin in the vitiligo and nevus depigmentosus 11 Table 4. Quantitative analysis of the number of melanocytes of in vitiligo leisonal, perilesional normal skin, and nevus depigmentosus 14 Table 5. Comparative analysis of the number of melanocytes between in vitiligo with inflammation and vitiligo without inflammation 18 Table 6. Comparison of the number of Langerhans cells in the epidermis of vitiligo with inflammation and vitiligo without inflammation 20 Table 7. Analysis of the components of the dermal inflammatory infiltrate in vitiligo 22 eng The Graduate School, Ajou University 아주대학교 논문은 저작권에 의해 보호받습니다. 백반증의 병리조직학적 소견 Yun Jeon Kim Thesis 아주대학교 일반대학원 Yun Jeon Kim 일반대학원 의학과 2006. 2 Master http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000001131 Background : It is sometimes difficult to differentiate vitiligo from other hypopigmented disorders only by clinical features. However, only a few reports are available on histopathological changes in vitiligo. Purpose : The purpose of the study was to delineate the microscopic alterations that are important in the diagnosis or differential diagnosis of vitiligo. Methods : We examined histopathologic findings of 100 cases with vitiligo and compared them with those of perilesional normal skin. We also compared them to 30 cases with nevus depigmentosus skin. Results : The general histologic features of vitiligo showed more frequent basal hypopigmentation and dermal inflammation than perilesional normal skin. Basal hypopigmentation compared with perilesional normal skin was also found in nevus depigmentosus but the incidence was much lower than vitiligo skin. In Fontana-Masson staining, 16% of vitiliginous skin showed the presence of melanin. The ratio of pigmented area to epidermal area was 0.06% in vitiligo, while 17% in perilesional normal skin and 8.9% in nevus depigmentosus skin. In immunohistochemical staining for melanocytes, 12% of vitiliginous skin showed the presence of melanocytes in NKI/beteb stain, and their average number of melanocytes was 7.68/mm2 while 384.36/mm2 in normal skin. In nevus depigmentosus lesion, the average number of melanocytes was also decreased but the amount of decrease was much less than that of vitiligo. MART-1 staining showed similar findings to NKI/beteb staining. However, S-100 protein positive cells were detected 100% of vitiligo skin and their average number 175.36/mm2, which is much higher than those of NKI/beteb and MART-1 staining. Especially, S-100 protein positive cells were increased in inflammatory vitiligo than noninflammatory vitiligo. This may be due to Langerhans cells, which were increased in inflammatory vitiligo. We also confirmed the presence of melanocytes on electron microscopy, which showed vacuolization and tansepidermal elimination. Conclusions : There exist a few melanocytes and melanin in some vitiligo. Therefore the diagnosis of vitiligo should be made considering clinicopathologic features together.