Difference between revisions of "Panniculitis"

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'''Panniculitis''' is inflammation of the adipose tissue.  It is encountered in [[dermatopathology]] specimens.
'''Panniculitis''' is inflammation of the adipose tissue and fits into the larger category of ''[[inflammatory skin disorders]]''.  It is encountered in [[dermatopathology]] specimens.
 


=Classification=
=Classification=
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==A simple general DDx==
==A simple general DDx==
Septal:
*[[Erythema nodosum]].
*[[Erythema nodosum]].
Lobular:
*[[Erythema induratum]].
*[[Erythema induratum]].
*Self-inflicted trauma (factitial panniculitis).
*Self-inflicted trauma (factitial panniculitis).
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Septal:
Septal:
*[[Erythema nodosum]].
*[[Erythema nodosum]].
*Morphea profunda.
*[[Scleroderma panniculitis]], also ''morphea profunda''.<ref name=pmid18948765/>


Lobular:<ref name=pmid18948765>{{Cite journal  | last1 = Brinster | first1 = NK. | title = Dermatopathology for the surgical pathologist: a pattern-based approach to the diagnosis of inflammatory skin disorders (part II). | journal = Adv Anat Pathol | volume = 15 | issue = 6 | pages = 350-69 | month = Nov | year = 2008 | doi = 10.1097/PAP.0b013e31818b1ac6 | PMID = 18948765 }}</ref>
Lobular:<ref name=pmid18948765>{{Cite journal  | last1 = Brinster | first1 = NK. | title = Dermatopathology for the surgical pathologist: a pattern-based approach to the diagnosis of inflammatory skin disorders (part II). | journal = Adv Anat Pathol | volume = 15 | issue = 6 | pages = 350-69 | month = Nov | year = 2008 | doi = 10.1097/PAP.0b013e31818b1ac6 | PMID = 18948765 }}</ref>
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=Specific conditions=
=Specific conditions=
==Erythema nodosum==
==Erythema nodosum==
===General===
*Most common from of panniculitis.<ref name=pmid17375516>{{Cite journal  | last1 = Schwartz | first1 = RA. | last2 = Nervi | first2 = SJ. | title = Erythema nodosum: a sign of systemic disease. | journal = Am Fam Physician | volume = 75 | issue = 5 | pages = 695-700 | month = Mar | year = 2007 | doi =  | PMID = 17375516 | URL = http://www.aafp.org/afp/2007/0301/p695.html }}</ref>
*Most common from of panniculitis.<ref name=pmid17375516>{{Cite journal  | last1 = Schwartz | first1 = RA. | last2 = Nervi | first2 = SJ. | title = Erythema nodosum: a sign of systemic disease. | journal = Am Fam Physician | volume = 75 | issue = 5 | pages = 695-700 | month = Mar | year = 2007 | doi =  | PMID = 17375516 | URL = http://www.aafp.org/afp/2007/0301/p695.html }}</ref>
*Classically on the shins - resolves without scarring.<ref name=medscape_en>URL: [http://www.medscape.com/viewarticle/440356_8 http://www.medscape.com/viewarticle/440356_8]. Accessed on: 11 September 2011.</ref>
*Classically on the shins - resolves without scarring.<ref name=medscape_en>URL: [http://www.medscape.com/viewarticle/440356_8 http://www.medscape.com/viewarticle/440356_8]. Accessed on: 11 September 2011.</ref>
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*[[ulcerative colitis|'''U'''lcerative colitis]] & [[Crohn's disease]] ~ 2% of cases.
*[[ulcerative colitis|'''U'''lcerative colitis]] & [[Crohn's disease]] ~ 2% of cases.
*'''M'''alignancy ([[leukemia]], [[Hodgkin's lymphoma]]) ~ 1% of cases
*'''M'''alignancy ([[leukemia]], [[Hodgkin's lymphoma]]) ~ 1% of cases
Clinical:<ref name=pmid12165214/>
*Painful.
*Tender.
*Sudden onset.
*Heal without scarring.
===Gross===
*Red/brown nodules.
**Classically shins<ref>{{Cite journal  | last1 = Babamahmoodi | first1 = F. | last2 = Babamahmoodi | first2 = A. | last3 = Barani | first3 = H. | last4 = Delavarian | first4 = L. | title = Simultaneous occurrence of erythema nodosum in monozygotic twin sisters. | journal = Case Rep Med | volume = 2012 | issue =  | pages = 109427 | month =  | year = 2012 | doi = 10.1155/2012/109427 | PMID = 22719770 }}</ref> - also knees and ankles.<ref name=pmid12165214>{{Cite journal  | last1 = Requena | first1 = L. | last2 = Requena | first2 = C. | title = Erythema nodosum. | journal = Dermatol Online J | volume = 8 | issue = 1 | pages = 4 | month = Jun | year = 2002 | doi =  | PMID = 12165214 }}</ref>
**Often bilateral.<ref name=pmid12165214/>
<gallery>
Image: ENlegs.JPG | EN. (WC)
</gallery>


===Microscopic===
===Microscopic===
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Notes:
Notes:
#No [[vasculitis]].
#No [[vasculitis]].
#+/-Granulomas.<ref name=uscf_en>URL: [http://missinglink.ucsf.edu/lm/DermatologyGlossary/erythema_nodosum.html http://missinglink.ucsf.edu/lm/DermatologyGlossary/erythema_nodosum.html]. Accessed on: 11 September 2011.</ref>
#+/-Granulomas - within the septa.<ref name=uscf_en>URL: [http://missinglink.ucsf.edu/lm/DermatologyGlossary/erythema_nodosum.html http://missinglink.ucsf.edu/lm/DermatologyGlossary/erythema_nodosum.html]. Accessed on: 11 September 2011.</ref>
#No ulceration.<ref name=pmid12165214/>


Images:
DDx:
*[[Scleroderma panniculitis]].
*[[Necrotizing fasciitis]].
 
====Images====
*[http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/Erythema_Nodosum_low_power.jpg EN - low mag. (ucsf.edu)].<ref name=uscf_en>URL: [http://missinglink.ucsf.edu/lm/DermatologyGlossary/erythema_nodosum.html http://missinglink.ucsf.edu/lm/DermatologyGlossary/erythema_nodosum.html]. Accessed on: 11 September 2011.</ref>
*[http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/Erythema_Nodosum_low_power.jpg EN - low mag. (ucsf.edu)].<ref name=uscf_en>URL: [http://missinglink.ucsf.edu/lm/DermatologyGlossary/erythema_nodosum.html http://missinglink.ucsf.edu/lm/DermatologyGlossary/erythema_nodosum.html]. Accessed on: 11 September 2011.</ref>
*[http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/Erythema_Nodosum_high_power.jpg EN - high mag. (ucsf.edu)].
*[http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/Erythema_Nodosum_high_power.jpg EN - high mag. (ucsf.edu)].
*[http://dermaamin.com/site/histopathology-of-the-skin/57-e/1720-erythema-nodosum-.html EN - several images (dermaamin.com)].
==Morphea profunda==
*[[AKA]] ''scleroderma panniculitis''.
{{Main|Morphea profunda}}


==Erythema induratum==
==Erythema induratum==
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*Uncommon.
*Uncommon.
*Etiology: unknown.
*Etiology: unknown.
**''Brinster''<ref name=pmid18948765>{{Cite journal  | last1 = Brinster | first1 = NK. | title = Dermatopathology for the surgical pathologist: a pattern-based approach to the diagnosis of inflammatory skin disorders (part II). | journal = Adv Anat Pathol | volume = 15 | issue = 6 | pages = 350-69 | month = Nov | year = 2008 | doi = 10.1097/PAP.0b013e31818b1ac6 | PMID = 18948765 }}</ref> suggests an association, in some cases, with ''[[Mycobacterium tuberculosis]]'' and ''[[hepatitis C]]''.


Clinical:<ref name=Ref_PCPBoD8_609>{{Ref PCPBoD8|609}}</ref>
Clinical:<ref name=Ref_PCPBoD8_609>{{Ref PCPBoD8|609}}</ref>
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DDx:
DDx:
*Infection.
*Granulomatous infection.
*[[Vasculitis]].


Images:
Images:
*[http://img.medscape.com/fullsize/migrated/440/356/doj440356.fig17a.jpg Erythema induratum - low mag. (medscape.com)].
*[http://img.medscape.com/fullsize/migrated/440/356/doj440356.fig17a.jpg Erythema induratum - low mag. (medscape.com)].
*[http://img.medscape.com/fullsize/migrated/440/356/doj440356.fig17d.jpg Erythema induratum - high mag. (medscape.com)].
*[http://img.medscape.com/fullsize/migrated/440/356/doj440356.fig17d.jpg Erythema induratum - high mag. (medscape.com)].
===Stains===
*[[AFB stain]] - exclude Tuberculosis.


=See also=
=See also=
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=References=
=References=
{{Reflist|2}}
{{Reflist|2}}
=External links=
*[http://dermnetnz.org/dermal-infiltrative/panniculitis.html Panniculitis - classification (dermnetnz.org)].


[[Category:Dermatopathology]]
[[Category:Dermatopathology]]

Latest revision as of 19:42, 28 May 2021

Panniculitis is inflammation of the adipose tissue and fits into the larger category of inflammatory skin disorders. It is encountered in dermatopathology specimens.

Classification

  • Lobular - involve fat lobules.
  • Septal - involve interlobular septae.

A simple general DDx

Septal:

Lobular:

DDx by type

Septal:

Lobular:[1]

  • Infectious panniculitis.
  • Erythema induratum.
  • Lupus panniculitis.
  • Pancreatic panniculitis.
  • Alpha1-antitrypsin deficiency.
  • Subcutaneous fat necrosis of the newborn.
  • Sclerema neonatorum.

Specific conditions

Erythema nodosum

General

  • Most common from of panniculitis.[2]
  • Classically on the shins - resolves without scarring.[3]

Causes - mnemonic NODOSUM:[2]

  • NO cause (idiopathic) ~ 55% of cases.
  • Drugs (sulfonamides, amoxicillin, oral contraceptives) ~ 5% of cases.
  • Other infections - group A streptococci (streptococcal pharyngitis), Yersinia, chlamydia, mycobacteria, others ~ 30% of cases.
  • Sarcoidosis ~ 7% of cases.
  • Ulcerative colitis & Crohn's disease ~ 2% of cases.
  • Malignancy (leukemia, Hodgkin's lymphoma) ~ 1% of cases

Clinical:[4]

  • Painful.
  • Tender.
  • Sudden onset.
  • Heal without scarring.

Gross

  • Red/brown nodules.
    • Classically shins[5] - also knees and ankles.[4]
    • Often bilateral.[4]

  • EN. (WC)

Microscopic

Features:[6][7]

  • Expanded septa between fat lobules - key (low power) feature.
  • Neutrophils.
  • Lymphocytes.
  • Histiocytes.
  • Fibrin.

Notes:

  1. No vasculitis.
  2. +/-Granulomas - within the septa.[8]
  3. No ulceration.[4]

DDx:

Images

Morphea profunda

  • AKA scleroderma panniculitis.
Main article: Morphea profunda

Erythema induratum

General

Features:[6]

Clinical:[7]

  • Classic location: posterior shins.
  • Ulcerates and scars.

Microscopic

Features:[6]

  • Predominantly lobular process with:[3]
    • Necrotizing granulomatous inflammation.
    • Necrotizing vasculitis of small/medium sized vessels (early).

DDx:

Images:

Stains

See also

References

  1. ↑ 1.0 1.1 1.2 Brinster, NK. (Nov 2008). "Dermatopathology for the surgical pathologist: a pattern-based approach to the diagnosis of inflammatory skin disorders (part II).". Adv Anat Pathol 15 (6): 350-69. doi:10.1097/PAP.0b013e31818b1ac6. PMID 18948765.
  2. ↑ 2.0 2.1 Schwartz, RA.; Nervi, SJ. (Mar 2007). "Erythema nodosum: a sign of systemic disease.". Am Fam Physician 75 (5): 695-700. PMID 17375516.
  3. ↑ 3.0 3.1 URL: http://www.medscape.com/viewarticle/440356_8. Accessed on: 11 September 2011.
  4. ↑ 4.0 4.1 4.2 4.3 Requena, L.; Requena, C. (Jun 2002). "Erythema nodosum.". Dermatol Online J 8 (1): 4. PMID 12165214.
  5. ↑ Babamahmoodi, F.; Babamahmoodi, A.; Barani, H.; Delavarian, L. (2012). "Simultaneous occurrence of erythema nodosum in monozygotic twin sisters.". Case Rep Med 2012: 109427. doi:10.1155/2012/109427. PMID 22719770.
  6. ↑ 6.0 6.1 6.2 Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1199. ISBN 978-1416031215.
  7. ↑ 7.0 7.1 Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 609. ISBN 978-1416054542.
  8. ↑ 8.0 8.1 URL: http://missinglink.ucsf.edu/lm/DermatologyGlossary/erythema_nodosum.html. Accessed on: 11 September 2011.

External links

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