Difference between revisions of "Panniculitis"
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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=== | ||
| Line 54: | Line 69: | ||
#No [[vasculitis]]. | #No [[vasculitis]]. | ||
#+/-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> | #+/-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/> | |||
DDx: | DDx: | ||
*[[Scleroderma panniculitis]]. | *[[Scleroderma panniculitis]]. | ||
Images | ====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)]. | ||
Revision as of 04:26, 4 February 2014
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:
- Erythema induratum.
- Self-inflicted trauma (factitial panniculitis).
- Systemic lupus erythematosus.
- Other.
DDx by type
Septal:
- Erythema nodosum.
- Scleroderma panniculitis, also morphea profunda.[1]
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
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
EN. (WC)
Microscopic
- Expanded septa between fat lobules - key (low power) feature.
- Neutrophils.
- Lymphocytes.
- Histiocytes.
- Fibrin.
Notes:
- No vasculitis.
- +/-Granulomas - within the septa.[8]
- No ulceration.[4]
DDx:
Images
Morphea profunda
- AKA scleroderma panniculitis.
General
Main article: Scleroderma
- Think about the name... sclerotic (sclero-) dermis (-derma).
Microscopic
Features:[1]
- Septal fibrosis/expansion - key feature.
- Classically ~2-3x an adipocytes thick.
- +/-Deep dermal perivascular lymphocytes and plasma cells.
DDx:
- Erythema nodosum.
- Lichen sclerosus - fibrosis only superficial.
Images:
Erythema induratum
General
Features:[6]
- Uncommon.
- Etiology: unknown.
- Brinster[1] suggests an association, in some cases, with Mycobacterium tuberculosis and hepatitis C.
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:
- Granulomatous infection.
- Vasculitis.
Images:
Stains
- AFB stain - exclude Tuberculosis.
See also
References
- ↑ 1.0 1.1 1.2 1.3 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.
- ↑ 2.0 2.1 Schwartz, RA.; Nervi, SJ. (Mar 2007). "Erythema nodosum: a sign of systemic disease.". Am Fam Physician 75 (5): 695-700. PMID 17375516.
- ↑ 3.0 3.1 URL: http://www.medscape.com/viewarticle/440356_8. Accessed on: 11 September 2011.
- ↑ 4.0 4.1 4.2 4.3 Requena, L.; Requena, C. (Jun 2002). "Erythema nodosum.". Dermatol Online J 8 (1): 4. PMID 12165214.
- ↑ 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.
- ↑ 6.0 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.
- ↑ 7.0 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.
- ↑ 8.0 8.1 URL: http://missinglink.ucsf.edu/lm/DermatologyGlossary/erythema_nodosum.html. Accessed on: 11 September 2011.
- ↑ URL: http://www.dermaamin.com/site/histopathology-of-the-skin/71-s/2154-superficial-morphea-.html. Accessed on: 5 October 2011.