Difference between revisions of "Granuloma annulare"

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#redirect [[Non-malignant_skin_disease#Granuloma_annulare]]
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'''Granuloma annulare''' is relatively uncommon problem in [[dermatopathology]].
 
==General==
*Benign and self-limited condition.
*Etiology unknown - may be assoc. with trauma.<ref name=Ref_Derm51>{{Ref Derm|51}}</ref>
 
==Gross==
*Typically extremities - usu. arms and hands.<ref name=Ref_Derm51>{{Ref Derm|51}}</ref>
 
==Microscopic==
Features:<ref name=Ref_WMSP478>{{Ref WMSP|478}}</ref>
*Dermal palisading [[granuloma]] - typically superficial-to-mid dermis - surrounds:
**Necrotic collagen - '''key feature'''.
***Nuclei "missing" - have undergone karyolysis.
**Mucin - important.
***Loose/pale, paucicellular, eosinophilic.
*Chronic inflammatory cells.
 
Notes:
#There may be multiple small foci with intervening normal dermis.<ref name=Ref_Derm51>{{Ref Derm|51}}</ref>
#Granuloma annulare can be subclassified into ''subcutaneous'' and ''interstitial''.
#Histomorphologically similar to ''[[Rheumatoid nodule]].
#[[Neutrophil]]s may be seen.<ref name=pmid17544961>{{Cite journal  | last1 = Requena | first1 = L. | last2 = Fernández-Figueras | first2 = MT. | title = Subcutaneous granuloma annulare. | journal = Semin Cutan Med Surg | volume = 26 | issue = 2 | pages = 96-9 | month = Jun | year = 2007 | doi = 10.1016/j.sder.2007.02.006 | PMID = 17544961 }}</ref>
 
DDx:
*[[Necrobiosis lipoidica]] - little mucin, no normal dermis between foci,<ref name=Ref_Derm51>{{Ref Derm|51}}</ref> plasma cells - common,<ref name=dermnetnz_nl>URL: [http://dermnetnz.org/pathology/necrobiosis-lipoidica-path.html http://dermnetnz.org/pathology/necrobiosis-lipoidica-path.html]. Accessed on: 24 January 2012.</ref> may involve the fat - tend to be deeper.
*[[Rheumatoid nodule]] - has fibrin in the core of the granuloma (instead of mucin), multinucleated macrophages more common.<ref name=Ref_Derm52-3>{{Ref Derm|52-3}}</ref>
*[[Epithelioid sarcoma]] - esp. if the lesion appears to be mid-to-deep dermis.
 
===Images===
<gallery>
Image:Granuloma_annulare_-_add_-_intermed_mag.jpg | Granuloma annulare - intermed. mag. (WC/Nephron)
Image:Granuloma_annulare_-_high_mag.jpg | Granuloma annulare - high mag. (WC/Nephron)
Image:Granuloma_annulare_-_add_-_high_mag.jpg | Granuloma annular - palisaded granuloma - high mag. (WC/Nephron)
</gallery>
www:
*[http://www.dermaamin.com/site/histopathology-of-the-skin/61-i/1813-interstitial-granuloma-annulare-.html Granuloma annulare (dermaamin.com)].
 
==Stains==
*[[Alcian blue stain|Alcian blue]] (pH 2.5) +ve (for mucin).<ref name=pmid20523767/><ref name=Ref_Derm51>{{Ref Derm|51}}</ref>
 
Image:
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861218/figure/F7/ Granuloma annulare (nih.gov)].<ref name=pmid20523767>{{Cite journal  | last1 = Yun | first1 = JH. | last2 = Lee | first2 = JY. | last3 = Kim | first3 = MK. | last4 = Seo | first4 = YJ. | last5 = Kim | first5 = MH. | last6 = Cho | first6 = KH. | last7 = Kim | first7 = MB. | last8 = Lee | first8 = WS. | last9 = Lee | first9 = KH. | title = Clinical and pathological features of generalized granuloma annulare with their correlation: a retrospective multicenter study in Korea. | journal = Ann Dermatol | volume = 21 | issue = 2 | pages = 113-9 | month = May | year = 2009 | doi = 10.5021/ad.2009.21.2.113 | PMID = 20523767 | PMC = 2861218 }}</ref>
 
==Sign out==
<pre>
Skin lesion, left elbow, excision:
- Palisading granulomas with cores of necrobiotic collagen, and scant mucin
  consistent with granuloma annulare.
 
COMMENT:
An alcian-blue stain (pH 2.5) shows scant mucin.  The granulomas are relatively deep;
however, plasma cells are not apparent. The differential diagnosis is rheumatoid nodule.
</pre>
 
==See also==
*[[Dermatopathology]].
*[[Non-malignant skin disease]].
 
==References==
{{Reflist|1}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]

Revision as of 20:46, 25 June 2013

Granuloma annulare
Diagnosis in short


Granuloma annulare is relatively uncommon problem in dermatopathology.

General

  • Benign and self-limited condition.
  • Etiology unknown - may be assoc. with trauma.[1]

Gross

  • Typically extremities - usu. arms and hands.[1]

Microscopic

Features:[2]

  • Dermal palisading granuloma - typically superficial-to-mid dermis - surrounds:
    • Necrotic collagen - key feature.
      • Nuclei "missing" - have undergone karyolysis.
    • Mucin - important.
      • Loose/pale, paucicellular, eosinophilic.
  • Chronic inflammatory cells.

Notes:

  1. There may be multiple small foci with intervening normal dermis.[1]
  2. Granuloma annulare can be subclassified into subcutaneous and interstitial.
  3. Histomorphologically similar to Rheumatoid nodule.
  4. Neutrophils may be seen.[3]

DDx:

  • Necrobiosis lipoidica - little mucin, no normal dermis between foci,[1] plasma cells - common,[4] may involve the fat - tend to be deeper.
  • Rheumatoid nodule - has fibrin in the core of the granuloma (instead of mucin), multinucleated macrophages more common.[5]
  • Epithelioid sarcoma - esp. if the lesion appears to be mid-to-deep dermis.

Images

  • Granuloma annulare - intermed. mag. (WC/Nephron)

  • Granuloma annulare - high mag. (WC/Nephron)

  • Granuloma annular - palisaded granuloma - high mag. (WC/Nephron)

www:

Stains

Image:

Sign out

Skin lesion, left elbow, excision:
- Palisading granulomas with cores of necrobiotic collagen, and scant mucin
  consistent with granuloma annulare.

COMMENT:
An alcian-blue stain (pH 2.5) shows scant mucin.  The granulomas are relatively deep;
however, plasma cells are not apparent. The differential diagnosis is rheumatoid nodule.

See also

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 51. ISBN 978-0443066542.
  2. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 478. ISBN 978-0781765275.
  3. ↑ Requena, L.; Fernández-Figueras, MT. (Jun 2007). "Subcutaneous granuloma annulare.". Semin Cutan Med Surg 26 (2): 96-9. doi:10.1016/j.sder.2007.02.006. PMID 17544961.
  4. ↑ URL: http://dermnetnz.org/pathology/necrobiosis-lipoidica-path.html. Accessed on: 24 January 2012.
  5. ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 52-3. ISBN 978-0443066542.
  6. ↑ 6.0 6.1 Yun, JH.; Lee, JY.; Kim, MK.; Seo, YJ.; Kim, MH.; Cho, KH.; Kim, MB.; Lee, WS. et al. (May 2009). "Clinical and pathological features of generalized granuloma annulare with their correlation: a retrospective multicenter study in Korea.". Ann Dermatol 21 (2): 113-9. doi:10.5021/ad.2009.21.2.113. PMC 2861218. PMID 20523767. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861218/.
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