Rheumatoid nodule: Difference between revisions
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Rheumatoid_nodule_-_intermed_mag_2.jpg | |||
| Width = | |||
| Caption = Rheumatoid nodule. [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = necrotic collagen bundles with fibrin surrounded by [alisading [[granuloma]], +/-[[eosinophil]]s | |||
| Subtypes = | |||
| LMDDx = [[granuloma annulare]], [[necrobiosis lipoidica]] | |||
| Stains = [[Alcian blue stain|Alcian blue]] (pH 2.5) -ve | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = extensor aspect of the extremities, e.g. dorsal aspect of elbow | |||
| Grossing = | |||
| Site = [[skin]] (see ''[[rheumatoid lung nodule]]'' for the lung lesion) | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = skin nodule, close to joint - typically elbow | |||
| Symptoms = | |||
| Prevalence = uncommon | |||
| Bloodwork = RF +ve | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = benign | |||
| Other = | |||
| ClinDDx = | |||
| Tx = | |||
}} | |||
{{ Infobox external links | |||
| Name = Rheumatoid nodule | |||
| EHVSC = 10182 | |||
| pathprotocols = | |||
| wikipedia = | |||
| pathoutlines = | |||
}} | |||
'''Rheumatoid nodule''', abbreviated '''RN''', is a [[skin]] manifestation of [[rheumatoid arthritis]]. | |||
Nodules in the [[lung]] associated with rheumatoid arthritis are dealt with in ''[[rheumatoid lung nodule]]''. | |||
==General== | |||
*Seen in [[rheumatoid arthritis]] - usually only in seropositive cases, i.e. ''rheumatoid factor'' (RF) positive.<ref name=Ref_DCHH299>{{Ref DCHH|299}}</ref> | |||
**Exceptions are reported.<ref name=pmid6364806>{{Cite journal | last1 = Kaye | first1 = BR. | last2 = Kaye | first2 = RL. | last3 = Bobrove | first3 = A. | title = Rheumatoid nodules. Review of the spectrum of associated conditions and proposal of a new classification, with a report of four seronegative cases. | journal = Am J Med | volume = 76 | issue = 2 | pages = 279-92 | month = Feb | year = 1984 | doi = | PMID = 6364806 }}</ref> | |||
==Gross== | |||
*Usually on the extensor aspect of the extremities, e.g. dorsal aspect of elbow.<ref name=Ref_Derm53>{{Ref Derm|53}}</ref> | |||
*Typically close to a joint.{{fact}} | |||
==Microscopic== | |||
Features:<ref name=Ref_DCHH299>{{Ref DCHH|299}}</ref><ref name=Ref_Derm52>{{Ref Derm|52}}</ref> | |||
*Necrotic collagen bundles with fibrin surrounded by: | |||
**Palisading [[granuloma]]. | |||
*+/-Eosinophils. | |||
Notes: | |||
*Histomorphologically very similar to ''[[Granuloma annulare]]''. | |||
DDx: | |||
*[[Granuloma annulare]] - has mucin in the core of the granuloma.<ref name=Ref_Derm52>{{Ref Derm|52}}</ref> | |||
*[[Necrobiosis lipoidica]]. | |||
===Images=== | |||
www: | |||
*[http://granuloma.homestead.com/rheumatoid_nod_S89-2617-1.jpg Rheumatoid nodule (granuloma.homestead.com)].<ref name=ghc>URL: [http://granuloma.homestead.com/palisading.html http://granuloma.homestead.com/palisading.html]. Accessed on: 1 November 2010.</ref> | |||
*[http://granuloma.homestead.com/rheumatoid_nod_S89-2617-5.jpg Rheumatoid nodule (granuloma.homestead.com)].<ref name=ghc>URL: [http://granuloma.homestead.com/palisading.html http://granuloma.homestead.com/palisading.html]. Accessed on: 1 November 2010.</ref> | |||
*[http://library.med.utah.edu/WebPath/jpeg3/BONE045.jpg Rheumatoid nodule (utah.edu)].<ref>URL: [http://www.pathguy.com/lectures/joints.htm http://www.pathguy.com/lectures/joints.htm]. Accessed on: 1 November 2010.</ref> | |||
<gallery> | |||
Image:Rheumatoid_nodule_-_low_mag.jpg |Rheumatoid nodule - low mag. (WC) | |||
Image:Rheumatoid_nodule_-_intermed_mag_2.jpg |Rheumatoid nodule - intermed. mag. (WC) | |||
Image:Rheumatoid_nodule_-_high_mag.jpg |Rheumatoid nodule - high mag. (WC) | |||
</gallery> | |||
==Stains== | |||
*[[Alcian blue stain|Alcian blue]] (pH 2.5) -ve. | |||
**Positive staining of mucin in [[granuloma annulare]].<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> | |||
Submitted as "Rheumatoid Nodule Left Thumb", Excision: | |||
- Consistent with rheumatoid nodule (palisading granulomas with | |||
cores of necrobiotic collagen). | |||
- NEGATIVE for microorganisms with special stains (ZN, Grocott). | |||
</pre> | |||
<pre> | |||
Lesion (subcutaneous), right index finger, excision: | |||
- Palisading granulomas with cores of necrobiotic collagen, consistent with rheumatoid nodule. | |||
</pre> | |||
===Micro=== | |||
The sections show foci with strands of necrobiotic collagen surrounded by palisading granulomas. Rare Neutrophils are seen in the core of the granulomas. Multinucleated cells are not apparent. | |||
Benign fibroadipose tissue and dense connective tissue are also present. | |||
==See also== | |||
*[[Rheumatoid arthritis]]. | |||
*[[Rheumatoid lung nodule]]. | |||
==References== | |||
{{Reflist|1}} | |||
[[Category:Diagnosis]] | |||