Chondrodermatitis nodularis chronica helicis
Chondrodermatitis nodularis chronica helicis, abbreviated CNCH, is an uncommon painful condition that afflicts the ear.
| Chondrodermatitis nodularis chronica helicis | |
|---|---|
| Diagnosis in short | |
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| Synonyms | chondrodermatitis nodularis helicis, Winkler disease |
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| LM | cartilaginous pathology (esp. perichondrial inflammation, perichondrial disruption +/-necrosis, +/-hemorrhage), overlying dermal inflammation, epithelial hyperlasia, (dermal) fibrosis |
| Gross | papule on ear, +/-erythema, +/-crusting |
| Site | ear by definition (skin) |
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| Clinical history | more often right ear |
| Signs | tenderness |
| Symptoms | pain |
| Prevalence | uncommon |
| Prognosis | benign |
| Clin. DDx | BCC, SCC |
It is also known as chondrodermatitis nodularis helicis and Winkler disease.[1]
General
- Tender/painful - key clinical feature.
- Typically right ear - people more often sleep on this one.[2]
- Usually >40 years old.
Etiology:
- Trauma/mechanical.
Gross
- Papule on ear.
- +/-Erythematous.
- +/-Crust.
Clinical DDx:[2]
Images
CNCH. (WC)
www:
Microscopic
Features:[2]
- Dermal inflammation.
- Epithelial hyperlasia.
- Fibrosis.
- Cartilaginous pathology:
- Perichondrial inflammation - key feature.
- Perichondrial disruption.
- +/-Necrosis.
- +/-Hemorrhage.
Images
Sign out
Skin Lesion, Right Ear, Excision: - Compatible with chondrodermatitis nodularis chronica helicis.
Micro
The sections show skin with epidermal hyperplasia, parakeratosis and a thickened granular cell layer. The subepithelial tissue has a scattered perivascular lymphocyte predominant inflammatory infiltrate that extends to the cartilage. The cartilage shows focal ischemic changes and perichondral inflammation. Focal chondral necrosis and microabscess formation is identified. Maturing granulation tissue is seen adjacent to the cartilage.
Superficial biopsy
SKIN LESION, LEFT ANTIHELIX OF EAR, BIOPSY: - SUPERFICIAL SKIN WITH ACANTHOSIS, HYPERKERATOSIS, MODERATE SOLAR ELASTOSIS, HYPERGRANULOSIS AND A MILD LYMPHOCYTIC PERIVASCULAR INFILTRATE. - NO CARTILAGE IS IDENTIFIED. - NEGATIVE FOR DYSPLASIA AND MALIGNANCY. COMMENT: The findings are non-specific. Chondrodermatitis cannot be excluded.