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Difference between revisions of "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]] | ||