Difference between revisions of "Panniculitis"

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Panniculitis (view source)

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'''Panniculitis''' is inflammation of the adipose tissue.  It is encountered in [[dermatopathology]] specimens.
'''Panniculitis''' is inflammation of the adipose tissue and fits into the larger category of ''[[inflammatory skin disorders]]''.  It is encountered in [[dermatopathology]] specimens.


=General DDx=
=Classification=
*Erythema nodosum.
*Lobular - involve fat lobules.
*Erythema induratum.
*Septal - involve interlobular septae.
*Self-inflicted trauma.
 
==A simple general DDx==
Septal:
*[[Erythema nodosum]].
 
Lobular:
*[[Erythema induratum]].
*Self-inflicted trauma (factitial panniculitis).
*[[Systemic lupus erythematosus]].
*[[Systemic lupus erythematosus]].
*Weird stuff.  
*Other.
 
==DDx by type==
Septal:
*[[Erythema nodosum]].
*[[Scleroderma panniculitis]], also ''morphea profunda''.<ref name=pmid18948765/>
 
Lobular:<ref name=pmid18948765>{{Cite journal  | last1 = Brinster | first1 = NK. | title = Dermatopathology for the surgical pathologist: a pattern-based approach to the diagnosis of inflammatory skin disorders (part II). | journal = Adv Anat Pathol | volume = 15 | issue = 6 | pages = 350-69 | month = Nov | year = 2008 | doi = 10.1097/PAP.0b013e31818b1ac6 | PMID = 18948765 }}</ref>
*Infectious panniculitis.
*[[Erythema induratum]].
*[[SLE|Lupus panniculitis]].
*Pancreatic panniculitis.
*Alpha1-antitrypsin deficiency.
*Subcutaneous fat necrosis of the newborn.
*Sclerema neonatorum.


=Specific conditions=
=Specific conditions=
==Erythema nodosum==
==Erythema nodosum==
===General===
*Most common from of panniculitis.<ref name=pmid17375516>{{Cite journal  | last1 = Schwartz | first1 = RA. | last2 = Nervi | first2 = SJ. | title = Erythema nodosum: a sign of systemic disease. | journal = Am Fam Physician | volume = 75 | issue = 5 | pages = 695-700 | month = Mar | year = 2007 | doi =  | PMID = 17375516 | URL = http://www.aafp.org/afp/2007/0301/p695.html }}</ref>
*Most common from of panniculitis.<ref name=pmid17375516>{{Cite journal  | last1 = Schwartz | first1 = RA. | last2 = Nervi | first2 = SJ. | title = Erythema nodosum: a sign of systemic disease. | journal = Am Fam Physician | volume = 75 | issue = 5 | pages = 695-700 | month = Mar | year = 2007 | doi =  | PMID = 17375516 | URL = http://www.aafp.org/afp/2007/0301/p695.html }}</ref>
*Classically on the shins - resolves without scarring.<ref name=medscape_en>URL: [http://www.medscape.com/viewarticle/440356_8 http://www.medscape.com/viewarticle/440356_8]. Accessed on: 11 September 2011.</ref>


Causes - mnemonic ''NODOSUM'':<ref name=pmid17375516/>
Causes - mnemonic ''NODOSUM'':<ref name=pmid17375516/>
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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===
Features:<ref name=Ref_PBoD8_1199>{{Ref PBoD8|1199}}</ref>
Features:<ref name=Ref_PBoD8_1199>{{Ref PBoD8|1199}}</ref><ref name=Ref_PCPBoD8_609>{{Ref PCPBoD8|609}}</ref>
*Expanded (inter-adipocyte cluster) septa.
*Expanded septa between fat lobules - '''key (low power) feature'''.
*[[Neutrophil]]s.
*[[Neutrophil]]s.
*Lymphocytes.
*Histiocytes.
*Fibrin.
*Fibrin.


Notes:
Notes:
*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>
#No ulceration.<ref name=pmid12165214/>
 
DDx:
*[[Scleroderma panniculitis]].
*[[Necrotizing fasciitis]].
 
====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_high_power.jpg EN - high mag. (ucsf.edu)].
*[http://dermaamin.com/site/histopathology-of-the-skin/57-e/1720-erythema-nodosum-.html EN - several images (dermaamin.com)].
 
==Morphea profunda==
*[[AKA]] ''scleroderma panniculitis''.
{{Main|Morphea profunda}}


==Erythema induratum==
==Erythema induratum==
===General===
===General===
Features:<ref name=Ref_PBoD8_1199>{{Ref PBoD8|1199}}</ref>
Features:<ref name=Ref_PBoD8_1199>{{Ref PBoD8|1199}}</ref>
*Not common.
*Uncommon.
*Etiology: unknown.
*Etiology: unknown.
**''Brinster''<ref name=pmid18948765>{{Cite journal  | last1 = Brinster | first1 = NK. | title = Dermatopathology for the surgical pathologist: a pattern-based approach to the diagnosis of inflammatory skin disorders (part II). | journal = Adv Anat Pathol | volume = 15 | issue = 6 | pages = 350-69 | month = Nov | year = 2008 | doi = 10.1097/PAP.0b013e31818b1ac6 | PMID = 18948765 }}</ref> suggests an association, in some cases, with ''[[Mycobacterium tuberculosis]]'' and ''[[hepatitis C]]''.
Clinical:<ref name=Ref_PCPBoD8_609>{{Ref PCPBoD8|609}}</ref>
*Classic location: posterior shins.
*Ulcerates and scars.


===Microscopic===
===Microscopic===
Features:<ref name=Ref_PBoD8_1199>{{Ref PBoD8|1199}}</ref>
Features:<ref name=Ref_PBoD8_1199>{{Ref PBoD8|1199}}</ref>
*Necrotizing granulomatous inflammation.
*Predominantly lobular process with:<ref name=medscape_en>URL: [http://www.medscape.com/viewarticle/440356_8 http://www.medscape.com/viewarticle/440356_8]. Accessed on: 11 September 2011.</ref>
*Necrotizing vasculitis of small/medium sized vessels (early).
**Necrotizing granulomatous inflammation.
**Necrotizing [[vasculitis]] of small/medium sized vessels (early).


DDx:
DDx:
*Infection.
*Granulomatous infection.
*[[Vasculitis]].
 
Images:
*[http://img.medscape.com/fullsize/migrated/440/356/doj440356.fig17a.jpg Erythema induratum - low mag. (medscape.com)].
*[http://img.medscape.com/fullsize/migrated/440/356/doj440356.fig17d.jpg Erythema induratum - high mag. (medscape.com)].
 
===Stains===
*[[AFB stain]] - exclude Tuberculosis.


=See also=
=See also=
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=References=
=References=
{{Reflist|2}}
{{Reflist|2}}
=External links=
*[http://dermnetnz.org/dermal-infiltrative/panniculitis.html Panniculitis - classification (dermnetnz.org)].


[[Category:Dermatopathology]]
[[Category:Dermatopathology]]
Michael
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