Rheumatoid nodule

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Rheumatoid nodule
Diagnosis in short

Rheumatoid nodule. H&E stain.

LM necrotic collagen bundles with fibrin surrounded by [alisading granuloma, +/-eosinophils
LM DDx granuloma annulare, necrobiosis lipoidica
Stains Alcian blue (pH 2.5) -ve
Gross extensor aspect of the extremities, e.g. dorsal aspect of elbow
Site skin (see rheumatoid lung nodule for the lung lesion)

Signs skin nodule, close to joint - typically elbow
Prevalence uncommon
Blood work RF +ve
Prognosis benign
Rheumatoid nodule
External resources
EHVSC 10182

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.[1]
    • Exceptions are reported.[2]

Gross

  • Usually on the extensor aspect of the extremities, e.g. dorsal aspect of elbow.[3]
  • Typically close to a joint.[citation needed]

Microscopic

Features:[1][4]

  • Necrotic collagen bundles with fibrin surrounded by:
  • +/-Eosinophils.

Notes:

DDx:

Images

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Stains

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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).
Lesion (subcutaneous), right index finger, excision:
- Palisading granulomas with cores of necrobiotic collagen, consistent with rheumatoid nodule.

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

References

  1. 1.0 1.1 Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 299. ISBN 978-0470519035.
  2. Kaye, BR.; Kaye, RL.; Bobrove, A. (Feb 1984). "Rheumatoid nodules. Review of the spectrum of associated conditions and proposal of a new classification, with a report of four seronegative cases.". Am J Med 76 (2): 279-92. PMID 6364806.
  3. Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 53. ISBN 978-0443066542.
  4. 4.0 4.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 52. ISBN 978-0443066542.
  5. 5.0 5.1 URL: http://granuloma.homestead.com/palisading.html. Accessed on: 1 November 2010.
  6. URL: http://www.pathguy.com/lectures/joints.htm. Accessed on: 1 November 2010.
  7. 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. //www.ncbi.nlm.nih.gov/pmc/articles/PMC2861218/.