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Difference between revisions of "Granuloma annulare"
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| Gross = usu. arms and hands, papules | | Gross = usu. arms and hands, papules | ||
| Grossing = | | Grossing = | ||
| Site = [[skin]] | | Site = [[skin]] - esp. antecubital fossae | ||
| Assdx = | | Assdx = | ||
| Syndromes = | | Syndromes = | ||
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| ClinDDx = | | ClinDDx = | ||
}} | }} | ||
'''Granuloma annulare''' is relatively uncommon problem in [[dermatopathology]]. | '''Granuloma annulare''' is relatively uncommon problem in [[dermatopathology]]. | ||
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*Benign and self-limited condition. | *Benign and self-limited condition. | ||
*Etiology unknown - may be assoc. with trauma.<ref name=Ref_Derm51>{{Ref Derm|51}}</ref> | *Etiology unknown - may be assoc. with trauma.<ref name=Ref_Derm51>{{Ref Derm|51}}</ref> | ||
**Associations: trauma, infections, diabetes mellitus, dyslipidemia, thyroid disease, malignancy, medications.<ref name=pmid32941717>{{cite journal |authors=Fox JD, Aramin H, Ghiam N, Freedman JB, Romanelli P |title=Secukinumab-associated localized granuloma annulare (SAGA): a case report and review of the literature |journal=Dermatol Online J |volume=26 |issue=8 |pages= |date=August 2020 |pmid=32941717 |doi= |url=}}</ref> | |||
*A deep GA can mimic a [[rheumatoid nodule]]; may be called a ''pseudorheumatoid nodule''.<ref>{{Cite journal | last1 = Barzilai | first1 = A. | last2 = Huszar | first2 = M. | last3 = Shpiro | first3 = D. | last4 = Nass | first4 = D. | last5 = Trau | first5 = H. | title = Pseudorheumatoid nodules in adults: a juxta-articular form of nodular granuloma annulare. | journal = Am J Dermatopathol | volume = 27 | issue = 1 | pages = 1-5 | month = Feb | year = 2005 | doi = | PMID = 15677968 }}</ref> | |||
==Gross== | ==Gross== | ||
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Image:Granuloma_annulare.jpg | Granuloma annulare. (WC) | Image:Granuloma_annulare.jpg | Granuloma annulare. (WC) | ||
</gallery> | </gallery> | ||
==Gross== | |||
*Antecubital fossae.<ref name=pmid32941717/> | |||
==Microscopic== | ==Microscopic== | ||
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*[[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> | *[[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. | *[[Epithelioid sarcoma]] - esp. if the lesion appears to be mid-to-deep dermis. | ||
*Tattoo reaction (granuloma annulare-like) - case report.<ref>{{Cite journal | last1 = Bagwan | first1 = IN. | last2 = Walker | first2 = M. | last3 = Theaker | first3 = JM. | title = Granuloma annulare-like tattoo reaction. | journal = J Cutan Pathol | volume = 34 | issue = 10 | pages = 804-5 | month = Oct | year = 2007 | doi = 10.1111/j.1600-0560.2006.00666.x | PMID = 17880589 }}</ref> | |||
===Images=== | ===Images=== | ||
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Image: | 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> | *[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> | ||
==IHC== | |||
*CD68 +ve. | |||
*Factor XIIIa +ve<ref name=pmid16132226>{{Cite journal | last1 = Töröcsik | first1 = D. | last2 = Bárdos | first2 = H. | last3 = Nagy | first3 = L. | last4 = Adány | first4 = R. | title = Identification of factor XIII-A as a marker of alternative macrophage activation. | journal = Cell Mol Life Sci | volume = 62 | issue = 18 | pages = 2132-9 | month = Sep | year = 2005 | doi = 10.1007/s00018-005-5242-9 | PMID = 16132226 }}</ref> -- nuclear.<ref name=pmid11372678>{{Cite journal | last1 = Adány | first1 = R. | last2 = Bárdos | first2 = H. | last3 = Antal | first3 = M. | last4 = Módis | first4 = L. | last5 = Sárváry | first5 = A. | last6 = Szücs | first6 = S. | last7 = Balogh | first7 = I. | title = Factor XIII of blood coagulation as a nuclear crosslinking enzyme. | journal = Thromb Haemost | volume = 85 | issue = 5 | pages = 845-51 | month = May | year = 2001 | doi = | PMID = 11372678 }}</ref> | |||
Note: | |||
*Not routinely used. | |||
==Sign out== | ==Sign out== | ||
<pre> | |||
SKIN LESION, UPPER BACK, PUNCH BIOPSY: | |||
- SUPERFICIAL PALISADING GRANULOMAS WITH CORES OF NECROBIOTIC COLLAGEN, AND SCANT | |||
MUCIN; CONSISTENT WITH GRANULOMA ANNULARE. | |||
</pre> | |||
<pre> | <pre> | ||
Skin lesion, left elbow, excision: | Skin lesion, left elbow, excision: | ||
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however, plasma cells are not apparent. The differential diagnosis is rheumatoid nodule. | however, plasma cells are not apparent. The differential diagnosis is rheumatoid nodule. | ||
</pre> | </pre> | ||
===Micro=== | |||
The sections show hair bearing skin with superficial palisading granuloma with cores of necrobiotic collagen and mucin. Plasma cells are not apparent in association with the lesion. | |||
The overlying epidermis matures normally to the surface and has no basal atypia. | |||
==See also== | ==See also== | ||
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[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Dermatopathology]] | |||