NON-INFECTIOUS GRANULOMATOUS DERMATITIS & HISTIOCYTIC DISEASES

Question 1

Conditions with sarcoidal granuloma

Answer 1

Lichen nitidus, Sarcoidosis

Question 2

Conditions with Tuberculoid granuloma

Answer 2

TB, Leprosy

Question 3

Conditions with palisaded granuloma

Answer 3

Granuloma annulare, Necrobiosis lipoidica, Rheumatoid nodule, Gout

Question 4

Conditions with suppurative granuloma

Answer 4

Ruptured follicular cyst, Infections

Question 5

Answer 5

Langhans type giant cells: Collection of macrophages in a Horseshoe-shaped pattern

Question 6

Answer 6

Langerhans cells: Dendritic cells in the skin and bone marrow with immune response function

Question 7

Answer 7

Foam cells / Xanthomatous cells: Lipid-laden macrophages

Question 8

Answer 8

Necrobiosis: Degeneration of collagen; blurring and loss of definition of collagen bundles possibly due to mucin, fibrin, lipids etc

Question 9

Answer 9

Asteroid body: Stellate inclusion bodies composed of crystalline inclusions (lipoproteins, calcium, phosporus, etc) seen in granulomatous diseases like sarcoidosis, sporotrichosis, etc

Question 10

Answer 10

Conchoidal body / Schaumann body: Large concentric calcifications containing protein, calcium oxalate, and iron seen in granulomatous diseases (sarcoidosis, Crohns, foreign body reaction etc.)

Question 11

Identify what type of giant cells

Answer 11

Question 12

What type of granuloma

Answer 12

Question 13

Answer 13

Sarcoidosis

• Naked granuloma
• Non-caseating, well-demarcated granulomas with sparse lymphocytes
• normal epidermis

Question 14

Answer 14

PALISADED GRANULOMA

Question 15

What is located at the center of the palisaded granuloma in granuloma annulare?

Answer 15

Mucin

Question 16

What is located at the center of the palisaded granuloma in Rheumatoid nodule ?

Answer 16

Degenerated collagen

Question 17

What is located at the center of the palisaded granuloma in necrobiosis lipoidica?

Answer 17

Degenerated collagen + lipid

Question 18

What is located at the center of the palisaded granuloma in necrobiotic xanthogranuloma?

Answer 18

Cholesterol clefts

Question 19

Answer 19

Granuloma Annulare

*Palisading granuloma with central necrobiosis
*no fibrosis
*abundant mucin in central area
*No plasma cells seen (unlike necrobiosis lipoidica)

Question 20

Answer 20

Necrobiosis lipoidica

*“tiers/layers of cake”
*Broad horizontal tiers of degenerated collagen sandwiched between palisading granulomatous infiltrate
*plasma cells
*may have thrombi
*lipids in necrobiotic areas
*no mucin

Question 21

Answer 21

Rheumatoid nodule

• Deep in dermis/subcutis
• Irregular areas of necrobiosis with palisade of elongated histiocytes
• Fibrin, homogeneous, eosinophilic necrobiotic area
• Eosinophils & lymphos
• no mucin

Question 22

Answer 22

Ruptured Follicular cyst

*Suppurative granuloma around cyst or hair follicle
*Foreign body giant cells
*Keratin spicules engulfed by MNGC
*+/-Scar tissue formation

Question 23

Answer 23

Xanthogranuloma
*Nodular, poorly demarcated dense infiltrate of small foamy histiocytes in dermis
*Touton giant cells
*Eosinophils

Question 24

Answer 24

Xanthoma

*Aggregates of lipidladen cells (xanthomatous cells)
*Epidermis (may vary based on type)
*Few scattered inflammatory cells

Question 25

Answer 25

Necrobiotic xanthogranuloma

*Palisading granuloma with focal hyaline necrobiosis
*numerous giant cells, foam cells and bizarre histiocytes
*(+) cholesterol clefts
* May be similar to NLD, but significantly different clinically