Necrobiosis Lipoidica: A Histopathological and Histochemical Study*

Gray, Howard R.; Graham, James H.

doi:10.1038/jid.1965.69

Cited by 32 publications

(12 citation statements)

References 19 publications

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“…Several studies have been undertaken to compare granuloma annulare with sarcoidosis; however, difficulty in histologic differentiation may occur, as granuloma annulare may show epithelioid tubercules (4,9). An association between the two disorders has been suggested by the histologic occurrence of granuloma annulare in skin lesions of some patients with systemic sarcoidosis (6), while both conditions have increased scrum macrophage migration inhibition activity (5,6) and defective neutrophil migration (10).…”

mentioning

confidence: 99%

Immunopathologic Demonstration of T Lymphocyte Subpopulations and Interleukin 2 in Graneloma Annulare

Modlin

Horwitz

Jordan

et al. 1984

Pediatric Dermatology

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Immunopathologic aspects of granuloma annulare were studied in frozen sections of nine skin biopsy specimens with monoclonal antibodies directed against T lymphocytes, Langerhans' cells, interleukin 2, and interleukin 2 receptors in conjunction with immunoperoxidase techniques. The predominant lymphocyte was an activated T lymphocyte (Leu 1+, HLA-DR+) with an excess of helper/inducer phenotype (Leu 3a+) as compared with suppressor/cytotoxic phenotype (Leu 2a+). Langerhans' cells were increased in the epidermis and numerous OKT6+ cells were observed in the perivascular and granulomatous infiltrate. Both interleukin 2-positive cells and interleukin 2 receptor-positive cells were identified in the dermal lesions according to observed reactivity with the corresponding monoclonal antibodies. These findings suggest that a cell-mediated immune response producing cytokines may be important in the pathogenesis of granuloma annulare. Comparison of these results with skin specimens from patients with sarcoidosis and from a patient with granuloma annulare having some of the histologic features of sarcoidosis, suggests that the cutaneous infiltrate in granuloma annulare represents a response distinct from that of sarcoidosis.

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mentioning

confidence: 99%

Immunopathologic Demonstration of T Lymphocyte Subpopulations and Interleukin 2 in Graneloma Annulare

Modlin

Horwitz

Jordan

et al. 1984

Pediatric Dermatology

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“…4 It is not uncommon for an individual clinical lesion to demonstrate both infiltrative and palisading granuloma pathologic patterns. 3,5,18,19 The concept of a sarcoidal granuloma pattern of granuloma annulare was, to the best of our knowledge, introduced by Ellis and Kirby-Smith 20 in 1942. 4 Indeed, the pathologic features are nearly identical to those observed in lesions of cutaneous sarcoidosis.…”

Section: Discussionmentioning

confidence: 99%

“…4 Indeed, the pathologic features are nearly identical to those observed in lesions of cutaneous sarcoidosis. 20 Nearly a quarter century later, in a study of 14 patients with necrobiosis lipoidica, Gray et al 18 Ackerman 17 included a photomicrograph of "granuloma annulare with sarcoidal features" as an "unusual histologic variant of granuloma annulare (that) resembles sarcoidosis by formation of 'naked' epithelioid tubercules" in the first edition of seminal dermatopathology textbook published in 1978. 1,4 One group of investigators found areas of an infiltrative pattern around the epithelioid nodules 4 ; yet, this is not usually observed.…”

Section: Discussionmentioning

confidence: 99%

Granuloma Annulare Mimicking Sarcoidosis

Cohen

Carlos

2015

The American Journal of Dermatopathology

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Granuloma annulare, a benign dermatosis of undetermined etiology, typically presents in a localized or generalized form. It has 3 distinctive histologic patterns: an infiltrative (interstitial) pattern, a palisading granuloma pattern, and an epithelioid nodule (sarcoidal granuloma) pattern. A man whose granuloma annulare skin lesions mimicked sarcoidosis is described. His localized granuloma annulare presented with a total of 3 lesions that each had a distinctive clinical morphology: an annular lesion of individual papules, a dermal nodule, and a linear arrangement of 3 papules. Two of his lesions showed a palisading granuloma histology pattern of granuloma annulare; however, the linear papules on his posterior neck lesion demonstrated noncaseating granulomas consistent with either the epithelioid nodule histology pattern of granuloma annulare or sarcoidal granuloma compatible with sarcoidosis. A comprehensive evaluation excluded the diagnosis of systemic sarcoidosis. Using the PubMed database, an extensive literature search was performed on granuloma annulare, epithelioid nodule, sarcoidal granuloma, and sarcoidosis. The histology patterns of granuloma annulare-emphasizing the history and differentiating features of the epithelioid nodule pattern from cutaneous sarcoidosis-were reviewed. The epithelioid nodule (sarcoidal granuloma) histology pattern of granuloma annulare is uncommon and may mimic the histology changes observed in sarcoidosis skin lesions; the absence of asteroid or other giant cell inclusions and an increase in mucin deposition between the collagen bundles favor the diagnosis of granuloma annulare. In addition, the epithelioid nodule pattern of granuloma annulare can rarely also show other histologic patterns of granuloma annulare in the same biopsy specimen or concurrently present with other clinical lesions of granuloma annulare that demonstrate a palisading granuloma, or possibly an infiltrative, histology pattern. However, the presence of an isolated skin lesion demonstrating sarcoidal granulomas--even when concurrently appearing with other lesions of granuloma annulare showing either an infiltrative or a palisading granuloma histologic pattern--may prompt the clinician to evaluate and exclude the possibility of systemic sarcoidosis.

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“…Capillarycndothelial prolifera- tion and thickening and tortuosity of the vessel walls is more pronounced in necrobiosis lipoidica than in granuloma annulare. These vascular changes may be associated with diabetes rather than being specific for necrobiosis lipoidica, and this association is seen more frequently in necrobiosis lipoidica than in granuloma annulare (21). Some reports indicate vaseulitis occurs more frequently in the generalized type of granuloma annulare (22) but this may again be due to a more frequent relationship to diabetes.…”

Section: Differential Diagnosismentioning

confidence: 99%

Necrobiotic granulomas

Johnson

1985

J Cutan Pathol

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Necrobiosis Lipoidica: A Histopathological and Histochemical Study*

Cited by 32 publications

References 19 publications

Immunopathologic Demonstration of T Lymphocyte Subpopulations and Interleukin 2 in Graneloma Annulare

Immunopathologic Demonstration of T Lymphocyte Subpopulations and Interleukin 2 in Graneloma Annulare

Granuloma Annulare Mimicking Sarcoidosis

Necrobiotic granulomas

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