Palisased granuloma differential Necorbiosis lipodica, Rheumatoid nodule Necorbiosis lipodica 0:55 - cake layer pattern of inflammation and sclerosis. Inflammation is lymphohistiocytic infiltrate, histiocytes admixe giant cells, scattered plasma cells. Sclerotic areas ar mostly sclerotic dermis, if you did an EVG stain, would see some loss of elastic. Usually no vasculitis. Rheumatoid nodule 2:40 - Palasiaded granulomas ) like a necklace or fence around a house) Usually in lower part of dermis, Palisade formed by lymphocytes and macrophages, completely eosinophillic necrotic fibrinoid areas within palasise Granuloma annulare pallisaded 5:00 -- All variants of granuloma annulare tend to have eosinophils their presence of eosinophils favours it over rheumatoid nodule Palisade if macrophges and lymphoctes Altered collagen bundles but still maintain outline -- ie necrobiosis, A mucin stainw ill show icnreased mucin within the palisade Granuloma annulare interstiital varaint 6:35 A lot of inflammation described as a busy dermis , vaguely there is some palisade formation, pools of mucin will be seen throughout demis if stian is done. Perivascular lymphocytes and interstitial macrophages. Granuloma annulare deep variant 7:37 Could be mistaken for a rhumatoid nodule Deep part of demis see granuloma forming pallisades around necobiotic collagen, usually on an extremity. Often admixed infiltrates seen within infiltrate. Younger pts. Mucin increased in palisade Necrobiotic xanthogranuloma 8:55 Periobrbital red brown plagues Necrosis, xanthomatous clls grnaulomatous cells Large areas of necrosis surrounded by palisaded grnaulomas## Xanthomatous cells are lipid lalden macropaghes. touton giant cells , choesterol celfts within necrotic areas. Non- necrotic grnaulomas 11:15 Sarcoidoisis naked granulomas, composed of mostly macrophages , naked due to lack of associated lymphocytes ( which are normally seen with granuomas) need to exclude infeciton to stains , sarcoid is a diagnosis of exclusion Other cause of sarcoidal type of granulomas : Cutaneous TB, Lepromatous leprosy, tuberculoid leprosy, zirconium and beryllium 13:40 leprost Material (bacilli) within macrophges. Fite acid-fast stain for leprosy would show organsims . Grenz zon also seen (uninvolved papillary dermis) Causes of grenz zone: B cell lymphoma , Granuloma faciale, Lepromatous leprosy Foreign body granulomas 15:06 15:10 Ruptured epidermoid cyst fb reaction -- look for admixed keratin flake within giant cells 15:45 Gout pale pink homogenous material, need to see FB reaction around pale eoiniophillic material composed of macrophages and giant cells Triamcinolone injection ( steroid) 16:47 -- Pale material similar to gout but no FB reaction , this is characteristic of Triamcinolone injection 17:34 Tattoo - Important to rule out underlying sarcoid as tatto an aus a sarcoid like reaction - black or red ink 18:25 paraffinomas or sclerosing lipogranuloma -- Lipoma like reaction but you can see the spaces that look like lipoctes but thereis large variationn in size and shape and there are associated by alarge amount of inflammation - histioctyes and lymohioctes fb giant cells +/- slcerosis. Xanthomatous Granulomas 19:55 Xanthelasma 20:40 Eruptive xanthoma - Sudden onset - Xanthomatous cells but also associated lymhpoctes , plasma cells nad eosniophils, classic feature is extracellular lacelike lipid foam material, may be some fibrosis 22.04 Tendinous xanthoma 23:00 Plane xanthoma 24:05 Verruciform xanthoma - Characteristic eosinophilic redish/ fire like strateum corneum, dermal papillar have collections of foamy cells. Usually orl cavity or genitalia. 25:00 Xanthogranuloma /Juvenile if in young kid -- lots of different cells so can look atypical , also can be fibrosis - xanthomatous cells, plasma cells, eosinophils, touton cells ( wreath of nulei with clear cytopasm) 26:18 Roasi dorfman - Xanthomatous macropaghes forming a nodule, they have big nucleus and prominent nucleoli associated with lymphoctes neutriphils and plasma cells, empiropooiosis is also seen in macrophges of lymphocyts - do s100 and cd68. Plasma cells are always present 28:00 Reticulohisticytoma Composed of histiocytes that look a bit xanthomatous - but they have a ground glass /sand paper like cytoplasm, also admixture of eosinophils lymphocyes and plasma cells
Palisased granuloma differential Necorbiosis lipodica, Rheumatoid nodule
Necorbiosis lipodica 0:55 - cake layer pattern of inflammation and sclerosis. Inflammation is lymphohistiocytic infiltrate, histiocytes admixe giant cells, scattered plasma cells. Sclerotic areas ar mostly sclerotic dermis, if you did an EVG stain, would see some loss of elastic. Usually no vasculitis.
Rheumatoid nodule 2:40 - Palasiaded granulomas ) like a necklace or fence around a house)
Usually in lower part of dermis, Palisade formed by lymphocytes and macrophages, completely eosinophillic necrotic fibrinoid areas within palasise
Granuloma annulare pallisaded 5:00 -- All variants of granuloma annulare tend to have eosinophils their presence of eosinophils favours it over rheumatoid nodule
Palisade if macrophges and lymphoctes
Altered collagen bundles but still maintain outline -- ie necrobiosis,
A mucin stainw ill show icnreased mucin within the palisade
Granuloma annulare interstiital varaint 6:35
A lot of inflammation described as a busy dermis , vaguely there is some palisade formation, pools of mucin will be seen throughout demis if stian is done.
Perivascular lymphocytes and interstitial macrophages.
Granuloma annulare deep variant 7:37
Could be mistaken for a rhumatoid nodule
Deep part of demis see granuloma forming pallisades around necobiotic collagen, usually on an extremity. Often admixed infiltrates seen within infiltrate. Younger pts. Mucin increased in palisade
Necrobiotic xanthogranuloma 8:55
Periobrbital red brown plagues
Necrosis, xanthomatous clls grnaulomatous cells
Large areas of necrosis surrounded by palisaded grnaulomas##
Xanthomatous cells are lipid lalden macropaghes. touton giant cells , choesterol celfts within necrotic areas.
Non- necrotic grnaulomas
11:15 Sarcoidoisis naked granulomas, composed of mostly macrophages , naked due to lack of associated lymphocytes ( which are normally seen with granuomas)
need to exclude infeciton to stains , sarcoid is a diagnosis of exclusion
Other cause of sarcoidal type of granulomas : Cutaneous TB, Lepromatous leprosy, tuberculoid leprosy, zirconium and beryllium
13:40 leprost Material (bacilli) within macrophges. Fite acid-fast stain for leprosy would show organsims . Grenz zon also seen (uninvolved papillary dermis)
Causes of grenz zone: B cell lymphoma , Granuloma faciale, Lepromatous leprosy
Foreign body granulomas 15:06
15:10 Ruptured epidermoid cyst fb reaction -- look for admixed keratin flake within giant cells
15:45 Gout pale pink homogenous material, need to see FB reaction around pale eoiniophillic material composed of macrophages and giant cells
Triamcinolone injection ( steroid) 16:47 -- Pale material similar to gout but no FB reaction , this is characteristic of Triamcinolone injection
17:34 Tattoo - Important to rule out underlying sarcoid as tatto an aus a sarcoid like reaction - black or red ink
18:25 paraffinomas or sclerosing lipogranuloma -- Lipoma like reaction but you can see the spaces that look like lipoctes but thereis large variationn in size and shape and there are associated by alarge amount of inflammation - histioctyes and lymohioctes fb giant cells +/- slcerosis.
Xanthomatous Granulomas
19:55 Xanthelasma
20:40 Eruptive xanthoma - Sudden onset - Xanthomatous cells but also associated lymhpoctes , plasma cells nad eosniophils, classic feature is extracellular lacelike lipid foam material, may be some fibrosis
22.04 Tendinous xanthoma
23:00 Plane xanthoma
24:05 Verruciform xanthoma - Characteristic eosinophilic redish/ fire like strateum corneum, dermal papillar have collections of foamy cells. Usually orl cavity or genitalia.
25:00 Xanthogranuloma /Juvenile if in young kid -- lots of different cells so can look atypical , also can be fibrosis - xanthomatous cells, plasma cells, eosinophils, touton cells ( wreath of nulei with clear cytopasm)
26:18 Roasi dorfman - Xanthomatous macropaghes forming a nodule, they have big nucleus and prominent nucleoli associated with lymphoctes neutriphils and plasma cells, empiropooiosis is also seen in macrophges of lymphocyts - do s100 and cd68.
Plasma cells are always present
28:00 Reticulohisticytoma
Composed of histiocytes that look a bit xanthomatous - but they have a ground glass /sand paper like cytoplasm, also admixture of eosinophils lymphocyes and plasma cells
Another good lecture! Thank you !
Thanks
thank you so much ..this is a great lecture indeed
Very nice sir
Thanks