granulomas

Question 1

granuloma annulare

Answer 1

• epidermis normal
• pallisading granulomas( histiocytes giant cells)
• necrobiosis( foci mild connective tissue degeneration)
• mucin accumulation
• single filing/subtle interstitial patterm histiocytes btw collagen bundles
• perivascular lymphocytes

Question 2

mucin stain

Answer 2

colloidal fe, PAS, alcian blue, toluidine blue

Question 3

necrobiosis lipoidica

Answer 3

1. epidermis normal/atrophic, ulcerated
2. necrobiotic collagen, sclerosis, pallisading granuloma in dermis oriented parallel to epidermis resmble layered cake
3. dermal interstitial inifltrate consist histiocyte, MNGC lymphocytes, plasma cells

Question 4

rheumatoid nodule

Answer 4

1. pallisading granuloma around
2. degenerated connective tissue/fibrin,
3. deep dermis/subcut tissue
4. histiocytes lymphocytes few MN GC

Question 5

rheumatoid nodule location

condition found in

Answer 5

elbows finger joints

RA, 5% LE

Question 6

sarcoidosis

Answer 6

• epidermis normal para/hyperkeratosis acanthosis
• non casseating well demarcated granulomas in dermis/subcut tissue often naked( few lymphocytes)
• schauman/asteroid bodies in MNC GC

Question 7

schauman bodies

Answer 7

round blue calcified laminated inclusions

Question 8

asteroid bodies

Answer 8

stellate intracytoplasmic eosinophilic inclusions

Question 9

xanthoma

Answer 9

foam cells in dermis (oil-red-O posiitve)
touton giant cells
lymp/neut
fibrosis cholesterol clefts-older

Question 10

juvenile xanthogranuloma

Answer 10

nodular/diffuse mixed infiltrate histiocytes lymphocytes eosinophils
foamy histiocytes/touton giant cells
fibrosis (older)

Question 11

JXG stains

Answer 11

CD56, factor 13a(dermal dendorcytes), HAM 56(macrophage)

Question 12

tuberculosis

Answer 12

epithelial hyperplasia intraepidermal microabscess
granulomatous inflammation
casseation necrosis pallisading macrophages
MNGC

Question 13

confirmation of TB

Answer 13

+ PPD( tuberculin purified protein derivative)
ZN AFB stain, c/s
PCR

Question 14

atypical mycobacterial

Answer 14

epidermis hyperplastic ulcerated neutrophilic micrabscesses
diffuse dermal mixed infiltrate neut/histiocyte/plasma cells
tuberculoid granulomas (non cassesating)
AFB stain/c/s PCR

Question 15

lepromatous leprosy

Answer 15

diffuse infilatreate predominant foamy histiocytes separated from epidermis by grenz zone
globi
AFB with fite stain

Question 16

tuberculoid leprosy

Answer 16

tuberculoid granulomas reach epidermis(no grenz)
linear along cutaneous nerves, non caseating
AFB rare /absent