Subcutaneous Granuloma Annulare (Pseudorheumatoid nodule). ,F 38, Ankles.

8/9/2019 Subcutaneous Granuloma Annulare (Pseudorheumatoid nodule). ,F 38, Ankles.

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Subcutaneous granuloma annulareSubcutaneous granuloma annulare

(pseudorheumatoid nodule)(pseudorheumatoid nodule)

Deba P Sarma, MDDeba P Sarma, MD

OmahaOmaha


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F 38, erythematous indurated plaques, bothF 38, erythematous indurated plaques, both

anklesankles


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CommentComment

Pseudorheumatoid nodules are considered a deepPseudorheumatoid nodules are considered a deep

form of granuloma annulare.form of granuloma annulare.

Most cases are in children, rare in adults.Most cases are in children, rare in adults.

Presents mainly on the legs,scalp and hands asPresents mainly on the legs,scalp and hands as

erythematous, violaceous, or skinerythematous, violaceous, or skin--colored nodules.colored nodules.

No evidence of clinical rheumatoid arthritis or otherNo evidence of clinical rheumatoid arthritis or other

collagen vascular disease.collagen vascular disease.

Histology: Deep dermal and subcutaneousHistology: Deep dermal and subcutaneous

necrobiotic epitheliod granulomas separated bynecrobiotic epitheliod granulomas separated by

thick collagen. Increased stromal mucin is present.thick collagen. Increased stromal mucin is present.

Lesion represents a juxtaLesion represents a juxta--articular variant ofarticular variant of

granuloma annulare.granuloma annulare.


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Am J Dermatopathol. 2005 Feb;27(1):1Am J Dermatopathol. 2005 Feb;27(1):1--5.5.

Pseudorheumatoid nodules in adults: a juxtaPseudorheumatoid nodules in adults: a juxta--articular form of nodulararticular form of nodulargranuloma annulare.granuloma annulare.

Barzilai ABarzilai A,, Huszar MHuszar M,, Shpiro DShpiro D,, Nass DNass D,, Trau HTrau H..

Department of Dermatology, Sheba Medical Center, TelDepartment of Dermatology, Sheba Medical Center, Tel--Hashomer, andHashomer, and

Sackler Faculty of Medicine, TelSackler Faculty of Medicine, Tel--Aviv University, TelAviv University, Tel--Aviv, Israel.Aviv, [email protected]@post.tau.ac.il

AbstractAbstract

Pseudorheumatoid nodules are considered a deep form of granulomaPseudorheumatoid nodules are considered a deep form of granulomaannulare. Most cases are described in children, occur mainly on the lower legsannulare. Most cases are described in children, occur mainly on the lower legsand scalp, and have favorable prognosis. Their appearance in adults is rare. Inand scalp, and have favorable prognosis. Their appearance in adults is rare. Inthis series, fourteen women with pseudorheumatoid nodules were studied. Thethis series, fourteen women with pseudorheumatoid nodules were studied. The

average age of onset was 36 years old. Lesions consisted of erythematous,average age of onset was 36 years old. Lesions consisted of erythematous,violaceous, or skinviolaceous, or skin--colored nodules located mainly on the small joints of thecolored nodules located mainly on the small joints of thehands. None of the patients developed collagen vascular disease. Persistencehands. None of the patients developed collagen vascular disease. Persistencewas common. Biopsy specimens showed deep dermal nodules composed ofwas common. Biopsy specimens showed deep dermal nodules composed ofepithelioid granulomata separated by thickened collagen bundles. In someepithelioid granulomata separated by thickened collagen bundles. In someareas eosinophilic material was surrounded by histiocytes in a palisaded array.areas eosinophilic material was surrounded by histiocytes in a palisaded array.Granuloma annulare was present at the periphery of eight cases. SpecialGranuloma annulare was present at the periphery of eight cases. Specialstains revealed that most of the eosinophilic material was collagen and mucinstains revealed that most of the eosinophilic material was collagen and mucin

was present in eleven cases. In sum these findings demonstrate thatwas present in eleven cases. In sum these findings demonstrate thatpseudorheumatoid nodules in adults are a distinct clinical and pathologic entity,pseudorheumatoid nodules in adults are a distinct clinical and pathologic entity,which may be mistaken for rheumatoid nodules. They are probably a juxtawhich may be mistaken for rheumatoid nodules. They are probably a juxta--articular variant of granuloma annulare.articular variant of granuloma annulare.

PMID: 15677968 [PubMedPMID: 15677968 [PubMed -- indexed for MEDLINE]indexed for MEDLINE]


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Pediatr Dermatol. 1994 Mar;11(1):6Pediatr Dermatol. 1994 Mar;11(1):6--9.9.

Pseudorheumatoid nodule (deep granuloma annulare) ofPseudorheumatoid nodule (deep granuloma annulare) ofchildhood: clinicopathologic features of twenty patients.childhood: clinicopathologic features of twenty patients.

Evans MJEvans MJ,, Blessing KBlessing K,, Gray ESGray ES..Department of Pathology, Aberdeen University, United Kingdom.Department of Pathology, Aberdeen University, United Kingdom.

AbstractAbstract

Pseudorheumatoid nodule of childhood is seen uncommonly byPseudorheumatoid nodule of childhood is seen uncommonly bypathologists and is thought to be a variant of granuloma annulare.pathologists and is thought to be a variant of granuloma annulare.We report a series of 20 patients (13 M, 7 F) age 1 to 17 years.We report a series of 20 patients (13 M, 7 F) age 1 to 17 years.

Fourteen lesions arose on the front of the lower limb, and 14Fourteen lesions arose on the front of the lower limb, and 14children had numerous lesions at diagnosis. Seven developedchildren had numerous lesions at diagnosis. Seven developedsome form of recurrence, except for one case occurring at the sitesome form of recurrence, except for one case occurring at the siteof the original lesion. Only one patient had a weakly positiveof the original lesion. Only one patient had a weakly positiverheumatoid factor, and was the patient with remote recurrence. As arheumatoid factor, and was the patient with remote recurrence. As asignificant number of lesions arose around the foot when the childsignificant number of lesions arose around the foot when the childwas beginning to walk or starting to wear shoes, it is suggested thatwas beginning to walk or starting to wear shoes, it is suggested that

trauma plays a role in the development of some of these lesions.trauma plays a role in the development of some of these lesions.PMID: 8170852 [PubMedPMID: 8170852 [PubMed -- indexed for MEDLINE]indexed for MEDLINE]


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Turk Neurosurg. 2007;17(1):19Turk Neurosurg. 2007;17(1):19--22.22.

Subcutaneous granuloma annulare of the scalp in childhood: a caseSubcutaneous granuloma annulare of the scalp in childhood: a casereport and review of the literature.report and review of the literature.

Sabuncuolu HSabuncuolu H,, Oge KOge K,, Sylemezolu FSylemezolu F,, Salam ASalam A..

Neurosurgery Department, Ufuk University School of Medicine, Ankara,Neurosurgery Department, Ufuk University School of Medicine, Ankara,

Turkey. [email protected]. [email protected]

Granuloma annulare is a benign inflammatory skin lesion of unknownGranuloma annulare is a benign inflammatory skin lesion of unknownetiology that is usually seen in adults and children and subtypes of itetiology that is usually seen in adults and children and subtypes of itincludes localized granuloma annulare, generalized granuloma annulare,includes localized granuloma annulare, generalized granuloma annulare,subcutaneous granuloma annulare and arcuate dermal erythema. Etiologysubcutaneous granuloma annulare and arcuate dermal erythema. Etiologyand pathogenesis of granuloma annulare are obscure, although there isand pathogenesis of granuloma annulare are obscure, although there is

much evidence for an immunologic mechanism. Precipitating factors aremuch evidence for an immunologic mechanism. Precipitating factors areinsect bites, sunburn, photochemotherapy, drugs, physical trauma, acuteinsect bites, sunburn, photochemotherapy, drugs, physical trauma, acutephlebitis and sepsis after surgery. Some investigators were suggested aphlebitis and sepsis after surgery. Some investigators were suggested arelationship of granuloma annulare to a latent or clinically manifest diabetesrelationship of granuloma annulare to a latent or clinically manifest diabetesor rheumatoid arthritis. In contrast, an association of subcutaneousor rheumatoid arthritis. In contrast, an association of subcutaneousgranuloma annulare with these diseases in childhood has not been reportedgranuloma annulare with these diseases in childhood has not been reportedin the literature. Subcutaneous granuloma annulare of the scalp is rarein the literature. Subcutaneous granuloma annulare of the scalp is rarelesion in childhood and nodules on the scalp are usually nonlesion in childhood and nodules on the scalp are usually non--, or slightly, or slightly

mobile, whereas lesions on the extremities are freely mobile. For definitivemobile, whereas lesions on the extremities are freely mobile. For definitivediagnosis, a biopsy should be performed but wide surgical intervention ordiagnosis, a biopsy should be performed but wide surgical intervention ormedical treatment is not indicated. In case of recurrence, no additionalmedical treatment is not indicated. In case of recurrence, no additionaldiagnostic studies are necessary.diagnostic studies are necessary.

PMID: 17918673 [PubMedPMID: 17918673 [PubMed -- indexed for MEDLINE]indexed for MEDLINE]Free ArticleFree Article


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Semin Cutan Med Surg. 2007 Jun;26(2):96Semin Cutan Med Surg. 2007 Jun;26(2):96--9.9.

Subcutaneous granuloma annulare.Subcutaneous granuloma annulare.

Requena LRequena L,, FernndezFernndez--Figueras MTFigueras MT..

Department of Dermatology, Fundacin Jimnez Daz, Universidad Autnoma deDepartment of Dermatology, Fundacin Jimnez Daz, Universidad Autnoma deMadrid, Spain. [email protected], Spain. [email protected]

AbstractAbstract

Subcutaneous granuloma annulare is a rare clinicopathologic variant of granulomaSubcutaneous granuloma annulare is a rare clinicopathologic variant of granulomaannulare, characterized by subcutaneous nodules that may appear alone or inannulare, characterized by subcutaneous nodules that may appear alone or inassociation with intradermal lesions. The pathogenesis of this deep variant ofassociation with intradermal lesions. The pathogenesis of this deep variant ofgranuloma annulare remains uncertain. Subcutaneous granuloma annulare appearsgranuloma annulare remains uncertain. Subcutaneous granuloma annulare appearsmore frequently in children and young adults, and the lesions consist ofmore frequently in children and young adults, and the lesions consist ofsubcutaneous nodules with no inflammatory appearance at the skin surface, mostsubcutaneous nodules with no inflammatory appearance at the skin surface, mostcommonly located on the anterior aspects of the lower legs, hands, head, andcommonly located on the anterior aspects of the lower legs, hands, head, andbuttocks. Usually, subcutaneous granuloma annulare is an authentic and exclusivebuttocks. Usually, subcutaneous granuloma annulare is an authentic and exclusive

panniculitic process with no dermal participation, although in 25% of the patientspanniculitic process with no dermal participation, although in 25% of the patientslesions of subcutaneous granuloma annulare coexist with the classic findings oflesions of subcutaneous granuloma annulare coexist with the classic findings ofgranuloma annulare in the dermis. Histopathologically, subcutaneous granulomagranuloma annulare in the dermis. Histopathologically, subcutaneous granulomaannulare consist of areas of basophilic degeneration of collagen bundles withannulare consist of areas of basophilic degeneration of collagen bundles withperipheral palisading granulomas involving the connective tissue septa of theperipheral palisading granulomas involving the connective tissue septa of thesubcutis. Usually, the area of necrobiosis in subcutaneous granuloma annulare issubcutis. Usually, the area of necrobiosis in subcutaneous granuloma annulare islarger than in the dermal counterpart. The central necrobiotic areas contain increasedlarger than in the dermal counterpart. The central necrobiotic areas contain increasedamounts of connective tissue mucin and nuclear dust from neutrophils between theamounts of connective tissue mucin and nuclear dust from neutrophils between thedegenerated collagen bundles. Eosinophils are more common in subcutaneousdegenerated collagen bundles. Eosinophils are more common in subcutaneousgranuloma annulare than in the dermal counterpart. There are not descriptions ofgranuloma annulare than in the dermal counterpart. There are not descriptions ofsubcutaneous granuloma annulare showing a histopathologic pattern of the sosubcutaneous granuloma annulare showing a histopathologic pattern of the so--calledcalledincomplete or interstitial variant. Histopathologic differential diagnosis ofincomplete or interstitial variant. Histopathologic differential diagnosis ofsubcutaneous granuloma annulare includes rheumatoid nodule, necrobiosis lipoidicasubcutaneous granuloma annulare includes rheumatoid nodule, necrobiosis lipoidicaand epithelioid sarcoma.and epithelioid sarcoma.

PMID: 17544961 [PubMedPMID: 17544961 [PubMed -- indexed for MEDLINE]indexed for MEDLINE]


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Int J Dermatol. 1986 Mar;25(2):109Int J Dermatol. 1986 Mar;25(2):109--12.12.

Deep granuloma annulare in adults.Deep granuloma annulare in adults.

Salomon RJSalomon RJ,, Gardepe SFGardepe SF,, Woodley DTWoodley DT..

AbstractAbstractSubcutaneous nodules with the histopathologic featuresSubcutaneous nodules with the histopathologic featuresof rheumatoid nodules can occur in both rheumatic andof rheumatoid nodules can occur in both rheumatic andnonrheumatic diseases. When there is no evidence ofnonrheumatic diseases. When there is no evidence ofsystemic disease, they often are classified as deepsystemic disease, they often are classified as deep

granuloma annulare. While there are numerous reportsgranuloma annulare. While there are numerous reportsof such nodules occurring in children without systemicof such nodules occurring in children without systemicdisease, there are few reports of similarly affecteddisease, there are few reports of similarly affectedadults. Two adults are described with multipleadults. Two adults are described with multiplesubcutaneous nodules that were overlying joints andsubcutaneous nodules that were overlying joints and

were histologically similar to rheumatoid nodules. Neitherwere histologically similar to rheumatoid nodules. Neitherpatient had other clinical or laboratory manifestations ofpatient had other clinical or laboratory manifestations ofrheumatic disease. These cases most likely represent anrheumatic disease. These cases most likely represent anadult form of deep granuloma annulare. The wide clinicaladult form of deep granuloma annulare. The wide clinicalspectrum in which similar nodules can occur and theirspectrum in which similar nodules can occur and their

pathogenesis is discussed.pathogenesis is discussed.

Subcutaneous Granuloma Annulare (Pseudorheumatoid nodule). ,F 38, Ankles.

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Transcript of Subcutaneous Granuloma Annulare (Pseudorheumatoid nodule). ,F 38, Ankles.