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 Dr Sampurna Roy MD

http://www.histopathology-india.net/dermpath.htm

Glossary   

Gross examination of the skin specimen

Reporting of biopsies taken for Inflammatory Skin Diseases

Lichenoid (Interface)Tissue Reaction Pattern

Psoriasiform Reaction Pattern

Granulomatous Reaction Pattern

Vesiculobullous Reaction Pattern

Spongiform Reaction Pattern

Vasculopathic Reaction Pattern

Lichen planus-like lesions

Lichen Nitidus

Bullous Pemphigoid

Hailey-Hailey Disease 

Granuloma Annulare

Necrobiosis Lipoidica

Necrobiotic Xanthogranuloma   

Rheumatoid Nodule

Cutaneous Sarcoidosis

Foreign body granuloma

Rosacea

Erythema Nodosum

Folliculitis

Impetigo

Furuncle(Boil)

Carbuncle

Toxic Shock Syndrome

Role of immunohistochemistry in Dermatopathology 

Cutaneous Pseudolymphoma

Cutaneous infection and infestations

1: Bacterial, Rickettsial and Chlamydial infection

2: Spirochetal Infection

3 : Mycoses and algal infections

4 : Protozoal Infections

5 : Helminth Infections

6: Viral Infections

Cutaneous lesion associated with AIDS

Pathology of the Eyelid

Inflammatory diseases of the Eyelid

Tumour and tumour-like lesions of the Eyelid

Adnexal Tumours of the eyelid

Epidermal tumours of the Eyelid

Mesenchymal Tumours of the Eyelid

Melanocytic tumours of the Eyelid

Examples of granulomas due to exogenous material:
Starch (Maltese cross birefringence in polarized light)
Talc - birefringent
Suture material - (nylon, silk, dacron)- birefringent refractile multicoloured.
Wood splinter or bone fragment- Special stains for microorganisms should be performed to rule out infection due to contamination.
Plant material can be identified by PAS stain
Arthropod bite can cause granulomatous reaction
Silica (glass or sand ), zirconium & beryllium elicit sarcoidal granulomatous reaction.
Tattoo material- Extracellular pigment is identified and may induce local sarcoidal granulomas.
Tetanus toxoid (aluminium-adsorbed vaccines) may induce foreign body reaction. (Granular debris at the centre surrounded by histiocytes and lymphoid infiltrate with follicle & eosinophils at the periphery). May resemble Kimura's disease.
Silicone granulomas: A silicone granuloma is a tissue reaction elicited by silicone. Silicone granuloma in the breast arises from leakage of prosthesis. Foreign body giant cells are present near lacunar spaces filled with amorphous refractile material. PathCase 56

Examples of granulomas due to endogenous material:

Calcium deposits;   Urates- Gouty Tophus - PathCase 57 ;  Oxalate;
Keratin & hair : Granulomatous inflammation is present adjacent to ruptured epidermal and pilar cyst, pilomatrixomas and dermoid cyst. Damaged hair follicle can elicit granulomatous reaction. Fragments of keratin may be identified in the dermis.
Hair shafts are round or oval shaped on section, birefringent and  Ziehl- Neelson stain positive.

Note: Foreign body reaction to keratin is an indication for a careful search for residual squamous cell carcinoma or recurrent tumour in a patient with H/O of carcinoma.

Histological feature:
Initially there is suppuration around the foreign material.

This is followed by granulomatous inflammation which may be tuberculoid, sarcoidal, suppurative or necrobiotic  type.

In the later stage there is fibrosis.

Around the foreign material there are histiocytes, some of these have differentiated into large cells with indistinct cell boundaries called epithelioid cells.

There are multinucleated giant cell of foreign body-type often containing ingested foreign material.

In foreign body giant cells the nuclei are scattered irregularly throughout the cytoplasm.

A few Langhans type of  giant  cells may be present, in which the nuclei are distributed along the periphery in a semicircle.
 

Diagnostic clue:

In most cases foreign material can be recognized in H&E sections.

In difficult cases (granulomatous inflammation of skin or panniculitis in which the nature cannot be diagnosed ) polarized light  should be used to identify birefringent foreign material.

Differential diagnosis:   Granulomatous inflammation in deep fungal infection, atypical mycobacteria or leishmaniasis may simulate features of foreign body reaction. Special stains for microorganisms are useful in establishing the diagnosis.                

 Visit:  Infectious Granuloma of the Lung  ; Pathological Diagnosis of Granulomatous Lung Diseases ; Non-necrotising Granulomatous Inflammation of the lung ; An approach to Histopathological examination of Pulmonary Granulomatous Inflammation ;