Granulomatous skin inflammation: Difference between revisions
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==Microscopic examination== | |||
Granulomatous inflammation is defined by the presence of mononuclear leukocytes, specifically histiocytes, appearing as epithelioid cells with round to oval nuclei, often with irregular contours and abundant granular eosinophilic cytoplasm with indistinct cell borders. They may also coalesce to form multinucleated giant cells.<ref name="ShahPritt2017">{{cite journal|last1=Shah|first1=Kabeer K.|last2=Pritt|first2=Bobbi S.|last3=Alexander|first3=Mariam P.|title=Histopathologic review of granulomatous inflammation|journal=Journal of Clinical Tuberculosis and Other Mycobacterial Diseases|volume=7|year=2017|pages=1–12|issn=24055794|doi=10.1016/j.jctube.2017.02.001}}</ref> | |||
===Differential diagnosis=== | |||
*Other forms of '''[[dermatitis]]''' if other types of inflammatory cells are prevalent. | |||
*'''[[Suspected malignant skin excisions|Suspected malignant skin lesions]]''' if demonstrating cellular atypia | |||
===Workup=== | |||
*Look for '''foreign bodies''', conferring a diagnosis of ''foreign body granuloma''. | *Look for '''foreign bodies''', conferring a diagnosis of ''foreign body granuloma''. | ||
*Look for any specific '''appearance''' of the giant cells. | *Look for any specific '''appearance''' of the giant cells. | ||
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File:Touton giant cell (annotated).jpg|Appearance: A '''Touton giant cell''' contains a ring of nuclei surrounding a central homogeneous cytoplasm, with foamy cytoplasm surrounding the nuclei.<ref>{{cite book | last = Grant-Kels | first = Jane | title = Color Atlas of Dermatopathology | publisher = Informa Healthcare | location = City | year = 2007 | isbn = 978-0-8493-3794-9 | pages = 107, 119 }}</ref><ref>{{cite journal |last1=Carmen Gómez-Mateo |first1=Maria |last2=Monteagudo |first2=Carlos |date=2013 |title=Nonepithelial skin tumors with multinucleated giant cells |url=http://www.semdiagpath.com/article/S0740-2570(12)00009-3/fulltext |journal=Seminars in Diagnostic Pathology |volume=30 |issue=1 |pages=58–72 |pmid=23327730 |doi=10.1053/j.semdp.2012.01.004}}</ref> The central cytoplasm (surrounded by the nuclei) may be both amphophilic and eosinophilic.<ref>{{cite journal |last1=Sequeira |first1=Fiona |last2=Gandhi |first2=Suneil |date=2012 |title=Named cells in dermatology |url=http://www.ijdvl.com/article.asp?issn=0378-6323;year=2012;volume=78;issue=2;spage=207;epage=216;aulast=Sequeira |journal=Indian Journal of Dermatology, Venereology and Leprology |volume=78 |issue=2 |pages=207–16 |doi=10.4103/0378-6323.93650 |pmid=22421663}}</ref> | File:Touton giant cell (annotated).jpg|Appearance: A '''Touton giant cell''' contains a ring of nuclei surrounding a central homogeneous cytoplasm, with foamy cytoplasm surrounding the nuclei.<ref>{{cite book | last = Grant-Kels | first = Jane | title = Color Atlas of Dermatopathology | publisher = Informa Healthcare | location = City | year = 2007 | isbn = 978-0-8493-3794-9 | pages = 107, 119 }}</ref><ref>{{cite journal |last1=Carmen Gómez-Mateo |first1=Maria |last2=Monteagudo |first2=Carlos |date=2013 |title=Nonepithelial skin tumors with multinucleated giant cells |url=http://www.semdiagpath.com/article/S0740-2570(12)00009-3/fulltext |journal=Seminars in Diagnostic Pathology |volume=30 |issue=1 |pages=58–72 |pmid=23327730 |doi=10.1053/j.semdp.2012.01.004}}</ref> The central cytoplasm (surrounded by the nuclei) may be both amphophilic and eosinophilic.<ref>{{cite journal |last1=Sequeira |first1=Fiona |last2=Gandhi |first2=Suneil |date=2012 |title=Named cells in dermatology |url=http://www.ijdvl.com/article.asp?issn=0378-6323;year=2012;volume=78;issue=2;spage=207;epage=216;aulast=Sequeira |journal=Indian Journal of Dermatology, Venereology and Leprology |volume=78 |issue=2 |pages=207–16 |doi=10.4103/0378-6323.93650 |pmid=22421663}}</ref> | ||
File:Histopathology of granulomatous folliculitis.jpg|thumb|Relation: '''Folliculitis''' with multinucleated giant cells surrounding a hair follicle. | File:Histopathology of granulomatous folliculitis.jpg|thumb|Relation: '''Folliculitis''' with multinucleated giant cells surrounding a hair follicle. | ||
File:Histopathology of granulomatous inflammation by a ruptured inclusion cyst.jpg|Granulomatious inflammation following an epidermal inclusion '''cyst rupture''', with giant cells surrounding keratin flakes. | |||
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Latest revision as of 14:58, 29 July 2020
Author:
Mikael Häggström [note 1]
Microscopic examination
Granulomatous inflammation is defined by the presence of mononuclear leukocytes, specifically histiocytes, appearing as epithelioid cells with round to oval nuclei, often with irregular contours and abundant granular eosinophilic cytoplasm with indistinct cell borders. They may also coalesce to form multinucleated giant cells.[1]
Differential diagnosis
- Other forms of dermatitis if other types of inflammatory cells are prevalent.
- Suspected malignant skin lesions if demonstrating cellular atypia
Workup
- Look for foreign bodies, conferring a diagnosis of foreign body granuloma.
- Look for any specific appearance of the giant cells.
- Look for relation to adnexae or other particular structures.
-
Foreign body: Suture granuloma, with multinucleated giant cells surrounding (grey) suture material.
-
Relation: Folliculitis with multinucleated giant cells surrounding a hair follicle.
-
Granulomatious inflammation following an epidermal inclusion cyst rupture, with giant cells surrounding keratin flakes.
![Appearance: A Touton giant cell contains a ring of nuclei surrounding a central homogeneous cytoplasm, with foamy cytoplasm surrounding the nuclei.[2][3] The central cytoplasm (surrounded by the nuclei) may be both amphophilic and eosinophilic.[4]](/index.php?title=Special:Upload&wpDestFile=Touton_giant_cell_(annotated).jpg){kind=link}
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
Main page
References
- ↑ Shah, Kabeer K.; Pritt, Bobbi S.; Alexander, Mariam P. (2017). "Histopathologic review of granulomatous inflammation ". Journal of Clinical Tuberculosis and Other Mycobacterial Diseases 7: 1–12. doi:. ISSN 24055794.
- ↑ Grant-Kels, Jane (2007). Color Atlas of Dermatopathology . City: Informa Healthcare. pp. 107, 119. ISBN 978-0-8493-3794-9.
- ↑ Carmen Gómez-Mateo, Maria; Monteagudo, Carlos (2013). "Nonepithelial skin tumors with multinucleated giant cells ". Seminars in Diagnostic Pathology 30 (1): 58–72. doi:. PMID 23327730. Archived from the original. .
- ↑ Sequeira, Fiona; Gandhi, Suneil (2012). "Named cells in dermatology ". Indian Journal of Dermatology, Venereology and Leprology 78 (2): 207–16. doi:. PMID 22421663. Archived from the original. .
Image sources