Histologic Diagnosis of Inflammatory Skin Diseases

Images

…n in the reticular dermis + 10.67.1C + 10.67.1D = Necrobiosis lipoidica┬áVasculitis, as can be seen in a fibrous septum, probably is common to all lesions of necrobiosis lipoidica at an early stage of that process, seemingly being fundame…

Histologic Diagnosis of Inflammatory Skin Diseases

Identification of Basic Patterns: Subcutaneous Fat: Panniculitis

…icular dermis resolves the matter in an instant; the dermis of necrobiosis lipoidica displays findings diagnostic of it (Fig. 5.398 A&B). Figure 5.390 A&B. A distinctive panniculitis, at first septal and then lobular, too: necrobiosis lipo…

Differential Diagnosis in Dermatopathology

Discussions

Necrobiosis lipoidica (diabeticorum) and necrobiotic xanthogranuloma are granulomatous diseases marked by widespread changes in the dermis and the panniculus adiposus. The processes pathologic spare the upper part of the dermis and may extend as dee…

Differential Diagnosis in Dermatopathology

Discussions

…of granuloma annulare, but, practical, never is discernible in necrobiosis lipoidica. When, episodically, it is exceedingly difficult for a histopathologist to differentiate granuloma annulare from necrobiosis lipoidica in sections stained by hematox…

Histologic Diagnosis of Inflammatory Skin Diseases

Identification of Basic Patterns: Skin: Fibrosing Dermatitis

…ythema elevatum diutinum, acrodermatitis chronica atrophicans, necrobiosis lipoidica (Fig. 3.359 A&B), and morphea (Fig. 5.360 A&B). At a late stage in the life of a lesion of necrobiosis lipoidica, collagen bundles may be thickened and crowd…

Histologic Diagnosis of Inflammatory Skin Diseases

Confusing Terms (to be Avoided Scrupulously)

…in and subcutaneous fat. Diverse diseases purported to display necrobiosis are granuloma annulare, necrobiosis lipoidica, necrobiotic xanthogranuloma, and rheumatoid nodule. The “necrobiotic” change is mostly mucin in conjunction with deg…

Histologic Diagnosis of Inflammatory Skin Diseases

Necrobiotic xanthogranuloma

…cholesterol clefts, whereas the latter are not encountered in necrobiosis lipoidica. Moreover, the panniculitis in necrobiosis lipoidica is confined largely to septa affecting lobules undramatically, whereas that of necrobiotic xanthogranuloma affec…

Histologic Diagnosis of Inflammatory Skin Diseases

Limitations of the Algorithmic Method

The algorithmic method proposed in these pages and predicated on patterns histopathologic is intended to be more than just a guide to diagnosis of particular pathologic processes in skin and subcutaneous fat; it is meant to serve as a springboard fo…

Histologic Diagnosis of Inflammatory Skin Diseases

Images

Images 10.68.1A: Perivascular and interstitla dermatitis, and panniculitis, lobular + 10.68.1B: Histiocytes, many of them multinucleate, in palisaded array around foci of extensive degeneration of collagen and extracellular deposits of li…

Histologic Diagnosis of Inflammatory Skin Diseases

Cells That Mediate Inflammation (Inflammatory Cells)

Neutrophils, eosinophils, lymphocytes, plasma cells, and histiocytes are called inflammatory cells because they enter tissue during the process of inflammation. A more exact designation for them is “cells of an inflammatory process”; the…