Case Number : CT0018 Dr. Richard Carr

Guest - Granuloma faciale.
 
Guest Rodrigo Restrepo - Granuloma faciale.
 
Guest Amira Tawdy - agree

Sasi Attili - Agree, classic GF. Nice case.

IgorSC - Agree, Granuloma faciale. I read recently an interesting paper correlating Granuloma faciale with IgG4-related disease.

Guest Jim Davie MD - Agree with GF.

Mark A. Hurt MD - GF makes sense, but I don't think I have ever seen such a florid example. Most cases I have seen are relatively superficial, not involving adipose tissue. In my experience with GF, I have found that the lesions contain considerable numbers of siderophages. Has anyone else looked for that? I'll be curious to learn the final diagnosis. Edited July 12, 2013 by Guest
  
Dr. Mona Abdel-Halim - GF

Robledo F. Rocha - Scalp is not a typical site for granuloma faciale. Only to run away from general agreement I will suggest epithelioid hemangioma (angiolymphoid hyperplasia with eosinophilia) reasoned on vessels lined by plump endothelial cells.

Guest Graham Reilly - Granuloma faciale - although there doesn`t seem to be a clear Grenz zone.
 
Dr. Richard Carr - Thanks all. I called this granuloma faciale too but I had not seen such a florid and deep example either. However it has pretty much all the typical features (can't remember if I saw siderophages but agree Perl's can be nice in such cases). Eduardo Calonje's team presented a retrospective review of 34 cases at the BSD/BAD meeting last week in Liverpool (abstract is probably available on line in the BJD, Vol 169; Suppl 1, Jul 2013) with IgG4 and basically there was no evidence for any association.

Mark A. Hurt MD - Great case, Richard.