Case Number : CT0116 Adam_Bates

inflammatory myofibroblastic tumor

Granuloma faciale.
 

Forgot to say the case kindly shared with me by Dr Chris Allen.
 

Difficult case. I also think about Granuloma faliale, but I would perform special stains for atypical mycobacteriosis as this is a common location for aesthetic procedures.
 

Microscopic images are of granuloma faciale, but I feel a little confused about the clinical presentation as a cystic lesion.

Granuloma faciale. Inflammatory myofibroblastic tumour is typically a visceral tumour of younger patients.
 

Granuloma faciale, typical storiform pattern of fibroblastic proliferation with evidence of leucocytoclastic debris, more neutrophils than eosinophils in this case though.
 

My opinion as follows:
This is a fascinating case, and in my opinion shows histological features typical of erythema elevatum diutinum. This is considered to be a chronic leucocytoclastic vasculitis with fibrosclerosis. The typical clinical picture is not present in your patient because lesions normally present at acral sites and can resemble nodular keloids in the fingers and toes. However, I have occasionally seen presentations of EED at other anatomical locations. Traditionally, it is grouped with granuloma faciale, but in my experience, the latter diagnosis is more plaque-like and always histologically has an abundance of histiocytes and eosinophils which is not present in your case. Therefore, I favour an unusual location for EED rather than granuloma faciale in this case.