Case Number : Case 823 - 13th August Posted By: Guest

Elastotic granuloma.At the end a granuloma annulare.

Granuloma annulare

Incomplete GA d.d.Interstitial granulomatous dermatitis and elastolytic granuloma

Granuloma annulare

Granuloma annulare, probably located in sun-damaged skin due to elastophagocytosis.

Interstitial GA

A question to the panel: do you believe actinic granuloma is a distinct entity or it is simply granuloma annulare at sun-exposed areas? Why?

Granuloma annulare with elastophagocytosis. I also wonder if there´s some importance about this elastophagocytosis.

[quote name='Robledo F. Rocha' timestamp='1376395606']
A question to the panel: do you believe actinic granuloma is a distinct entity or it is simply granuloma annulare at sun-exposed areas? Why?
[/quote]
Interested in the answer to that question. I thought of Actinic granuloma ( O'Brien) too based on the elastophagocytosis and location on the neck; was not aware that this is considered as a variant of GA.

[color=#1C2837][font=arial, verdana, tahoma, sans-serif][size=4]Granuloma annulare[/size][/font][/color]

The palisading of the histiocytes, the absence of multiple multinucleated giant cells and the presence of necrobiosis (albeit subtle) support the diagnosis of granuloma annulare. Alcian blue stain may substantiate the diagnosis.

[size=4][quote name='Robledo F. Rocha' timestamp='1376395606'][/size]
A question to the panel: do you believe actinic granuloma is a distinct entity or it is simply granuloma annulare at sun-exposed areas? Why?
[/quote]
I slightly favor the argument that these represent separate entities, given that actinic granulomas tend to be restricted to the superficial dermis, most commonly as interstitial or palisading pattern lacking central necrobiosis or mucin, in contrast to conventional or interstitial GA.

I often see elastophagocytosis in foreign-body giant cells as an incidental 'bystander' finding in multiple inflammatory settings where GA is clearly not the clinical impression, e.g. granulomatous changes near scars in wide excisions, or resolving/fibrosing keratoacanthomas. [size=4]For that reason, I tend to discount these elastolytic granuloma giant cells more than I used to...unless they are the predominant inflammatory cell in a superficial granulomatous infiltrate.[/size]

[quote name='Robledo F. Rocha' timestamp='1376395606']
A question to the panel: do you believe actinic granuloma is a distinct entity or it is simply granuloma annulare at sun-exposed areas? Why?
[/quote]
Answering my own query, I believe actinic granuloma is nothing but a granuloma annulare at sun-damaged skin. [url="http://archderm.jamanetwork.com/article.aspx?articleid=532980"]Miescher's granuloma[/url] for lesions located on the face and [url="http://archderm.jamanetwork.com/article.aspx?articleid=534886"]granuloma of O’Brien[/url] for those sited on the remainder regions, particularly the neck, are confusing terms which should be avoided.
Elastophagocytosis with granulomatous inflammation is a nonspecific reactive pattern that can occur [url="http://www.ncbi.nlm.nih.gov/pubmed/2794162"]even in sun-protected areas[/url].