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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

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

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62 years old female.


Case posted by Dr. Mark Hurt.


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Guest Maria George

Posted

Elastotic granuloma.At the end a granuloma annulare.

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Guest C Torre

Posted

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

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Robledo F. Rocha

Posted

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

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Robledo F. Rocha

Posted

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?

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

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Arti Bakshi

Posted

[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.

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Guest Rodrigo Restrepo

Posted

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

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Hanan Vaknine MD

Posted

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.

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Mark A. Hurt MD

Posted

My diagnosis was granuloma annulare, which correlated with the clinical diagnosis.

The lesion was from the neck; in this respect, it might be thought of as actinic granuloma (O'Brien), which I consider to be a variant of granuloma annulare, and which is similar to Miescher's granuloma of the face.

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Guest Jim Davie MD

Posted

[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]

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Robledo F. Rocha

Posted

[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].

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