Granuloma Faciale

Nodular dermatitis with neutrophils, eosinophils, and plasma cells prominent.

Clinical Presentation:

■ Uncommon to rare condition

■ Solitary or several reddish brown nodules to plaques (Fig. 3A)

■ Typically on the face although rarely extrafacial

■ Persistent and asymptomatic

Histopathology:

■ Nodular mixed infiltrate with characteristic sparing of the papillary and periadnexal dermis (together known as the adventitial dermis) (Fig. 3B).

■ Polymorphous infiltrate consisting of numerous neutrophils, many of them with fragmented nuclei (leukocytoclasis), eosinophils, plasma cells, as well as lymphocytes (Fig. 3C).

■ Despite its name (which is based on the clinical appearance), histiocytes are not a histologic feature.

Differential Diagnosis:

■ Erythema elevatum diutinum—shares a similar pattern (nodular to diffuse predominantly neutrophilic infiltrate with leukocytoclasis) although fewer eosinophils and plasma cells.

Pathophysiology:

■ No known cause although in view of the presence of vas-culitis in early lesions, a localized Arthus-like process has been suggested.

References:

1. Lever WF, Leeper RW. Eosinophilic granuloma of the skin. Arch Dermatol 1950; 62:85-96.

2. Selvaag E, Roald B. Immunohistochemical findings in granuloma faciale. The role of eosinophilic granulocytes. J Eur Acad Dermatol Venereol 2000; 14:517-518.

CUTANEOUS HODGKIN'S DISEASE

Nodular mixed infiltrate with eosinophils, plasma cells, and lymphocytes.

Clinical Presentation:

■ Cutaneous involvement by Hodgkin's disease is rare and controversial

■ Late manifestation of the lymphoma (rarely the initial manifestation)

■ Cutaneous involvement often adjacent to the vicinity of involved lymph nodes

Histopathology:

■ Nodular to diffuse infiltrate involving the dermis and subcutaneous tissue (Fig. 4B)

■ Mixed infiltrate with characteristic large atypical lymphocytes, some of them binucleate (Reed-Sternberg cells) (Fig. 4C)

■ Small lymphocytes, eosinophils, plasma cells, and neutrophils

■ Occasional epithelioid granulomas

Differential Diagnosis:

■ Lymphomatoid papulosis/anaplastic large cell lymphoma. Both are characterized by CD 30 positive, CD15 positive lymphocytes.

Pathophysiology:

■ Epstein Barr virus is a suspected causative agent in Hodgkin's disease.

References:

1. Cerroni L, Behim-Schmid C, Kerl H. Cutaneous Hodgkin's disease: an Immunohistochemical Analysis. J Cutan Pathol 1995; 22:229-235.

2. Guitart J, Fretzin D. Skin as the primary site of Hodgkin's disease. Am J Dermapathol 1998; 20:218-222.

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