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Monocyte/Macrophage Disorders

Monocyte/Macrophage Disorders. Northeast Regional Medical Center/KCOM. Granuloma Annulare. Localized Generalized Macular Deep Perforating In HIV In Lymphoma. GA - Histology.

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Monocyte/Macrophage Disorders

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  1. Monocyte/Macrophage Disorders Northeast Regional Medical Center/KCOM

  2. Granuloma Annulare • Localized • Generalized • Macular • Deep • Perforating • In HIV • In Lymphoma

  3. GA - Histology • Classic – histiocytes palisading around “necrobiotic” collagen. Granulomas located in the upper dermis with perivascular lymphocytic infiltrate • Necrobiosis – “altered” collagen, paler grayer hue, fragmented, haphazardly arranged, more compact. • Mucin prominent in older lesions.

  4. GA- Histology • Interstitial – diffuse dermal infiltrate between collagen bundles consisting of histiocytes, monocytes, neutrophils. • “Skip” areas of normal dermis seen. • Interstitial mucin often seen. • May be adjacent to classic granulomas

  5. GA

  6. Epithelioid histiocytes

  7. Papular GA

  8. Localized GA • Young adults • Acral • Annular, scalloped • White or pink flat topped papules spread peripherally • 75% clear in 2 yrs • 25% last 8 yrs

  9. Generalized/Diffuse GA • MC women past middle age • Diabetes reported in 20% cases • MC neck, upper trunk, shoulders • Sun exposure may trigger • MC form of GA seen in HIV. • Clears spontaneously in 3-4 years. • Difficult to treat.

  10. Disseminated GA

  11. Subcutaneous GA • Aka Deep, Pseudorheumatoid Nodule • MC children, boys > girls 2:1 • MC ages 5-12. • Acral distribution, usually multiple lesions • History of trauma preceding lesion • Asymptomatic but often an extensive workup is done to rule out JRA.

  12. Subcutaneous GA

  13. Perforating GA • MC dorsum of hands • Papules with central keratotic core • Core represents transdermal elimination of degenerated or “necrobiotic” material in center of palisaded histiocytes.

  14. Perforating GA

  15. GA in HIV disease • GA may occur at all phases of HIV disease. • Typically papular lesions • 60% Diffuse, 40% Localized • Photodistributed and perforating lesions may occur • Identical histology

  16. GA and Lymphoma • Rare • Atypical presentation: • Facial or Palmar • Painful • Any type of lymphoma can occur. • Lymphoma may occur before or after the GA.

  17. GA- Treatment • Biopsy, IL, Cryo, topical Vit. E, Excision • GENERALIZED: Problematic • Oral steroids, high dose but high relapse rate – diabetes complicates • Dapsone, Nicotinomide, SSKI, Cyclosporine, Accutane.

  18. Annular Elastolytic Giant Cell Granuloma of Meischer/Actinic Granuloma of O’Brien • ? Variants of GA. • AEGCG – solitary atrophic thin yellow plaque on the forehead, NLD-like. Chronic and refractory to tx • AGOB – Photo- distribution, papules and plaques

  19. Annular Elastolytic Giant Cell Granuloma of Meischer/Actinic Granuloma of O’Brien

  20. Granuloma Mulitforme of Leiker • Similar histology to AEGCG & AGOB • Only Central Africa, Adults > 40 yrs old. • Upper Trunk and Arms • Begin as small papules, expand into round or oval plaques 15cm wide and as much as 4mm in height. • Must rule out tuberculoid leprosy.

  21. Granuloma Mulitforme of Leiker

  22. Sarcoidosis • A systemic granulomatous disease of undetermined etiology with a persistant courseinterrupted by remissions and rrelapses • Lungs, lymph nodes, skin and eyes MC. • 10x more frequent in blacks in US • Women under age 40 • Irish, African, Afro-Caribbean.

  23. NON-CASEATING GRANULOMAS COMPOSED OF EPITHELIOID CELLS AND OCCASIONAL LANGERHAN’S GIANT CELLS

  24. “NAKED” GRANULOMAS “NAKED” meanse a sparse rather than a dense infiltrate. Lymphocytes, macrophages & fibroblasts may occur

  25. Asteroid Body inside a multinucleated giant cell

  26. Sarcoidosis

  27. SCHAUMANN OR CONCHOIDAL BODIES ARE COMPOSED OF CALCIUM CARBONATE. THEY ARE EASILY MISSED (LEFT) IF NOT VIEWED UNDER POLARIZED LIGHT (RIGHT)

  28. Sarcoidosis AKA…. • Besnier-Boeck-Schaumann Disease • Boeck’s sarcoid • Besnier’s lupus pernio • Schaumann’s benign lymphogranulomatosis

  29. Sarcoid Skin Involvement • Anywhere from 9% to 37% of cases. • 2 types: specific and non-specific • Specific: granulomas on biopsy • Non-Specific: reactive, Erythema Nodosum • Skin findings may occur before, during or after systemic findings.

  30. Sarcoid – like syphillis, mimics many other dz’s • Papules, nodules, plaques. • Subcutaneous nodules. • Scar sarcoid, erythroderma. • Ulcerations, verrucous. • Ichthyosiform, hypomelanotic

  31. Papular Sarcoid • MC form • AKA Miliary Sarcoid • Face, eyelids, neck, shoulders • May involute to macules • Ddx: syringomas

  32. Papular Sarcoid

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