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PANNICULITIS

PANNICULITIS. Stephen Hughes, MD Dermatopathologist Maize Center for Dermatopathology Mt. Pleasant, SC. Lipodermatosclerosis. Mostly Septal Panniculitis. Without vascular lesions. Morphea profunda. Septal panniculitis Widening and sclerosis of septa

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PANNICULITIS

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  1. PANNICULITIS Stephen Hughes, MD Dermatopathologist Maize Center for Dermatopathology Mt. Pleasant, SC

  2. Lipodermatosclerosis

  3. Mostly Septal Panniculitis Without vascular lesions

  4. Morphea profunda • Septal panniculitis • Widening and sclerosis of septa • May or may not have dermal involvement • Eosinophils common but may be absent • Plasma cells should be present

  5. DDX: • Erythema nodosum • Has granulomas/radial granulomas not seen in scleroderma • Plasma cells not a feature • Eosinophilic fasciitis • Microscopically identical • Clinically distinct • Eosinophilic panniculitis • Mixed septal and lobular with massive eosinophils • Various associations (bites, parasites, atypical EN)

  6. Erythema Nodosum • Microscopic features (fully developed): • Septal widening +/- fibrosis • Mixed inflammatory infiltrate: • Lymphocytes, macrophages, multinuc gc’s, neuts, eos • Miescher’s radial granulomas • Occasional foamy histiocytes (lipophages) in lobules

  7. Mostly Septal Panniculitis With vascular lesions

  8. Polyarteritis Nodosa • Neuts, leukocytoclastic debris (dust), eos, lcs • Medium artery in a septum of fat • (+/- deep dermis) • Fibrin in vessel wall • Mixed infiltrate in septum with little spillover into lobule • +/- thrombus

  9. Thrombophlebitis • Thrombus in vessel lumen • Little inflammation (if at all) • Usually no fat necrosis • Late finding – organization of thrombus

  10. Mostly Lobular Panniculitis With Vasculitis

  11. Nodular Vasculitis/Erythema Induratum (Bazin) • MIXED SEPTAL AND LOBULAR PATTERN • MIXED INFILTRATE • LCs, neuts, histiocytes, mn gcs • GRANULOMAS +/- caseation • +/- ULCERATION • AFB stain usually NEGATIVE • PCR (+) 25-75% (Erythema induratum)

  12. Mostly Lobular Panniculitis Without Vasculitis

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