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Eruptive xanthoma: a microscopic simulant of granuloma annulare
Author(s) -
Cooper P. H.
Publication year - 1986
Publication title -
journal of cutaneous pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 75
eISSN - 1600-0560
pISSN - 0303-6987
DOI - 10.1111/j.1600-0560.1986.tb01646.x
Subject(s) - pathology , histiocyte , granuloma annulare , dermis , reticular connective tissue , eosinophilic , reticular dermis , xanthoma , giant cell , biology , medicine
The microscopic appearance of eruptive xanthoma (EX) presents the potential for misinterpretation as granuloma annulare (GA). Both exhibit one or multiple lesions in the superficial reticular dermis. Both have a perivascular and interstitial inflammatory cell infiltrate. Extracellular lipid in EX separates and disrupts the reticular dermis, simulating necrobiosis. There are several useful differential diagnostic features. The perivascular infiltrate is histiocytic in EX and lymphoid in GA. The histiocytes of EX have translucent, finely stippled cytoplasm, whereas those of GA have denser eosinophilic cytoplasm. EX lacks a distinctly granulomatous appearance, whereas epithelioid and multinuclear cells arc typical of GA. The semilucent extracellular deposits of lipid in EX are associated with only minimal fragmentation of collagen and no evidence of cellular necrosis. Necrobiotic material stains more deeply eosinophilic or basophilic; degradation of collagen is discern‐able, and there is often evidence of cell death. Both EX and GA exhibit deposits of hyaluronic acid. They tend to be concentrated at the borders of lesions in EX and in the centers of lesions in GA. Elastolysis was not appreciated in EX. It was present in some eases of GA.