S12C17P7-Granulomas-misc


S12C17P7-1: In the area outlined by green arrows, the patterns are angioplastic. In aggregate, the patterns among the vessels have an insular quality. Vessels of the islands are increased in number per unit area. They are tortuous, and have thickened walls. There are loose perivascular infiltrates of lymphoid cells. The papillary dermis is spared; the zone of spared connective tissue between the epidermis and the dermal lesion is a “grenz” zone. In the reticular dermis, the abnormal tissue is rather well-defined among follicles; it is molded to accommodated the follicles and their sheaths (granuloma faciale - insular, facial vasculitis).

S12C17P7-2: This island is rich in vessels. The vessels have thickened walls and dilated lumens. Near the top of the field on the right, green arrows identify a vessel outlined by acidophilic lamellae; the lamellae have fibrinoid qualities. The vessel, identified by green arrows to the left of the center of the field, is outlined by concentrically arranged fibrous lamellae. The fibrous lamellae are interpreted as a product that is sequentially related to fibrinoid (toxic hyalin). Organization of the fibrinoid results in the formation of the fibrous lamellae. Inflammation is not a prominent feature but, near the grenz zone, eosinophils are recognizable in the inflammatory infiltrates of this island. To the left of the center of the field, there is a zone showing lysis of the fibrous matrix.

S12C17P7-3: Red arrows identify a vessel showing fibrinoid degeneration. Infiltrates of neutrophils are present among the fibrin deposits. Connective tissue cells are activated. Vessels have thickend walls and swollen endothelium.

S12C17P7-4: In this field, toxic hyalin and pleomorphic infiltrates of inflammatory cells (neutrophils, histiocytes, plasma cells, and eosinophils) are represented. Green arrows identify pigmented histiocytes; the pigment has the tinctorial qualities of hemosiderin. The process is focally collagenolytic.

S12C17P7-5: The grenz zone is represented beneath the epidermis. A portion of an island, that is comprised of inflamed vessels and fibrous tissue, is represented in the dermis beneath the grenz zone.The vessel just to the right of the center of the field shows numerous migratory histiocytes in the adventitia. There is a focal, loose cluster of neutrophils near the center of the field. Blue arrows identify the nuclei of migratory histiocytes. There is a high component of histiocytes in the infiltrates, but the histiocytes do not cluster in the pattern of an epithelioid granuloma. Eosinophils and plasma cells are also represented.

S12C17P7-6: In this lesion of Hansen’s disease, the infiltrates are granulomatous. In contrast to the tubercle-like patterns of sarcoidosis, the infiltrates are cuff-like along vessels. Epithelioid histiocytes form columns about vessels of the dermis. The infiltrates also involve the adventitia of sweat glands. They extend along vessels to the lower margin of the dermis (borderline tuberculoid leprosy).

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