S1C31P21-3:In this allergic granuloma, a yellow arrow points to a portion of a dead parasite. The organism is within a defect containing degenerating eosinophils. The viable eosinophils, and the necrotic debris combine to produce the zone of eosinophilia. Histiocytes are arranged in palisades about the zone of necrosis.

S1C31P21-4: Centrally, eosinophils and eosinophilic debris have collected in a defect (eosinophilic abscess). A yellow arrow points to the remnant of a necrotic parasite. To the right, there is a smudgy zone of eosinophilic necrosis. To the left and below the center of the field, there is a cluster of histiocytes in palisades.

S1C31P21-5: The remnant of the parasite floats in an infiltrate of eosinophils along with collections of acidophilic, necrotic debris.

S1C31P21-6: The clinical presentation was interpreted as compatible with Well’s syndrome. Focally, collagen bundles are sequestered by infiltrates of neutrophils, histiocytes and eosinophils. The patterns are not those of “flame figures,” but the relationships are of a type that may be seen in the clinical setting of Well’s syndrome. The organization of the patterns is such that it appears that individual collagen bundles are antigenic; degenerating neutrophils surround swollen, individual collagen bundles.

S1C31P21-7: Neutrophils and eosinophils infiltrate the dermis among collagen bundles. Some of the bundles are sequestered in the infiltrates; the inflammatory debris is basophilic rather than manifesting the intense eosinophilia of a classic flame figure. Patterns of this type may be seen as a regional variation in the setting of Well’s syndrome.