S8C18P5-Granuloma Faciale

S8C18P5-1: In this third example of granuloma faciale, the basic patterns are represented, but the infiltrates are unusually dense and somewhat confluent. In addition, on the right in an area outlined by blue arrows, there is a small pustule which extends to the dermal-epidermal interface; it violates the grenz zone.

S8C18P5-2: In this field, green arrows identify a zone of  fibrinoid in laminated patterns. Purple arrows identify plasma cells. Blue arrows point to eosinophils. The yellow arrow points to an acidophilic body, probably a Russell body. The infiltrates are supported by a loose fibrous matrix.

S8C18P5-3: Red arrows define a boundary between two types of fibrous tissue. Above, the fibrous tissue is composed of  parallel, fibrous lamellae with fibrinoid qualities; this is an unusual pattern for a grenz zone. Below, the pattern is characteristic of the changes commonly seen in the reticular dermis in lesions of granuloma faciale. Blue arrows point to eosinophils. Dark green arrows point to pigmented histiocytes; the pigment is probably hemosiderin. Purple arrows (left lower corner) point to plasma cells.

S8C18P5-4: Blue arrows define a boundary between the angioplastic lesion of the reticular dermis and the grenz zone. Red arrows point to an area of fibrinoid degeneration. Yellow arrows identify a neighboring intact vessel. The fibrinoid is perivascular in this area.

S8C18 P5-5: A patch of inflamed granulation tissue sits in the reticular dermis; it is separated from the papillary dermis by a thin zone of uninvolved reticular dermis showing solar elastosis (this zone and the papillary dermis qualify as a grenz zone). The vessel in the center of the field is outlined by a zone of edematous, fibrous tissue. Outside this zone, deposits of fibrinoid (a mesh of bright red fibers) are arranged concentrically around the vessel. The adjacent infiltrates are pleomorphic; the cells include lymphocytes, plasma cells, eosinophils, neutrophils, and migratory histiocytes (granuloma faciale).

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