S8C23P10-1: Wegener’s granulomatosis is an immune disorder manifested in both vasculitic and granulomatous patterns. The vasculitis, itself, often has granulomatous qualities. In the skin, some examples show the pattern of a leukocytoclastic vasculitis, but some show granulomatous infiltrates affecting the walls of vessels. This field is representative of a lesion of the upper respiratory tract. In this example, there is extensive fibrosis with an increased prominence of thick-walled vessels. The vessels show perivascular fibrosis; many of the vessels show perivascular condensations of dense fibrous tissue (a marker for chronicity), but one to the left of the center of the field shows a pale, loose fibrous matrix. Inflammatory infiltrates are spotty in distribution; they are both perivascular and interstitial.

S8C23P10-3:  Inflammatory infiltrates are mixed. Cell types include lymphocytes, histiocytes, eosinophils, and neutrophils.

S8C23P10-4:  In this area of perivascular fibrosis, there is a central palisaded granuloma; it involves the wall of the vessel. Histiocytes at the periphery of the granuloma are arranged in palisades. Within the granuloma, the histiocytes have the cytologic features of migratory variants. There are scattered eosinophils in the fibrous tissue. The process, in this area, qualifies as a granulomatous vasculitis ; the changes are compatible with Wegener’s granulomatosis.