S8C36aP22a-1: Histiocytes are clustered among collagen bundles of the reticular dermis. The histiocytic infiltrates are not well organized. Collagen bundles of the reticular dermis, within the domain of the lesion, are coarsened. The patient had an established diagnosis of Wegener’s granulomatosis.

S8C36aP22a-2: At a higher magnification, the histiocytic infiltrates have partially displaced the collagen bundles of the reticular dermis. Blue arrows identify two areas of basophilic necrosis; in these areas, the relationships qualify the lesion as a variant of a palisaded granuloma. Small, palisaded granulomas are acceptable in the setting of the collagen-vascular diseases.

S8C36aP22a-3: The zones of basophilic necrosis are associated with a smudgy, fibrinoid change in some of the neighboring collagen bundles. Some of the histiocytes form ill-defined palisades adjacent to the smudgy collagen bundles (palisaded granuloma of collagen-vascular disease in clinical setting of Wegener’s granulomatosis).