S9C24P15-Granuloma Annulare

S9C24P15-1: This lesion of GA shows activated histiocytes. Prominent cell processes of the histiocytes are  in intimate contact with fibrillated collagen bundles. The histiocytes apparently are digesting the collagenous material.

S9C24P15-2: The complex cell processes of activated histiocytes are intimately associated with fissured and fibrillated collagen bundles (GA).

S9C24P15-3: This lesion qualifies as a lymphocytic infiltrate of the dermis by most criteria. There are prominent, perivenular cuffs of lymphoid cells which extend along vessels from the upper portion of the reticular dermis to the lower margin of the biopsy. The dermis among the inflamed vessels (a pattern of lymphocytic vasculitis by an alternate set of criteria) is characterized by widening of spaces among collagen bundles. The collagen bundles are delicate. In the focal area outlined by green arrows, the connective tissue changes are prominent. Perhaps some observers might interpret the changes as those of an early lesion of granuloma annulare.

S9C24P15-4: At higher magnification, the collagen bundles vary in size (diameter)  and are widely spaced. There is an increased number of cells among the altered collagen bundles (lymphohistiocytic collagenosis).

S9C24P15-5: With a slightly different technique, spaces among the collagen bundles are widened. Elastotic fibers also are represented among the altered collagen bundles; they contribute much of the basophilia. The lesion is a lymphocytic infiltrate of the dermis; it also qualifies as a mucinosis. Collagen-vascular disease should be mentioned in the differential diagnosis. Reticulated erythematous mucinosis might be mentioned.

 

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