Transcript Actinic Granuloma (Annular Elastolytic Giant Cell Granuloma)

Actinic Granuloma
(Annular Elastolytic Giant Cell
Granuloma)
-Report of A Case高雄長庚醫院皮膚科
陳毅書 郭宏文 何宜承
Case Report
• A 53 y/o male patient, with multiple
erythematous to brownish , annular shaped
plaques
• Site: forehead, neck, v-chest, bil dorsal
hands (sun-exposure area)
• Size: about 35cm in diameter
• Number: total 8 10
• Combined S/S: (-)
Case Report
• Clinical Impression
– R/O Granuloma annulare , R/O sarcoidosis,
R/O leprosy
• Skin biopsy (89/04/12)
• H&E stain , Verhoeff-van Gieson stain
Diagnosis
Actinic Granuloma
(Annular Elastolytic Giant Cell
Granuloma)
Discussion
Actinic Granuloma
(Annular Elastolytic Giant Cell
Granuloma)
History
• 1967 Dowling et al : atypical (annular)
necrobiosis lipoidica of the face and scalp
• 1973 Mehregan et al : Miescher’s
granuloma of the face
• 1975 O’Brien : Actinic Granuloma
• 1979 Hanke et al : Annular Elastolytic Giant
Cell Granuloma
Clinical Features
• Sex : female predominant
• Age of onset: middle to old age ( >30
40y/o)
• Etiology: unknown, may be due to the
“ cell-mediated immune response to weakly
antigenic determinants on actinically
altered elastotic fibers”
Clinical Features
(Skin lesion)
• Single or multiple, asymptomatic,
erythematous to brownish , annular to
serpinginous plaques, with slowly
centrifugal progression
• Size: millimeters to centimeters
• Site:
– sun-exposure area : forehead, neck, v-chest,
extensor site of extremities
– covered area: abdomen, back (case report)
Histopathological Findings
• Elevated border:
– granulomatous infiltration , histiocytes in a
palisade of interstitual pattern.
– multinucleated giant cell , elastotic fibers
adjacent to and within the giant cells.
– Asteroid body
– Mucin : (-)
Histopathological Findings
• Central Zone:
– near or total absence of elastic fibers (Verhoefvan Gieson stain)
– collagen: scarlike appearance, slightly
• The zone peripheral to the annulus:
– increase amount of thick elastotic metarial with
the staining properties of elastic tissue
Differential Diagnosis
•
•
•
•
Granuloma Annulare
Necrobiosis Lipoidica
Sarcoidosis
Lupus vulgaris
Differential Diagnosis
• Granuloma Annulare
– complete loss of elastic tissue in the central
zone (actinic granuloma)
– larger and more numerous giant cells (actinic
granuloma)
– mucin :actinic granuloma (-)
– Necrobiosis : actinic granuloma (-)
– engulfment of abnormal elastic fibers (both)
Differential Diagnosis
• Necrobiosis Lipoidica
– clinical: marked atrophy, alopecia,
sclerodermoid change
– complete loss of elastic tissue in the central
zone (actinic granuloma)
– necrobiosis : sclerosis, lipids and vascular
changes
– deeper dermis / subcutis infiltration
– multiple giant cells, asteroid body (-)
Differential Diagnosis
• Sarcoidosis
–
–
–
–
naked epitheloid tubercles
asteroid body (both)
elastolysis (actinic granuloma)
fragments of elastic fibers in multinucleated
giant cells (actinic granuloma)
Differential Diagnosis
• Lupus Vulgaris
– Tuberculin test : always positive
– Acid-fast bacilli : can sometimes be
demonstrated.
– Caseation necrosis (+)
– Asteroid body(-), elastic fibers in giant cells (-)
Treatment
• Topical steroid: poor response
• Intralesional injection of steroid : poor
response
• Isotretinoin (0.5mg/kg/day) for 12 weeks -case report
Criteria for diagnosis
• annular, slowly enlarging plaques develop on sun-exposed
skin of patients at least 30 or 40 years of age
• elastotic material is present within the giantr cells, and the
inflammation is granulomatous.
• Elastotic material and elastic fibers are absent from the
postreactive central zone and greatly reduced in number
and density in the vicinity of giant cells in the annular zone
Conclusion
• Actinic granuloma
– A reactive process toward the abnormal
elastotic tissue of the skin damaged by sun
– Clinical: similar to Granuloma Annulare
– Histopathology & VVG stain: special finding
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