|LETTER TO EDITOR
|Year : 2016 | Volume
| Issue : 1 | Page : 24-25
Annular elastolytic giant cell granuloma
Naveen Kumar Hvs, Uday Kiran Raja, Bhanu Prakash
Department of DVL, Narayana Medical College, Nellore, Andhra Pradesh, India
|Date of Web Publication||14-Jun-2016|
Naveen Kumar Hvs
Department of DVL, Narayana Medical College, Nellore, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Hvs NK, Raja UK, Prakash B. Annular elastolytic giant cell granuloma. Indian J Dermatopathol Diagn Dermatol 2016;3:24-5
Annular elastolytic giant cell granuloma (AEGCG) is a rare granulomatous skin disease characterized histologically by phagocytosis of elastic fibers by multinucleated giant cells and clinically, by annular patches with elevated borders and atrophic centers, found mainly on sun-exposed skin. The pathogenesis of the disease remains controversial. We report the case of a 50-year-old man with the classical clinical and histological findings of the disease.
A 50-year-old man presented with a 1-year complaint of asymptomatic gradually increasing annular lesions over both the hands and neck. These lesions first appeared on the hand and gradually progressed to involve the sides of the neck. He was prescribed topical antifungal agents earlier, but the lesions did not subside. There was no family history of similar skin lesions. Cutaneous examination revealed annular plaques with papular erythematous borders, and reddish-brown atrophic center, on the dorsa of hands and sides of the neck [Figure 1] and [Figure 2]. There were no similar lesions elsewhere on the trunk and extremities. There was no mucosal or nail involvement. Histopathological examination revealed a broad band-like infiltrate in the upper dermis predominantly composed of giant cells and histiocytes with reduced elastic fibers [Figure 3] and [Figure 4]. Elastophagocytosis was noted in many giant cells [Figure 5] and [Figure 6]. Necrobiosis, mucin deposition and solar elastosis were not seen. Laboratory tests including complete blood count, chest X-ray and urinalysis were within normal limits. We advised intralesional triamcinolone (10mg/ml) for our patient.
|Figure 3: Upper dermal infiltrate showing mixture of lymphocytes and giant cells traversed by collagen bundles (H and E, ×10)|
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The term “AEGCG” was proposed by Hanke et al. in 1979 and includes lesions previously called actinic granuloma, atypical necrobiosis lipoidica, and Miescher's granuloma. The relationship between AEGCG and granuloma annulare remains controversial, and an exact distinction between them may be difficult. However recent histopathological studies  suggest AEGCG to be a distinct condition, with the following characteristics:(i) Absence of mucin and necrobiosis, (ii) predominance of multinucleated giant cells, elastolysis, and elastophagocytosis, and (iii) absence of palisading granuloma. The histopathological features of the present case therefore favored a diagnosis of AEGCG rather than granuloma annulare.
Clinically, the lesions are usually isolated or clustered in annular plaques with raised borders and atrophic centers. However atypical forms have also been described. The condition is found mainly on sun exposed skin and is rarely described in covered areas. Diagnosis is based on the histopathological findings of a granulomatous reaction with elastolysis and phagocytosis of elastic fibers by multinucleated giant cells and the absence of elastic fibers in the center of the granuloma. In addition, in AEGCG, there is no necrobiosis of collagen or mucin deposition and elastosis is absent in some cases. The pathogenesis of this condition is unknown. It has been suggested that ultraviolet radiation may cause changes in the antigenicity of elastic fibers, leading to a cellular immune response to these fibers. Therapeutic options include clofazimine, chloroquine, topical and systemic corticosteroids. Our patient responded well to intralesional corticosteroids.
Financial support and sponsorship
Histopathological examination done and reported by Dr. Asha kubba.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ruth R, Fernando M. Annular elastolytic giant cell granuloma–Case report. An Bras Dermatol 2011;86:1-4.
Hanke CW, Bailin PL, Roenigk HH Jr. Annular elastolytic giant cell granuloma. A clinicopathologic study of five cases and a review of similar entities. J Am Acad Dermatol 1979;1:413-21.
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Pock L, Blazková J, Caloudová H, Varjassyová I, Konkolová R, Hercogová J. Annular elastolytic giant cell granuloma causes an irreversible disappearance of the elastic fibres. J Eur Acad Dermatol Venereol 2004;18:365-8.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]