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 Table of Contents  
LETTER TO EDITOR
Year : 2016  |  Volume : 3  |  Issue : 1  |  Page : 24-25

Annular elastolytic giant cell granuloma


Department of DVL, Narayana Medical College, Nellore, Andhra Pradesh, India

Date of Web Publication14-Jun-2016

Correspondence Address:
Naveen Kumar Hvs
Department of DVL, Narayana Medical College, Nellore, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2349-6029.184003

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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

How to cite this URL:
Hvs NK, Raja UK, Prakash B. Annular elastolytic giant cell granuloma. Indian J Dermatopathol Diagn Dermatol [serial online] 2016 [cited 2020 Oct 28];3:24-5. Available from: https://www.ijdpdd.com/text.asp?2016/3/1/24/184003

Sir,

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.[1] 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 1: Annular plaque on the dorsum of left hand

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Figure 2: Erythematous annular lesions on the side of neck

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Figure 3: Upper dermal infiltrate showing mixture of lymphocytes and giant cells traversed by collagen bundles (H and E, ×10)

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Figure 4: Reduced elastic fibers in the upper dermis (Von Gieson, ×10)

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Figure 5: Multiple histiocytes with elastophagocytosis (H and E, ×40)

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Figure 6: Elastophagocytosis of elastic fibers (Von Gieson, ×40)

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The term “AEGCG” was proposed by Hanke et al.[2] 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 [3] 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.[4] 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.[5] 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 Top

1.
Ruth R, Fernando M. Annular elastolytic giant cell granuloma–Case report. An Bras Dermatol 2011;86:1-4.  Back to cited text no. 1
    
2.
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.  Back to cited text no. 2
    
3.
Limas C. The spectrum of primary cutaneous elastolytic granulomas and their distinction from granuloma annulare: A clinicopathological analysis. Histopathology 2004;44:277-82.  Back to cited text no. 3
    
4.
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.  Back to cited text no. 4
    
5.
Vehring KH, Bonsmann G, Brocker EB, Hamm H. The anulare elastolytic giant cell granuloma-a differential diagnosis of cutaneous granulomatois. Dermatologist 1991;42:391-5.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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