UPMC Dermatopathology "Case of the Month" Presentations
UPP - Department of Dermatology, Dermatopathology Unit
Angela S. Casey MD, Jonhan Ho MD, Thaddeus Mully MD, Joseph C. English III MD
SEPTEMBER 2006 CASE OF THE MONTH
CLINICAL FINDINGS
RB is a 44-year-old white female with a past medical history significant for diabetes who presented with a 2-year history of asymptomatic erythematous nodules on her left forearm and left dorsal foot (near the PIP joint) as well as an asymptomatic yellow-brown plaque involving her right ankle and extending onto right left dorsal foot and lower leg. These lesions had been fairly stable over the past few years, and the patient had not treated them. Past medical history is significant for coronary artery disease status post myocardial infarction, schizophrenia, and diabetes. Medications included insulin, Avandia, Glucophage, Imdur, Zocor, Norvasc, Plavix, Toprol XL, Prilosec, Nitrostat, Albuterol, Niaspan, Reglan, Neurontin, Spiriva, Abilify, Flovent, Oxycontin, Percocet, Dyazide, Buspar
The patient is a well-appearing white female. Cutaneous exam was significant for 2-3 cm erythematous nodules on her left forearm distal to the elbow and left dorsal foot (near the PIP joint) as well as a large indurated reddish-brown plaque involving her right ankle and extending onto her right dorsal foot and lower leg. Biopsies were taken from the nodule on her left forearm as well as from the plaque on her right lateral ankle.
1. Left forearm: Examination of this specimen reveals palisades of histiocytes, which surround zones of degenerating collagen. Within these areas there are deposits of connective tissue mucin highlighted with a colloidal iron stain. A trichrome stain also highlights scattered fibrin deposits. The presence of fibrin is somewhat unusual in granuloma annulare and may be the result of prior trauma to the lesion.
2. Right lateral ankle: Examination of this specimen reveals a proliferation of mono and multinucleated histiocytes between collagen bundles. A colloidal iron stain highlights an increased amount of connective tissue mucin
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