Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
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        SKIN: Granulomatous lesions

Nodular Dermatitis, Histiocytes Predominant:

  1. sarcoidal:
    • interface, lichenoid:
      1. lichen nitidus.
      2. sarcoid.
    • dermal, subcutaneous:
      1. no evidence of foreign body:
        • sarcoid.
        • Crohn's disease.
        • Melkersson-Rosenthal syndrome (cheilitis granulomatosa Miescher Melkerson Rosenthal).
      2. evidence of foreign body:
        • silica granuloma.
        • tatto material (such as mercury, cobalt).
    • peri-infundibular: granulomatous rosacea.
    • pseudolymphoma with focal granuloma component HERE.
    • perineural: tracking S100-positive nerve twigs [S08-16360 & CN08-48], suggests tuberculoid & dimorphous leprosy (but can't be "diagnosed" unless actually see organisms by stain), but sarcoid can also do it.
  2. tuberculoid:
    • no foreign body & infectious:
    • no foreign body & noninfectious:
    • foreign body:
  3. palisaded:
    • mucin:
    • degenerated collagen early, coarse bundles late
    • degenerated collagen, cholesterol clefts, lipophages
    • ghost of venule in center & epithelioid histiocytes sometiomes in the periphery in a palisade (Churg-Strauss granuloma).
    • fibrin: rheumatoid nodule.
    • urate deposits: gout.
    • vasculitis, fibrin, necrosis of inflammatory cells: papulonecrotic tuberculid.
    • collagen bundles different from normal human ones: Zyderm (bovine) collagen reaction.
  4. interstitial:
    • mucin: granuloma annulare (GA).
    • degenerated collagen plus mixed cell infiltrate: interstitial granulomatous dermatitis with arthritis.
  5. suppurative:
    • no infectious agent identifiable:
      1. squames: ruptured millium, infundibular, or isthmic cyst.
      2. foreign material: metals, tattoo (mercury, cobalt), splinter, suture, cactus spine, silica, starch, drug injection, Talwin.
    • infectious agent identifiable:
      1. bacterial: botryomycosis (sulfur granules; bacterial); blastomycosis-like pyoderma (bacterial & vegetative), HERE; rhinoscleroma (bacterial), HERE; cat scratch disease (bacterial & lymph node necrosis foci as rods & cocci by Warthin-Starry silver & confirm with Brown-Hopps Gram stain showing as very thin Gram neg. rods3); lymphogranuloma venereum (LGV; due to chlamydia).
      2. mycobacterial: scrofuloderma, atypical mycobacterial infection, leprosy [S09-16360] (expert mycobacterial testing at ADL in National Jewish Hospital, Denver, Colorado).
      3. actinomycotic:
      4. fungal, deep:
      5. fungal, other than deep:
      6. algal:
      7. protozoal:
      8. parasitic:


  1. 3/24/10 expert consult from Dr. David Scollard @ National Hansen's Disease Programs, Baton Rouge, LA.
  2. Decision tree for leprosy [HERE] & other mycobacterial testing at ADL, above, or check with University of Washington molecular microbiology lab in Seattle.
  3. Carter JB, et. al., AJSP, p276, 1986, HERE.
  4. Chart after Ackerman BA.

(posted 29 December 2008; latest adjustment 24 May 2015)

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