Author: A/Prof Patrick Emanuel, Dermatopathologist, Auckland, New Zealand, 2013.
Annular elastolytic giant cellgranuloma is a histiocytic/granulomatousdermalinfiltrate that results in phagocytosis and destruction of elastic fibres. Atypical facial necrobiosis lipoidica is probably best considered a form of this disorder and because of this there is confusion in nomenclature.
Histology of annular elastolytic giant cellgranuloma
Sections show a granulomatous and lymphocyticinfiltrate involving the dermis (figures 1, 3). The giant cells often contain asteroid bodies (figure 2, arrows). There is an associated infiltrate containing histiocytes, lymphocytes and some plasma cells (figures 1, 2).
Special studies of annular elastolytic giant cellgranuloma
Elastic stains show a disruption of the elastic architecture (Figure 3, notice the reduced density of elastic fibres on the left side of the image).
Differential diagnosis of annular elastolytic giant cellgranuloma
Actinic granuloma (O’Brien) – Shows dense dermalelastosis which is thought to be responsible for the granulomatous reaction. Some of these cases have been considered synonymous with Annular Elastolytic Giant CellGranuloma which has caused some confusion with nomenclature
Atypical facial necrobiosis lipoidica – This is thought by many authors to be annular elastolytic giant cellgranuloma and seems to have no association with usual necrobiosis Lipoidica.
Sarcoidosis – Shows less associated inflammation and generally shows well-defined epithelioid granulomas.
Pathology of the Skin (Fourth edition, 2012). McKee PH, J. Calonje JE, Granter SR