Monocyte/Macrophage Issue.


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Granulomas situated in the upper dermis with perivascular lymphocytic penetrate ... Nose, cheeks, lips. Brow, ears. 43% connected with punched out ...
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Monocyte/Macrophage Disorders Northeast Regional Medical Center/KCOM

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Granuloma Annulare Localized Generalized Macular Deep Perforating In HIV In Lymphoma

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Granuloma Annulare Common, Idiopathic, all races half patients IgM and C3 in vessels LCV changes in some cases seen Suggests Ab interceded vasculitis Common in HIV patients EBV at times discovered Occurs in determined injuries Zoster

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GA - Histology Classic – histiocytes palisading around "necrobiotic" collagen. Granulomas situated in the upper dermis with perivascular lymphocytic penetrate Necrobiosis – "adjusted" collagen, paler grayer tint, divided, aimlessly masterminded, more minimized. Mucin unmistakable in more seasoned injuries.

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GA-Histology Interstitial – diffuse dermal invade between collagen groups comprising of histiocytes, monocytes, neutrophils. "Skip" territories of typical dermis seen. Interstitial mucin frequently seen. May be adjoining great granulomas

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Upper dermis "Skip regions" Mucin Deep dermis, subQ No "skip" territories No mucin Interstitial GA NLD

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Localized GA Young grown-ups Acral Annular, scalloped White or pink level topped papules spread incidentally 75% clear in 2 yrs 25% last 8 yrs

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Diffuse GA MC ladies past middle age Diabetes reported in 20% cases MC neck, upper trunk, shoulders MC type of GA found in HIV. Clears suddenly in 3-4 years. Hard to treat.

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Subcutaneous GA Aka Deep, Pseudorheumatoid Nodule MC kids, young men > young ladies 2:1 MC ages 5-12. Acral dissemination History of injury going before sore Asymptomatic however regularly a broad workup is done to preclude JRA.

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Perforating GA MC dorsum of hands Papules with focal keratotic center Core speaks to transdermal end of deteriorated or "necrobiotic" material in focus of palisaded histiocytes.

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GA in HIV sickness GA may happen at all periods of HIV malady. Regularly papular injuries 60% Diffuse, 40% Localized Photodistributed and puncturing sores may happen

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GA and Lymphoma Rare Atypical presentation: Facial or Palmar Painful Any kind of lymphoma can happen. Lymphoma may happen before or after the GA.

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GA-Treatment Biopsy, IL, Cryo, topical Vit. E, Excision GENERALIZED: Problematic Oral steroids, high dosage yet high backslide rate – diabetes confuses Dapsone, Nicotinomide, SSKI, Cyclosporine, Accutane.

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Annular Elastolytic Giant Cell Granuloma of Meischer/Actinic Granuloma of O\'Brien

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Annular Elastolytic Giant Cell Granuloma of Meischer/Actinic Granuloma of O\'Brien Variants of GA. AEGCG – lone atrophic flimsy yellow plaque on the temple, NLD-like. AGOB – Photo-appropriation, papules and plaques

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Histo: Like GA, however with Giant Cells, Elastophagocytosis

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Histo: Like GA, yet with Giant Cells, Elastophagocytosis

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Histo: Like GA, yet with Giant Cells, Elastophago-cytosis

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Photoexacerbated GA

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Granuloma Mulitforme of Leiker Similar histology to AEGCG & AGOB Only Central Africa, Adults > 40 yrs old. Upper Trunk and Arms Begin as little papules, venture into round or oval plaques 15cm wide and as much as 4mm in tallness. Must preclude tuberculoid sickness.

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Granuloma Mulitforme of Leiker

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Sarcoidosis Multisystem Disease Lungs, lymph hubs, skin and eyes MC. 10x more successive in blacks in US Women under age 40 Irish, African, Afro-Caribbean. Nearness conversely corresponding to the occurrence of TB and/or Leprosy.

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Sarcoidosis Etiology obscure HLA-A1 – Lofgren\'s disorder HLA-B13 – Chronic & Persistent structure HLA-B8 HLA-DR3 Final regular pathway is granuloma development

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NON-CASEATING GRANULOMAS COMPOSED OF EPITHELIOID CELLS AND OCCASIONAL LANGERHAN\'S GIANT CELLS

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"Exposed" GRANULOMAS "Stripped" meanse a scanty as opposed to a thick penetrate. Lymphocytes, macrophages & fibroblasts may happen

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Asteroid Body inside a multinucleated mammoth cell

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SCHAUMANN OR CONCHOIDAL BODIES ARE COMPOSED OF CALCIUM CARBONATE. THEY ARE EASILY MISSED (LEFT) IF NOT VIEWED UNDER POLARIZED LIGHT (RIGHT)

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Sarcoidosis AKA… . Besnier-Boeck-Schaumann Disease Boeck\'s sarcoid Besnier\'s lupus pernio Schaumann\'s generous lymphogranulomatosis

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Sarcoid Skin Involvement Anywhere from 9% to 37% of cases. 2 sorts: particular and non-particular Specific: granulomas on biopsy Non-Specific: receptive, Erythema Nodosum Skin discoveries may happen some time recently, amid or after systemic discoveries.

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Sarcoid – like syphillis, mirrors numerous other dz\'s Papules, knobs, plaques. Subcutaneous knobs. Scar sarcoid, erythroderma. Ulcerations, verrucous. Ichthyosiform, hypomelanotic

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Papular Sarcoid MC structure AKA Miliary Sarcoid Face, eyelids, neck, shoulders May involute to macules Ddx: syringomas

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Papular Sarcoid

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Papular Sarcoid

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Papular Sarcoid

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Papular Sarcoid

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Annular Sarcoidosis Central clearing Hypo-shade ation Atrophy Scarring Favor head & neck Assoc. with incessant sarcoidosis

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Annular Sarcoidosis

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Hypopigmented Sarcoid May be the most punctual indication of sarcoidosis in blacks. MC limits Visually macular, however regularly have a discernable dermal or subQ part in focal point of sore

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Hypopigmented Sarcoid

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Lupus Pernio Violaceous Nose, cheeks, lips Forehead, ears 43% connected with punched out bone sores. 37% Ocular sores Nasal puncturing

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Punched-Out Lytic injuries, Bone Cysts

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Ulcerative Sarcoidosis

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Lupus Pernio

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Lupus Pernio

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Lupus Pernio

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Lupus Pernio

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Darier-Roussy Sarcoid 5% or less of patients with sarcoidosis have subcutaneous knobs.

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Darier-Roussy (SubQ)

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Scar Sarcoid

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Scar Sarcoid

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Erythrodermic Sarcoid Extremely Rare Begins as erythematous patches that get to be intersecting.

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Ichthyosiform Sarcoid Legs Arms No discernable part

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Ichthyosiform Sarcoid

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Alopecia Occurs in 2 settings; 1) Existing plaques broaden onto scalp. - prompts changeless scarring. 2) Macular injuries show up on scalp looking like Alopecia Areata - might be lasting or reversible

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Morpheaform Sarcoid Rare Dermal Fibrosis Simulates Morphea Antimalarials may offer assistance.

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Morpheaform Sarcoid

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Morpheaform Sarcoid

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Mucosal Sarcoid Pinhead estimated papules Grouped or melded to shape a plaque.

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Erythema Nodosum in Sarcoid MC nonspecific cutaneous finding in sarcoidosis Young females Anterior shins Good guess Lofgren\'s Syndrome = fever, arthralgias, hilar adenopathy, weakness, EN

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Systemic Sarcoidosis MC – Lungs Ocular 20-30% Bones & Liver 20%, hoisted Alk Phos. Renal, Hypercalcemia Heart, CNS, Spleen Elevated ACE levels to take after ailment action as it were.

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Heerfort\'s Syndrome Parotid organ development Lacrimal organ growth Uveitis Fever Sarcoidosis

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Mikulicz\'s Syndrome Sarcoidosis with augmentation of the; Lacrimal organs Submaxillary and Parotid organs. Dangerous: various conditions including augmented partoid organs have since been named after Dr. Mikulicz.

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CXR-Hilar Adenopathy

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Sarcoidosis in Fingers

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Sarcoidosis in Fingers

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CNS

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Candle-wax drippings – granulomatous uveitis

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Sarcoid - Treatment Systemic Corticosteroids Antimalarials Methotrexate Thalidomide

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Non-X Histocytoses Juvenile Xanthogranuloma Benign Cephalic Histiocytosis Solitary/Multicentric Reticulohistiocytosis Generalized Eruptive Histiocytoma Necrobiotic Xanthogranuloma Xanthoma Disseminatum Papular Xanthoma Indeterminate Cell Histiocytosis Progressive Nodular Histiocytoma Hereditary Progressive Mucinous Histiocytosis Rosai-Dorfman Disease Sea-Blue Histiocytosis

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Juvenile Xanthogranuloma (JXG) MC Non-Langerhans\' histiocytosis 1 st year of life, usu. white guys 80% are singular, all around divided, firm, rubbery red to pink with yellow tinge Regress in 3-6 years with decay. Visual association uncommon, MC iris Assoc. with NF-1 and JCML

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JXG Histopathology Non-embodied Infiltrate in the upper and mid reticular dermis Mononuclear cells with bottomless amphophilic cytoplasm that is inadequately lipidized or vacuolated.

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MULTINUCLEATED "Froth" CELLS otherwise known as TOUTON GIANT CELLS ALONG WITH EOS, NEUTS, LYMPHS. STAINS: + CD1 + FACTOR XIIIa - S100

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Benign Cephalic Histiocytosis Rare Males 2:1, Onset 6-12 months of age Begins on head, cheeks, spreads to neck and upper trunk Multiple rosy yellow papules 2-3mm, may blend into a reticulate example. Involute more than 2 to 8 years with decay

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BENIGN CEPHALIC HISTIOCYTOSIS DIFFUSE DERMAL INFILTRATION OF NON-LIPIDIZED HISTIOCYTIC CELLS, S-100 NEGATIVE

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Reticulohistiocytosis Solitary structure – otherwise known as Reticulohistiocytic Granuloma or Reticulohistiocytoma Solitary structure has no systemic inclusion Multicentric structure – otherwise known as Multicentric Reticulohistiocytosis Underlying threat in 30%

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Reticulohistiocytic Granuloma

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Reticulohistiocytic Granuloma: Multinucleate Giant Cells, Histiocytes, Lymphocytes with some stroma fibrosis

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Multicentric Reticulohistiocytosis Multisystem illness, 5 th d

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