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Am J Dermatopathol. 2005 Feb;27(1):1-
Feb;27(1):1-5.
       $  ' (! (!     

    
Barzilai A,
A, Huszar M,M, Shpiro D,
D, Nass D,
D, Trau H.
H.
Department of Dermatology, Sheba Medical Center, Tel- Tel-Hashomer, and
Sackler Faculty of Medicine, Tel-
Tel-Aviv University, Tel-
Tel-Aviv, Israel.
avivb@post.tau.ac.il
)

Pseudorheumatoid nodules are considered a deep form of granuloma
annulare. Most cases are described in children, occur mainly on the lower legs
and scalp, and have favorable prognosis. Their appearance in adults is rare. In
this series, fourteen women with pseudorheumatoid nodules were studied. The
average age of onset was 36 years old. Lesions consisted of erythematous,
violaceous, or skin-
skin-colored nodules located mainly on the small joints of the
hands. None of the patients developed collagen vascular disease. Persistence
was common. Biopsy specimens showed deep dermal nodules composed of
epithelioid granulomata separated by thickened collagen bundles. In some
areas eosinophilic material was surrounded by histiocytes in a palisaded array.
Granuloma annulare was present at the periphery of eight cases. Special
stains revealed that most of the eosinophilic material was collagen and mucin
was present in eleven cases. In sum these findings demonstrate that
pseudorheumatoid nodules in adults are a distinct clinical and pathologic entity,
which may be mistaken for rheumatoid nodules. They are probably a juxta-
juxta-
articular variant of granuloma annulare.
PMID: 15677968 [PubMed - indexed for MEDLINE]
Pediatr Dermatol. 1994 Mar;11(1):6-
Mar;11(1):6-9.
     
     
$ 
    * 
Evans MJ,
MJ, Blessing K,
K, Gray ES.
ES.
Department of Pathology, Aberdeen University, United Kingdom.
)

Pseudorheumatoid nodule of childhood is seen uncommonly by
pathologists and is thought to be a variant of granuloma annulare.
We report a series of 20 patients (13 M, 7 F) age 1 to 17 years.
Fourteen lesions arose on the front of the lower limb, and 14
children had numerous lesions at diagnosis. Seven developed
some form of recurrence, except for one case occurring at the site
of the original lesion. Only one patient had a weakly positive
rheumatoid factor, and was the patient with remote recurrence. As a
significant number of lesions arose around the foot when the child
was beginning to walk or starting to wear shoes, it is suggested that
trauma plays a role in the development of some of these lesions.
PMID: 8170852 [PubMed - indexed for MEDLINE]
Turk Neurosurg. 2007;17(1):19-
2007;17(1):19-22.
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         $  
   *    
Sabuncuoğlu H, H, Oge K,
K, Söylemezoğlu F,F, Sağlam A.
A.
Neurosurgery Department, Ufuk University School of Medicine, Ankara,
Turkey. hsabuncuoglu@hotmail.com
)

Granuloma annulare is a benign inflammatory skin lesion of unknown
etiology that is usually seen in adults and children and subtypes of it
includes localized granuloma annulare, generalized granuloma annulare,
subcutaneous granuloma annulare and arcuate dermal erythema. Etiology
and pathogenesis of granuloma annulare are obscure, although there is
much evidence for an immunologic mechanism. Precipitating factors are
insect bites, sunburn, photochemotherapy, drugs, physical trauma, acute
phlebitis and sepsis after surgery. Some investigators were suggested a
relationship of granuloma annulare to a latent or clinically manifest diabetes
or rheumatoid arthritis. In contrast, an association of subcutaneous
granuloma annulare with these diseases in childhood has not been reported
in the literature. Subcutaneous granuloma annulare of the scalp is rare
lesion in childhood and nodules on the scalp are usually non-
non-, or slightly
mobile, whereas lesions on the extremities are freely mobile. For definitive
diagnosis, a biopsy should be performed but wide surgical intervention or
medical treatment is not indicated. In case of recurrence, no additional
diagnostic studies are necessary.
PMID: 17918673 [PubMed - indexed for MEDLINE]
MEDLINE]m )
m )
Semin Cutan Med Surg. 2007 Jun;26(2):96-
Jun;26(2):96-9.
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Requena L,L, Fernández
Fernández--Figueras MT MT..
Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma de
Madrid, Spain. lrequena@fjd.es
)

Subcutaneous granuloma annulare is a rare clinicopathologic variant of granuloma
annulare, characterized by subcutaneous nodules that may appear alone or in
association with intradermal lesions. The pathogenesis of this deep variant of
granuloma annulare remains uncertain. Subcutaneous granuloma annulare appears
more frequently in children and young adults, and the lesions consist of
subcutaneous nodules with no inflammatory appearance at the skin surface, most
commonly located on the anterior aspects of the lower legs, hands, head, and
buttocks. Usually, subcutaneous granuloma annulare is an authentic and exclusive
panniculitic process with no dermal participation, although in 25% of the patients
lesions of subcutaneous granuloma annulare coexist with the classic findings of
granuloma annulare in the dermis. Histopathologically, subcutaneous granuloma
annulare consist of areas of basophilic degeneration of collagen bundles with
peripheral palisading granulomas involving the connective tissue septa of the
subcutis. Usually, the area of necrobiosis in subcutaneous granuloma annulare is
larger than in the dermal counterpart. The central necrobiotic areas contain increased
amounts of connective tissue mucin and nuclear dust from neutrophils between the
degenerated collagen bundles. Eosinophils are more common in subcutaneous
granuloma annulare than in the dermal counterpart. There are not descriptions of
subcutaneous granuloma annulare showing a histopathologic pattern of the so- so-called
incomplete or interstitial variant. Histopathologic differential diagnosis of
subcutaneous granuloma annulare includes rheumatoid nodule, necrobiosis lipoidica
and epithelioid sarcoma.
PMID: 17544961 [PubMed - indexed for MEDLINE]
Int J Dermatol. 1986 Mar;25(2):109-
Mar;25(2):109-12.

       
Salomon RJ,
RJ, Gardepe SF,
SF, Woodley DT.DT.
)

Subcutaneous nodules with the histopathologic features
of rheumatoid nodules can occur in both rheumatic and
nonrheumatic diseases. When there is no evidence of
systemic disease, they often are classified as deep
granuloma annulare. While there are numerous reports
of such nodules occurring in children without systemic
disease, there are few reports of similarly affected
adults. Two adults are described with multiple
subcutaneous nodules that were overlying joints and
were histologically similar to rheumatoid nodules. Neither
patient had other clinical or laboratory manifestations of
rheumatic disease. These cases most likely represent an
adult form of deep granuloma annulare. The wide clinical
spectrum in which similar nodules can occur and their
pathogenesis is discussed.