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expressed cytotoxic granules (T-cell intracellular antigen-1+ and granzyme B+) and were CD8+ and CD56+. Expression of CD56 is associated with a poor prognosis in subcutaneous panniculitis-like T-cell lymphoma and blastic natural killer cell lymphoma. However, the two cases of CD56+ LyP previously reported and the 3 cases in this series all appear to be pursuing an indolent course with no evidence of systemic disease.
of the follow-up was 4.8 +/- 3.5 years from the time of LD diagnosis. Of patients, 30% had evidence of localized disease (7 of 23), 26% (6 of 23) had localized partial disease, and 44% (10 of 23) had generalized LD. The most common underlying diagnosis was dermatomyositis (78%), alone or in association with other autoimmune diseases (juvenile rheumatoid arthritis 17%). Panniculitis with autoimmunity was noted in 17% of the patients. More than half of the patients had at least one complication attributable
CXCR3-mediated recruitment of cytotoxic lymphocytes in lupus erythematosus profundus. Lupus erythematosus profundus (LEP) is a rare variant lupus erythematosus with unclear etiology characterized by lobular panniculitis. Recently, we observed a case of LEP involving the lower right eyelid. Our immunohistological analyses of lesional skin biopsies revealed a type I IFN signature in the context of cytotoxic lobular panniculitis.Since type I IFNs have been shown to be involved in other cutaneous (...) was characterized using monoclonal antibodies specific for CD3, CD4, CD8, CD20, CD68, and CD123. Subsequently, we analyzed the expression the type I IFN Marker MxA, the cytotoxic molecules granzyme B and Tia1, the chemokine receptor CXCR3 and its ligand, the interferon inducible protein IP10/CXCL10.LEP skin lesions were characterized by a lobular panniculitis, dominated by cytotoxic CXCR3(+) lymphocytes. Strong MxA expression indicated extensive type I IFN production within the fat lobules. Numerous
Annular lipoatrophy of the ankles. Lipoatrophic panniculitis likely represents a group of disorders characterized by an inflammatory panniculitis followed by lipoatrophy. It occurs locally in a variety of settings and has been reported in the literature under various terms, including annular atrophic connective tissue panniculitis of the ankles, annular and semicircular lipoatrophy, abdominal lipoatrophy, and connective tissue panniculitis. Herein, a case of annular lipoatrophy of the ankles (...) is described in a 6-year-old girl with autoimmune thyroid disease. Histologically, a mixed lobular panniculitis with lipophages was present. This pattern resembles that seen in lipoatrophic panniculitis. After a single, acute episode of an inflammatory process with subsequent lipoatrophy, her skin lesions have stabilized for 2 years requiring no treatment.
the literature relating to posttransplant primary CTCL. Of the 23 cases of posttransplant primary CTCL, 5 patients had erythrodermic disease, and 8 had primary cutaneous anaplastic large cell lymphoma. In addition, there are two cases of mycosis fungoides, one case of subcutaneous panniculitis-like T-cell lymphoma, one case of CD30+ lymphomatoid papulosis, and 6 cases of peripheral T-cell lymphoma, of which 3 were CD30+ large cell lymphomas. Seventeen cases had renal transplants and the majority received
Lupus erythematosus profundus in black South Africans. Lupus erythematosus profundus (lupus panniculitis) is a rare variant of lupus erythematosus with predominant involvement of the subcutaneous tissue. There are only a few reported series of patients with this condition; none in individuals of African ancestry. The aim of the study was to evaluate clinical, histopathological and laboratory findings in black South African patients with lupus profundus.Ten prospectively observed patients were
Peripheral T-cell lymphoma presenting as lipoatrophy and nodules. Cutaneous lymphomas have many morphologic forms and clinical features. Lymphoma presents rarely with a constellation of nodules, panniculitis, and localized lipoatrophy. The histopathologic similarities of lymphoma and connective tissue disease panniculitis may create a diagnostic challenge.We retrospectively reviewed the case of a 47-year-old man who presented 15 years earlier with recurrent fevers, fatigue, tender subcutaneous (...) nodules, and facial, trunk, and extremity lipoatrophy.Initial biopsy of a cutaneous nodule showed lymphohistiocytic panniculitis without atypical inflammatory cells. Serologic tests showed negative connective tissue serologies, yet the initial clinical impression was most consistent with lupus panniculitis. Initially, the patient was treated with oral prednisone; later, steroid-sparing agents were used with modest improvement evidenced by resolution of his systemic symptoms and stabilization
by immunohistochemistry. Using cultured human preadipocytes and adipocytes, we elucidated a possible mechanism leading to adipocyte loss in this patient.Analysis of adipose tissue samples of the patient with acquired lipodystrophy obtained from skin areas affected by panniculitis suggested that loss of adipocytes was mediated by CD95-induced apoptosis. Regression of adipose tissue was accompanied by lymphohistiocytic infiltration/inflammation and increased serum levels of inflammatory cytokines interferon-gamma
Normal subcutaneous fat, necrosis of adipocytes and classification of the panniculitides. The panniculitides represent a group of heterogeneous inflammatory diseases that involve the subcutaneous fat. The specific diagnosis of these diseases requires histopathologic study because different panniculitides usually show the same clinical appearance, which consists of erythematous nodules on the lower extremities. However, the histopathologic study of panniculitis is difficult because (...) of an inadequate clinicopathologic correlation and the changing evolutive nature of the lesions. In addition, large scalpel incisional biopsies are required. From histopathologic point of view, all panniculitides are somewhat mixed because the inflammatory infiltrate involves both the septa and lobules. However, nearly always the differential diagnosis between a mostly septal and a mostly lobular panniculitis is straightforward at scanning magnification on the basis of the structures more intensely involved
arteritis with variable amounts of fibrinoid necrosis and leukocytoclasia, edema and inflammatory cells. The presence of focal panniculitis surrounding the involved artery is characteristic, in contrast with the more diffuse panniculitis usually found in other nodular diseases. Cutaneous PAN has a variable course, with repeated exacerbations. Salicilates relieve the pain in most instances and may be the only treatment required to improve the symptoms in patients with moderate flare-ups. A short course
Necrobiosis lipoidica. Necrobiosis lipoidica (NL) is a granulomatous condition with a degenerative connective tissue of unknown etiology very often associated with diabetes. Histopathologically, NL involves all of the dermis and, often, the subcutaneous fat produces a septal panniculitis. There are some changes suggesting the diagnosis of NL, and systemic disease should be considered if there is the presence of necrotizing vasculitis in the skin biopsy. Many theories of pathogenesis have been
Erythema nodosum. Erythema nodosum is the most frequent clinicopathologic variant of panniculitis. The process is a cutaneous reaction that may be associated with a wide variety of disorders, including infections, sarcoidosis, rheumatologic diseases, inflammatory bowel diseases, medications, autoimmune disorders, pregnancy, and malignancies. Erythema nodosum typically manifest by the sudden onset of symmetrical, tender, erythematous, warm nodules and raised plaques usually located on the lower (...) limbs. Often the lesions are bilaterally distributed. At first, the nodules show a bright red color, but within a few days they become livid red or purplish and, finally, they exhibit a yellow or greenish appearance, taking on the look of a deep bruise. Ulceration is never seen, and the nodules heal without atrophy or scarring. Histopathologically, erythema nodosum is the stereotypical example of a mostly septal panniculitis with no vasculitis. The septa of subcutaneous fat are always thickened
consensus agreement compared with the original WHO and EORTC classifications. In cutaneous T-cell lymphomas, these include folliculotropic mycosis fungoides, defining features of Sézary syndrome, primary cutaneous CD30+ lymphoproliferative disorders (primary cutaneous anaplastic large cell lymphoma, lymphomatoid papulosis and borderline lesions) and subcutaneous panniculitis-like T-cell lymphoma. Primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoma, primary cutaneous aggressive
Rare complication of Q fever vaccination. A 32-year-old woman with a past history of malignant melanoma presented with a lump in the upper left arm that was excised. Histological examination revealed a granulomatous dermatitis and panniculitis that proved to be a rare reaction to Q fever vaccination.
, and panniculitis associated with dermatomyositis, but rarely associated with SLE. We speculate that ischaemic changes due to the vascular disturbance of the lower legs may have induced lipomembranous changes and calcification in the subcutaneous tissues in the present case.
is not usually required if MRI is available. Differential diagnosis - these may be differentiated by the punctum in their surface and also by their site in the dermis, attached to the surface. Subcutaneous tumours. Nodular fasciitis. Liposarcoma. Metastatic disease. . Nodular subcutaneous fat necrosis. Weber-Christian panniculitis (recurring inflammation in the fat layer of the skin). Vasculitic nodules. Rheumatic nodules. . Infections - eg, onchocerciasis. Haematoma. Management They can be left alone
for Research and Treatment of Cancer (EORTC) [ ] : Indolent clinical behaviour Mycosis fungoides. Variants and subtypes of mycosis fungoides. Folliculotropic mycosis fungoides. Pagetoid reticulosis. Granulomatous slack skin. Primary cutaneous anaplastic large cell lymphoma (CD30+). Lymphomatoid papulosis (CD30+). Subcutaneous panniculitis-like T-cell lymphoma. Primary cutaneous CD4+ small or medium pleomorphic T-cell lymphoma. Aggressive clinical behaviour Sézary's syndrome. Primary cutaneous natural (...) and infection as the skin turns into ulcerating, necrotic tumours. Differential diagnosis Early in the course of disease, skin lesions may be nonspecific, with a non-diagnostic biopsy result; hence, confusion with benign conditions is common. The most important differential diagnoses of the CTCLs include: [ ] All kinds of dermatitis and eczema. Adverse drug reactions. Parapsoriasis. Psoriasis. Lichen planus. Morphea. Panniculitis. Folliculitis. Pityriasis lichenoides chronica. Pityriasis lichenoides et
a poorer prognosis than those without. Associated diseases Concurrent autoimmune disorders occur in approximately 40% of patients, particularly autoimmune thyroid disorder. [ ] Haematological: , , , , . Gastrointestinal: , . . Fibrosing alveolitis. and . Endocrine: , autoimmune thyroiditis, . Rheumatological: and , , , , leukocytoclastic vasculitis, febrile panniculitis. . . . Management [ ] Patients with moderate or severe inflammation (defined as one or more of serum AST >5 times normal, serum
Gastrointestinal: Haemorrhage Ileus Weber-Christian disease: Subcutaneous fat necrosis - relapsing febrile nodular nonsuppurative panniculitis. Recurring crops of tender nodules in the skin and subcutaneous fat of the trunk, thighs and buttocks, which is more common in middle-aged women. These often ulcerate and then scar on healing. Difficult to treat - try prednisolone or immunosuppressives. Splenic vein thrombosis. Prognosis 80% of patients have mild disease and recover without complications
value (NPV) of 53% for appendicitis. [ ] Differential diagnosis Other causes of abdominal pain Gastrointestinal , , , , , , mesenteric adenitis, , , , , rectus sheath haematoma, . Urological , , . Gynaecological , torsion or rupture of an , . Others , , , adverse effects from immune modulation therapies (eg, panniculitis in the abdomen at the left iliac fossa, associated with beta-interferon injection). [ ] Other causes of RIF mass These include: Crohn's disease, carcinoma of colon, mucocele (...) adult. Ann Afr Med. 2009 Apr-Jun8(2):133-5. doi: 10.4103/1596-3519.56243. ; Diagnosis and Treatment of Caecal Volvulus, Postgrad Med J 200581:772-776. ; The use of the clinical scoring system by Alvarado in the decision to perform Am J Emerg Med. 2007 Jun25(5):489-93. ; Development of the RIPASA score: a new appendicitis scoring system for the diagnosis of acute appendicitis. Singapore Med J. 2010 Mar51(3):220-5. ; Interferon beta-induced panniculitis mimicking acute appendicitis. Arch Dermatol