Granuloma Faciale | Dermatopathology

This patient has a benign reactive process diagnostic of granuloma faciale. One could use the adjectival modifier of giant to denote the very extensive nature of the plaques and as well there is a significant degree of advanced patterned hyalinizing fibrosis, defining a morphology that is seen in the upper respiratory tract equivalent of granuloma faciale--namely angiocentric eosinophilic fibrosis. The clue in recognizing the diagnosis is really the identification of chronic and subacute vasculitic changes within the vessels of the dermis. In fact, the infiltrate shows accentuation around vessels which exhibit the very classic changes that one associates with granuloma faciale, a diagnosis that is somewhat obscured by the extensive diffuse nature of the background reactive lymphoplasmacytic infiltrate. The vessels are dilated with variable mural fibrin deposition and a healing phase of hyalinizing fibrosis accompanied by evidence of vascular compromise including hemorrhage and hemosiderin deposition, defining the classic subacute and chronic changes that one associates with eosinophilic angiocentric fibrosis.

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Slide 1: 48 year-old woman with a purplish plaque of the face. Low power examination discloses an extensive diffuse and nodular inflammatory cell infiltrate.

Slide 2: There is accentuation of the inflammatory cell infiltrate around blood vessels whereby this infiltrate is associated with concomitant vasculitic alterations which in turn range in quality from being more acute to chronic. In particular, the vessels are surrounded and permeated by this aforesaid inflammatory cell infiltrate and show evidence of vascular compromise characterized by hemorrhage and hemosiderin deposition.

Slide 3: There is accentuation of the inflammatory cell infiltrate around blood vessels whereby this infiltrate is associated with concomitant vasculitic alterations which in turn range in quality from being more acute to chronic. In particular, the vessels are surrounded and permeated by this aforesaid inflammatory cell infiltrate and show evidence of vascular compromise characterized by hemorrhage and hemosiderin deposition.

Slide 4: The vessel is surrounded and permeated by the inflammatory cell infiltrate and shows evidence of vascular compromise characterized by extensive red blood cell extravasation.

Slide 5: In examining the inflammatory cell infiltrate it has a polymorphous composition, comprising lymphocytes, plasma cells, and neutrophils with a few eosinophils.

Slide 6: There is focal mural fibrin deposition and some vessels have a more hyalinized fibrotic appearance with attendant vascular ectasia. The infiltrate is without any significant cytologic atypia. A very extensive array of immunohistochemical stainswas performed and did not demonstrate any phenotypic atypicality of the infiltrate.