PMC5343250_01
Granuloma annulare. (a) A palisading granuloma with central collagen degeneration (H&E stain, magnification x100); (b) Alcian blue stain showing increased mucin deposition within the granuloma (Alcian blue stain, magnification x100); (c) several annular red-brown plaques involving the thigh.
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fig1
Her past medical history was significant for a 9-year history of generalized GA proven on two skin biopsies for which she receives phototherapy 3 times per week (Figures 1(a) and 1(b)). Physical examination was unremarkable except for multiple generalized red-brown annular plaques involving the trunk and extremities (Figure 1(c)).
The portal tracts either contain scattered lymphocytes or are entirely devoid of inflammation. In the perivenular areas, Kupffer cells containing ceroid pigments indicative of prior cellular injury and cell turnover are noted. Scattered lymphocytes are also seen in the perivenular zone. Small aggregates of histocytes, "microgranulomata," are identified in the hepatic lobule and in the perivenular region. (a) and (b) 10x and 20x H&E stain; (c) and (d) 10x and 20x trichrome stain.
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fig2
Interestingly, granulomas were identified in the hepatic lobules and in the perivenular regions (Figure 2).