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Panniculitides, an algorithmic approach.

Authors: B, Zelger;

Panniculitides, an algorithmic approach.

Abstract

The issue of inflammatory diseases of subcutis and its mimicries is generally considered a difficult field of dermatopathology. Yet, in my experience, with appropriate biopsies and good clinicopathological correlation, a specific diagnosis of panniculitides can usually be made. Thereby, knowledge about some basic anatomic and pathological issues is essential. Anatomy differentiates within the panniculus between the fatty lobules separated by fibrous septa. Pathologically, inflammation of panniculus is defined and recognized by an inflammatory process which leads to tissue damage and necrosis. Several types of fat necrosis are observed: xanthomatized macrophages in lipophagic necrosis; granular fat necrosis and fat micropseudocysts in liquefactive fat necrosis; mummified adipocytes in "hyalinizing" fat necrosis with/without saponification and/or calcification; and lipomembranous membranes in membranous fat necrosis. In an algorithmic approach the recognition of an inflammatory process recognized by features as elaborated above is best followed in three steps: recognition of pattern, second of subpattern, and finally of presence and composition of inflammatory cells. Pattern differentiates a mostly septal or mostly lobular distribution at scanning magnification. In the subpattern category one looks for the presence or absence of vasculitis, and, if this is the case, the size and the nature of the involved blood vessel: arterioles and small arteries or veins; capillaries or postcapillary venules. The third step will be to identify the nature of the cells present in the inflammatory infiltrate and, finally, to look for additional histopathologic features that allow for a specific final diagnosis in the language of clinical dermatology of disease involving the subcutaneous fat.

Related Organizations
Keywords

Vasculitis, Panniculitis, Lipodystrophy, Necrobiosis Lipoidica, Biopsy, Calciphylaxis, Macrophages, Collagen Diseases, Subcutaneous Fat, Pancreatic Diseases, Necrobiotic Xanthogranuloma, Lymphoma, T-Cell, Cutaneous, Humans, Fat Necrosis, Skin Diseases, Infectious, Algorithms

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
2
Average
Average
Average
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