Indian Journal of Dermatology
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CASE REPORT
Year : 2006  |  Volume : 51  |  Issue : 1  |  Page : 44-46
Annualr elastolytic giant cell granuloma with penile involvement


Department of Dermatology, RKM Seva Pratisthan & Vivekananda Institute of Medical Sciences, Kolkata, India

Correspondence Address:
Sujata Sengupta
UV-24/3C, Udayan 1050/1, Survey Park, Kolkata - 700 075
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.25191

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  Abstract 

Annular elastolytic giant cell granuloma is a recently described entity of unknown origin that presents as indolently growing papules and plaques over sun-exposed skin. Histology shows a granulomatous infiltrate with loss of elastin in the center of the lesion. We came across a patient who had penile lesions and a paucity of literature about the involvement of the external genitalia in this disorder.


Keywords: Annular elastolytic giant cell granuloma, Granuloma annulare, Actinic granuloma


How to cite this article:
Sengupta S, Das J, Gangopadhyay A. Annualr elastolytic giant cell granuloma with penile involvement. Indian J Dermatol 2006;51:44-6

How to cite this URL:
Sengupta S, Das J, Gangopadhyay A. Annualr elastolytic giant cell granuloma with penile involvement. Indian J Dermatol [serial online] 2006 [cited 2019 Dec 15];51:44-6. Available from: http://www.e-ijd.org/text.asp?2006/51/1/44/25191



  Introduction Top


Annular elastolytic giant cell granuloma (AEGCG) previously known as annular necrobiosis lipoidica (NL) and actinic granuloma (AG) has recently been proved to be a distinct entity.[1],[2] It is a granulomatous process that presents as slowly growing papules and plaques over sun-exposed skin. Lesions on the covered parts are very rare.[3] We report a case of AEGCG over the external genitalia, in addition to the other commonly involved sites. Our extensive text and electronic search did not reveal any references for AEGCG with penile lesions.


  Case Report Top


A 24-year-old male student had several asymptomatic brownish patches that appeared in succession over the arms, chest and external genitalia, for the last ten months. These patches were gradually increasing in size to form ring-like patterns. Two lesions over the hands had spontaneously disappeared. No similar disease was present in his family members. On cutaneous examination, several ill-defined annular plaques with central depigmentation and a mild parchment-like atrophy alogn with a raised brownish margin that was incomplete in some areas were seen. These were present over the dorsal aspect of the forearms, hands and upper chest [Figure - 1]. Two similar plaques each about 1 cm in diameter and some smaller papules were seen on the penile shaft [Figure - 2]. The face and neck were devoid of any lesions. The palm, sole, mucosa, nail, hair and teeth were unaffected.

Routine hematological and biochemical investigations including blood sugar and serum calcium were normal. Mantoux test, VDRL, antinuclear antibody and rheumatoid factor were negative. Histopathology was done from the lesions over the forearm and penile shaft. The epidermis was normal but the dermis in the central zone showed scanty elastic fibres when stained by Verhoeff-von Gieson stain [Figure - 3]. At the periophery, the elastic tissue was normal. There was a granulomatous infiltrate of histiocytes and epithelioid cells with a tendency to palisading arrangement [Figure - 4]. A few multinucleated giant cells were found. No mucin or lipid deposit was seen and stain for AFB was negative. The patient was diagnosed as a case of AEGCG and prescribed sunscreens and topical steroids.


  Discussion Top


AEGCG, a recently described entity, is a granulomatous disorder of unknown etiology. There are very few Indian reports of this entity.[4],[5] It has been described in adults in their fourth and fifth decades and rarely affects children6. The centrifugal annular lesions almost always occur in the sun-exposed areas but there are reports of occurrence over sun-protected areas also.[3] Typically the large annular plaques with raised brown borders may show central depigmentation or atrophy and sometimes both. Our case was diagnosed as a case of AEGCG on the basis of the characteristic morphology of the lesions and the histological features of a granulomatous infiltate with giant cells and the total loss of elastin in the center of the granuloma. However the sparing of the face and neck and the presence of lesions on the external genitalia made our case very unusual. After six weeks of therapy, flattening of the lesions was observed. Some of the smaller lesions resembled granuloma annulare, but the central atrophy and the complete lack of elastin in the central zone clinched the diagnosis in favour of AEGCG. Other features that can distinguish the two are larger and more numerous giant cells and the absence of mucin in AEGCG.

Necrobiosis lipoidica (NL) is another mimicker but differs by the absence of degenerated collagen, sclerosis, lipids and vascular changes in the deeper dermis. The tissue changes in AG may be similar to AEGCG and it has been postulated that AG may be an etiopathological subset of AEGCG.[7]

Co-existence of AEGCG has been reported with cutaneous amyloidosis, adult T-cell leukaemia and vitiligo.[5],[8],[9] The plaques may disappear without treatment but topical steroids any cyclosporin have been used successfully.[10]



 
  References Top

1.Glusac EJ, Shapiro PE. Noninfectious granulomas. In: Elder D, Elenitas R, Johnson, Jr BL, Murphy GF, eds. Lever's Histopathology of the Skin. 9th ed. Philadelphia, USA: Lippincott Williams & Wilkins, 2005: 376-7  Back to cited text no. 1    
2.Hanke CW, Bailin PL, Roenigk HH Jr. Annular elastolytic giant cell granuloma. A clinicopathologic study of five cases and a review of similar entities. J Am Acad Dermatol 1997; 1: 413-21.  Back to cited text no. 2    
3.Ishibashi A, Yokoyama A, Hirano K. Annular elastolytic giant cell granuloma occurring in covered areas. Dermatologica 1987; 174: 293-7.  Back to cited text no. 3  [PUBMED]  
4.Khandpur S, Reddy BSN. Annular elastolytic giant cell granuloma. Indian J Dermatol 2001; 46: 238-41.  Back to cited text no. 4    
5.Gangopadhyay A. Vitiligo and annular elastolytic giant cell granuloma - a rare comradarie. Indian J Dermatol 2002; 47: S14-S16.  Back to cited text no. 5    
6.Herron MD, Coffin CM, Vanderhooft SL. Annular elastolytic giant cell granuloma. Pediatr Dev Pethol 2002; 5: 305-9.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Limas S. The spectrum of primary cutaneous elastolytic granulomas and their distinction from granuloma annulare: a clinicopathological analysis Histopathology 2004; 44: 277-82.  Back to cited text no. 7    
8.Lee YS, Vijayasingam S, Chan HL. Photosensitive annular elastolytic giant cell granuloma with cutaneous amyloidosis. Am J. Dermatopathol 1989; 11: 443-50.  Back to cited text no. 8  [PUBMED]  
9.Kuramoto Y, Watanabe M, Tagami H. Adult T cell leukemia accompanied by annular elastolytic giant cell granuloma. Acta Derm Venereol 1990; 70: 164-7.  Back to cited text no. 9  [PUBMED]  
10.Tsutsui K, Hirone T, Kubo K, Matsui Y. Annular elastolytic giant cell granuloma: response to cyclosporine. J Dermatol 1994; 21: 426-9.  Back to cited text no. 10  [PUBMED]  


    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]

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   Abstract
   Introduction
   Case Report
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   References
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