Annular Elastolytic Giant Cell Granuloma

Abstract

Annular elastolytic giant cell granuloma (AEGCG) is a rare, often self-limiting chronic inflammatory disorder mostly occurring in the sun-exposed areas such as the dorsum of hands, extensor surfaces of arms, face, anterior neck, and upper chest. The pathognomonic histological findings include the presence of numerous granulomas associated with loss of elastic fibers that appear to be ingested by multi-nucleated giant cells. Here, we present a case of a 56-year-old woman with multiple, anatomically variable erythematous lesions- annular and papular, mainly in the upper body. The clinical presentation and histopathologic findings support our diagnosis.

Keywords: actinic granuloma; annular; elastolysis; giant cell; sun exposure.

Figure 1. Annular lesions on the dorsum of hand

Figure 2. Erythematous papular lesions on bilateral forearms

Figure 3. Papular lesions on forehead

Figure 4. H&E 10X magnification showing multiple granulomas composed of histiocytes and giant cells

Arrow head points to the multi-nucleated giant cell within the dermis

Figure 5. H&E 40X magnification showing giant cells with elastophagocytosis

Arrowhead points to the ingested fibers seen within the giant cell

Figure 6. eVG stain 10X magnification reveals granulomas with complete loss of elastic fibers associated with preserved abundance of elastic fibers at the periphery of granuloma

eVG: elastin Verhoeff Van Gieson

Figure 7. eVG stain 40X magnification showing giant cells with elastophagocytosis

eVG: elastin Verhoeff Van Gieson; Arrowheads pointing to the ingested fibers within the giant cells

Figure 8. Comparative pictures of before (A) and after (B) three months of treatment with systemic corticosteroids

Figure 9. Left dorsal hand showing healing lesions, 8 months since the onset of symptoms

Figure 10. Bilateral hands showing complete healing, one and a half years since onset of symptoms