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Multiple palisading granulomas in the scalp of an infant: a case report
1Department of Neurosurgey, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Insights
Deep granuloma annulare, a benign condition, can present as subcutaneous scalp nodules in children. Surgical excision confirmed this rare diagnosis, preventing recurrence in a pediatric patient.
Area of Science:
- Pediatric Dermatology
- Dermatopathology
- Pediatric Oncology
Background:
- Subcutaneous scalp nodules in children necessitate a broad differential diagnosis.
- Distinguishing benign from malignant lesions is crucial for appropriate management.
Observation:
- A 1-year-old boy presented with rapidly growing subcutaneous scalp nodules.
- Imaging studies (CT, MRI) were nonspecific, and rheumatic disease was ruled out.
- Histopathology revealed palisading granulomas, indicative of deep granuloma annulare.
Findings:
- Deep granuloma annulare is a rare, benign cause of pediatric subcutaneous scalp nodules.
- Complete excision of the nodules led to a favorable outcome with no recurrence.
- Palisading granulomas represent a distinct histopathologic finding.
Implications:
- This case highlights deep granuloma annulare in the differential diagnosis of pediatric scalp masses.
- While total excision was performed, less invasive biopsy may suffice if benign etiology is suspected.
- Accurate histopathologic diagnosis is key to guiding treatment and prognosis.
Background:
We describe an unusual lesion that represents an uncommon but important element in the differential diagnosis of subcutaneous scalp nodules in a child.
Case Description:
A 1-year-old boy presented with two clusters of subcutaneous scalp nodules. The lesions increased in size and number. Computed tomography showed no changes in underlying bone. Findings on magnetic resonance imaging were nonspecific. Serologic and clinical evaluation showed no evidence of rheumatic disease. Complete excision of the nodules, together with adjacent fascia and galea, was performed. Histopathologic examination showed the lesions to be palisading granulomas; given the absence of rheumatic disease, these represented deep granuloma annulare, a benign condition. No recurrence has been observed in our patient.
Conclusion:
While we chose total excision because of preoperative concerns about a possible malignant tumor, some other authors have suggested that surgery be limited to confirmatory biopsy when a benign lesion such as palisading granuloma is strongly suspected.
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