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Lipophagic panniculitis in re-excision specimens
B D Zelickson1, R K Winkelmann
1Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
Abstract:
Lipophagic panniculitis consists of a macrophage infiltrate in the subcutaneous tissue. The macrophages transform into foam cells within the panniculus; they replace lipocytes and may form giant cells. Although those pathologic features have been described as diagnostic of Weber-Christian disease, we report the occurrence of lipophagic panniculitis in re-excision specimens. Among 252 re-excision specimens from previously biopsied skin tumors, 5 cases in which masses of lipophages were infiltrating and replacing the subcutaneous tissue were found. The infiltrate was localized to the deep dermis and superficial subcutaneous tissue below and beside the initial biopsy site. In 3 cases, suture or hair was detected within the tissue, and granulation tissue with foreign body giant cells was observed along the dermal suture line. In 4 cases there was evidence of phlebitis within or close to areas of infiltration. None of these patients developed symptomatic panniculitis. Lipophagia can be a normal response of wound healing in some patients.
Insights
Lipophagic panniculitis, characterized by macrophages in subcutaneous tissue, can be a normal wound healing response. This finding was observed in re-excision skin biopsy specimens, suggesting it is not always indicative of Weber-Christian disease.
Area of Science:
- Dermatopathology
- Histopathology
- Subcutaneous tissue disorders
Background:
- Lipophagic panniculitis involves macrophage infiltration and foam cell transformation in subcutaneous tissue.
- These pathological features have been historically associated with Weber-Christian disease diagnosis.
Purpose of the Study:
- To investigate the occurrence and significance of lipophagic panniculitis in re-excision specimens.
- To determine if lipophagia in this context represents a normal wound healing response.
Main Methods:
- Analysis of 252 re-excision specimens from previously biopsied skin tumors.
- Histopathological examination to identify lipophage infiltration, foam cells, giant cells, suture material, hair, granulation tissue, and phlebitis.
Main Results:
- Five cases of lipophagic panniculitis were identified in re-excision specimens.
- Infiltrates were localized near initial biopsy sites, often associated with suture material, hair, granulation tissue, and foreign body giant cells.
- Phlebitis was noted in proximity to the infiltration in four cases; no patients developed symptomatic panniculitis.
Conclusions:
- Lipophagia observed in re-excision specimens can be a manifestation of normal wound healing.
- The presence of lipophagic panniculitis in this setting does not necessarily indicate Weber-Christian disease.