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Subcutaneous palisading granulomas (benign rheumatoid nodules) in children
Insights
Subcutaneous palisading granulomas (SPG) are distinct clinicopathologic entities in children, presenting as painless nodules. Most lesions resolve spontaneously, but some may recur, highlighting the need for accurate diagnosis.
Area of Science:
- Pediatric Dermatology
- Dermatopathology
- Rheumatology
Background:
- Subcutaneous palisading granulomas (SPG), or benign rheumatoid nodules, are observed in healthy children.
- Histologically similar to adult rheumatoid nodules and other granulomatous conditions, SPGs are considered a distinct clinical entity.
- This study reviews 17 pediatric cases of SPG.
Purpose of the Study:
- To characterize the clinical presentation, diagnosis, and management of subcutaneous palisading granulomas in children.
- To evaluate the long-term outcomes and potential associations of SPG.
Main Methods:
- Retrospective review of 17 pediatric cases diagnosed with SPG.
- Analysis of clinical presentation, diagnostic methods, treatment interventions, and follow-up data.
- Histopathological correlation with clinical findings.
Main Results:
- Patients presented with painless, nonmobile subcutaneous nodules, most commonly on the lower extremities.
- Most patients had no significant past medical history; one had an elevated ESR, later developing rheumatoid arthritis.
- Nearly two-thirds of patients developed new lesions; spontaneous involution occurred in untreated subsequent lesions.
Conclusions:
- SPG represents a distinct clinicopathologic entity in children.
- Accurate preoperative diagnosis is challenging, with excisional biopsy being the standard.
- While most lesions resolve spontaneously, vigilance for recurrence and potential underlying conditions like rheumatoid arthritis is warranted.
Abstract:
Subcutaneous palisading granulomas (SPG), also known as benign rheumatoid nodules, occur in otherwise healthy children. Although these lesions have the same histology as rheumatoid nodules in adults, subcutaneous granuloma annulare, and diabetic lipoidicum, they appear to represent a distinct clinicopathologic entity. We reviewed our experience with 17 cases of SPG. All patients presented with one or more painless, nonmobile, subcutaneous nodules. Lower extremity involvement was most common, but lesions presented in the upper extremities and scalp as well. There were 14 girls and three boys ranging in age from 10 months to 15 2/12 years (mean, 4 5/12 years) at the time of diagnosis. Past medical histories were negative. Laboratory and radiologic studies were normal except for one child with an elevated erythrocyte sedimentation rate (ESR). The follow-up period ranged from 6 months to 14 10/12 years (mean, 4 11/12 years). Subsequent new lesions developed in nearly two thirds of the patients. In the one child with an initially elevated ESR, rheumatoid arthritis developed. All others were alive and well except for one who died in a motor vehicle accident without evidence of further disease. Preoperative diagnosis was correct in only three patients. Excisional biopsy was performed in all cases. However, one child had received prior radiation therapy, one received topical steroid therapy, and three patients had subsequent lesions excised. All subsequent lesions not surgically excised underwent spontaneous involution.(ABSTRACT TRUNCATED AT 250 WORDS)