Difference between revisions of "Rheumatoid nodule"

Rheumatoid nodule
	External resources
EHVSC	10182

Rheumatoid nodule
	Diagnosis in short
	; Rheumatoid nodule. H&E stain.
LM	necrotic collagen bundles with fibrin surrounded by [alisading granuloma, +/-eosinophils
LM DDx	granuloma annulare, necrobiosis lipoidica
Stains	Alcian blue (pH 2.5) -ve
Gross	extensor aspect of the extremities, e.g. dorsal aspect of elbow
Site	skin (see rheumatoid lung nodule for the lung lesion)
Signs	skin nodule, close to joint - typically elbow
Prevalence	uncommon
Blood work	RF +ve
Prognosis	benign

Latest revision as of 14:32, 7 October 2015

Rheumatoid nodule, abbreviated RN, is a skin manifestation of rheumatoid arthritis.

Nodules in the lung associated with rheumatoid arthritis are dealt with in rheumatoid lung nodule.

General

Seen in rheumatoid arthritis - usually only in seropositive cases, i.e. rheumatoid factor (RF) positive.^[1]
- Exceptions are reported.^[2]

Gross

Usually on the extensor aspect of the extremities, e.g. dorsal aspect of elbow.^[3]
Typically close to a joint.^{[citation needed]}

Microscopic

Features:^[1]^[4]

Necrotic collagen bundles with fibrin surrounded by:
- Palisading granuloma.
+/-Eosinophils.

Notes:

Histomorphologically very similar to Granuloma annulare.

DDx:

Granuloma annulare - has mucin in the core of the granuloma.^[4]
Necrobiosis lipoidica.

Images

www:

Rheumatoid nodule - low mag. (WC)
Rheumatoid nodule - intermed. mag. (WC)
Rheumatoid nodule - high mag. (WC)

Stains

Alcian blue (pH 2.5) -ve.
- Positive staining of mucin in granuloma annulare.^[7]

Sign out

Submitted as "Rheumatoid Nodule Left Thumb", Excision: 
- Consistent with rheumatoid nodule (palisading granulomas with 
  cores of necrobiotic collagen).
- NEGATIVE for microorganisms with special stains (ZN, Grocott).

Lesion (subcutaneous), right index finger, excision:
- Palisading granulomas with cores of necrobiotic collagen, consistent with rheumatoid nodule.

Micro

The sections show foci with strands of necrobiotic collagen surrounded by palisading granulomas. Rare Neutrophils are seen in the core of the granulomas. Multinucleated cells are not apparent.

Benign fibroadipose tissue and dense connective tissue are also present.

References

↑ ^1.0 ^1.1 Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 299. ISBN 978-0470519035.
↑ Kaye, BR.; Kaye, RL.; Bobrove, A. (Feb 1984). "Rheumatoid nodules. Review of the spectrum of associated conditions and proposal of a new classification, with a report of four seronegative cases.". Am J Med 76 (2): 279-92. PMID 6364806.
↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 53. ISBN 978-0443066542.
↑ ^4.0 ^4.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 52. ISBN 978-0443066542.
↑ ^5.0 ^5.1 URL: http://granuloma.homestead.com/palisading.html. Accessed on: 1 November 2010.
↑ URL: http://www.pathguy.com/lectures/joints.htm. Accessed on: 1 November 2010.
↑ Yun, JH.; Lee, JY.; Kim, MK.; Seo, YJ.; Kim, MH.; Cho, KH.; Kim, MB.; Lee, WS. et al. (May 2009). "Clinical and pathological features of generalized granuloma annulare with their correlation: a retrospective multicenter study in Korea.". Ann Dermatol 21 (2): 113-9. doi:10.5021/ad.2009.21.2.113. PMC 2861218. PMID 20523767. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861218/.

[Ref_DCHH299-1] 1.0 ^1.1 Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 299. ISBN 978-0470519035.

[pmid6364806-2] Kaye, BR.; Kaye, RL.; Bobrove, A. (Feb 1984). "Rheumatoid nodules. Review of the spectrum of associated conditions and proposal of a new classification, with a report of four seronegative cases.". Am J Med 76 (2): 279-92. PMID 6364806.

[Ref_Derm53-3] Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 53. ISBN 978-0443066542.

[Ref_Derm52-4] 4.0 ^4.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 52. ISBN 978-0443066542.

[ghc-5] 5.0 ^5.1 URL: http://granuloma.homestead.com/palisading.html. Accessed on: 1 November 2010.

[6] URL: http://www.pathguy.com/lectures/joints.htm. Accessed on: 1 November 2010.

[pmid20523767-7] Yun, JH.; Lee, JY.; Kim, MK.; Seo, YJ.; Kim, MH.; Cho, KH.; Kim, MB.; Lee, WS. et al. (May 2009). "Clinical and pathological features of generalized granuloma annulare with their correlation: a retrospective multicenter study in Korea.". Ann Dermatol 21 (2): 113-9. doi:10.5021/ad.2009.21.2.113. PMC 2861218. PMID 20523767. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861218/.

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@@ Line 1: / Line 1: @@
-#redirect [[Rheumatoid arthritis]]
+{{ Infobox diagnosis
+| Name       = {{PAGENAME}}
+| Image      = Rheumatoid_nodule_-_intermed_mag_2.jpg
+| Width      =
+| Caption    = Rheumatoid nodule. [[H&E stain]].
+| Synonyms   =
+| Micro      = necrotic collagen bundles with fibrin surrounded by [alisading [[granuloma]], +/-[[eosinophil]]s
+| Subtypes   =
+| LMDDx      = [[granuloma annulare]], [[necrobiosis lipoidica]]
+| Stains     = [[Alcian blue stain|Alcian blue]] (pH 2.5) -ve
+| IHC        =
+| EM         =
+| Molecular  =
+| IF         =
+| Gross      = extensor aspect of the extremities, e.g. dorsal aspect of elbow
+| Grossing   =
+| Site       = [[skin]] (see ''[[rheumatoid lung nodule]]'' for the lung lesion)
+| Assdx      =
+| Syndromes  =
+| Clinicalhx =
+| Signs      = skin nodule, close to joint - typically elbow
+| Symptoms   =
+| Prevalence = uncommon
+| Bloodwork  = RF +ve
+| Rads       =
+| Endoscopy  =
+| Prognosis  = benign
+| Other      =
+| ClinDDx    =
+| Tx         =
+}}
+{{ Infobox external links
+| Name           = Rheumatoid nodule
+| EHVSC          = 10182
+| pathprotocols  =
+| wikipedia      =
+| pathoutlines   =
+}}
+'''Rheumatoid nodule''', abbreviated '''RN''', is a [[skin]] manifestation of [[rheumatoid arthritis]].
+Nodules in the [[lung]] associated with rheumatoid arthritis are dealt with in ''[[rheumatoid lung nodule]]''.
+==General==
+*Seen in [[rheumatoid arthritis]] - usually only in seropositive cases, i.e. ''rheumatoid factor'' (RF) positive.<ref name=Ref_DCHH299>{{Ref DCHH|299}}</ref>
+**Exceptions are reported.<ref name=pmid6364806>{{Cite journal  | last1 = Kaye | first1 = BR. | last2 = Kaye | first2 = RL. | last3 = Bobrove | first3 = A. | title = Rheumatoid nodules. Review of the spectrum of associated conditions and proposal of a new classification, with a report of four seronegative cases. | journal = Am J Med | volume = 76 | issue = 2 | pages = 279-92 | month = Feb | year = 1984 | doi =  | PMID = 6364806 }}</ref>
+==Gross==
+*Usually on the extensor aspect of the extremities, e.g. dorsal aspect of elbow.<ref name=Ref_Derm53>{{Ref Derm|53}}</ref>
+*Typically close to a joint.{{fact}}
+==Microscopic==
+Features:<ref name=Ref_DCHH299>{{Ref DCHH|299}}</ref><ref name=Ref_Derm52>{{Ref Derm|52}}</ref>
+*Necrotic collagen bundles with fibrin surrounded by:
+**Palisading [[granuloma]].
+*+/-Eosinophils.
+Notes:
+*Histomorphologically very similar to ''[[Granuloma annulare]]''.
+DDx:
+*[[Granuloma annulare]] - has mucin in the core of the granuloma.<ref name=Ref_Derm52>{{Ref Derm|52}}</ref>
+*[[Necrobiosis lipoidica]].
+===Images===
+www:
+*[http://granuloma.homestead.com/rheumatoid_nod_S89-2617-1.jpg Rheumatoid nodule (granuloma.homestead.com)].<ref name=ghc>URL: [http://granuloma.homestead.com/palisading.html http://granuloma.homestead.com/palisading.html]. Accessed on: 1 November 2010.</ref>
+*[http://granuloma.homestead.com/rheumatoid_nod_S89-2617-5.jpg Rheumatoid nodule (granuloma.homestead.com)].<ref name=ghc>URL: [http://granuloma.homestead.com/palisading.html http://granuloma.homestead.com/palisading.html]. Accessed on: 1 November 2010.</ref>
+*[http://library.med.utah.edu/WebPath/jpeg3/BONE045.jpg Rheumatoid nodule (utah.edu)].<ref>URL: [http://www.pathguy.com/lectures/joints.htm http://www.pathguy.com/lectures/joints.htm]. Accessed on: 1 November 2010.</ref>
+<gallery>
+Image:Rheumatoid_nodule_-_low_mag.jpg |Rheumatoid nodule - low mag. (WC)
+Image:Rheumatoid_nodule_-_intermed_mag_2.jpg |Rheumatoid nodule - intermed. mag. (WC)
+Image:Rheumatoid_nodule_-_high_mag.jpg |Rheumatoid nodule - high mag. (WC)
+</gallery>
+==Stains==
+*[[Alcian blue stain|Alcian blue]] (pH 2.5) -ve.
+**Positive staining of mucin in [[granuloma annulare]].<ref name=pmid20523767>{{Cite journal  | last1 = Yun | first1 = JH. | last2 = Lee | first2 = JY. | last3 = Kim | first3 = MK. | last4 = Seo | first4 = YJ. | last5 = Kim | first5 = MH. | last6 = Cho | first6 = KH. | last7 = Kim | first7 = MB. | last8 = Lee | first8 = WS. | last9 = Lee | first9 = KH. | title = Clinical and pathological features of generalized granuloma annulare with their correlation: a retrospective multicenter study in Korea. | journal = Ann Dermatol | volume = 21 | issue = 2 | pages = 113-9 | month = May | year = 2009 | doi = 10.5021/ad.2009.21.2.113 | PMID = 20523767 | PMC = 2861218 }}</ref>
+==Sign out==
+<pre>
+Submitted as "Rheumatoid Nodule Left Thumb", Excision:
+- Consistent with rheumatoid nodule (palisading granulomas with
+  cores of necrobiotic collagen).
+- NEGATIVE for microorganisms with special stains (ZN, Grocott).
+</pre>
+<pre>
+Lesion (subcutaneous), right index finger, excision:
+- Palisading granulomas with cores of necrobiotic collagen, consistent with rheumatoid nodule.
+</pre>
+===Micro===
+The sections show foci with strands of necrobiotic collagen surrounded by palisading granulomas. Rare Neutrophils are seen in the core of the granulomas. Multinucleated cells are not apparent.
+Benign fibroadipose tissue and dense connective tissue are also present.
+==See also==
+*[[Rheumatoid arthritis]].
+*[[Rheumatoid lung nodule]].
+==References==
+{{Reflist|1}}
+[[Category:Diagnosis]]