Ann Dermatol.  2012 Nov;24(4):383-392. 10.5021/ad.2012.24.4.383.

Inflammatory Nodules of the Leg

• Cho KH

• KMID: 2266031
• DOI: http://doi.org/10.5021/ad.2012.24.4.383

Abstract

There is a group of diseases characterized by inflammatory nodules which generally located on the lower leg. They have certain clinical appearances in common, which often makes a differential diagnosis difficult or impossible on clinical grounds alone. There is a great variation in histopathologic appearance, which depends on the duration of the lesions and sites from specimens are obtained for biopsy. Therefore, separating and subclassifying inflammatory nodule lesions of the legs, based on the subtle clinical and histological variation, is not easy. Despite all these difficulties, a specific diagnosis can be made with an adequate clinic-pathologic correlation.

Keyword

Inflammatory nodules; Lower leg

MeSH Terms

Biopsy
Diagnosis, Differential
Leg

Figure

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  Fig. 1 Erythema induratum. (A) A brown colored, erythematous nodule-plaque on the ankle of the patient. (B) Multiple erythematous nodules on the both shin of the patient. (C) Coagulation necrosis with granulomatous inflammation (H&E stain, ×100).

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  Fig. 2 Erythema nodosum. (A) Symmetric, smooth and shiny, erythematous nodules affecting the both shins of the parient. (B) Classical appearance of septal inflammation (H&E stain, ×40).

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  Fig. 3 Behcet's disease. (A) Erythematous nodules on the both thighs of the patient. (B) Oral and genital ulcers in the patient with Behcet's disease.

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  Fig. 4 Superficial thrombophlebitis. (A) Nodular lesions are arranged in a linear configuration on the lower leg of the patient. (B) Typically involves vein located in the superficial subcutaneous tissue (H&E stain ×40). Inflammatory infiltrates obscure the vessel walls and the lumen is completely occluded by the thrombus.

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  Fig. 5 Cutaneous polyarteritis nodosa. (A) The patient presented with livedo reticularis on the lower legs. (B) Vasculitis involves the muscular artery of the deep dermis (H&E stain, ×100).

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  Fig. 6 Subcutaneous panniculitic T-cell lymphoma. (A) Multiple erythematous nodules on the both lower legs of the patient. (B) Subcutaneous infiltrate of neoplastic pleomorphic cells of various sizes and histiocytes and karyorrhexis are found (H&E stain, ×100).

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  Fig. 7 Pancreatic panniculitis. (A) Patient presented with multiple violaceous nodules on the both lower legs. (B) Characterisitic ghost cells (H&E stain, ×100).

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  Fig. 8 Sclerosing panniculitis. Patient presented with indurated plaques of wood-like consistency on the lower leg.

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  Fig. 9 Sarcoidosis. (A) Patient presented with subcutaneous nodules without changes in overlying epidermis. (B) Characteristic non-caseating granuloma with giant cell (H&E stain, ×100).

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