Gross examination of the specimen revealed a multicystic mass with a "Swiss cheese" appearance in the dermis and subcutaneous soft tissue. On microscopic examination, the lesion showed a mixed granulomatous inflammation surrounding cystic spaces that appeared to be lined by clusters of foamy histiocytes. The cystic spaces contained numerous membrane-encircled round bodies (spherules). The surrounding tissue showed occasional foreign body–type giant cells, refractive extracellular brown pigment, chronic inflammatory infiltrate, and fibrous reaction. There was no evidence of vasculitis or birefringent foreign bodies.
Multilobated Abdominal Nodule. Arch Dermatol. 2002;138(11):1509. doi:10.1001/archderm.138.11.1509