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December 1994

Periocular Granuloma Annulare, Nodular Type: Occurrence in Late Middle Age

Author Affiliations

From the Department of Ophthalmology, W. K. Kellogg Eye Center (Drs Burnstine, Oestreicher, and Elner), and the Departments of Dermatology (Dr Headington) and Pathology (Drs Headington and Elner), the University of Michigan, Ann Arbor; and College of Human Medicine (GRAMEC), Michigan State University, Grand Rapids (Dr Reifler).

Arch Ophthalmol. 1994;112(12):1590-1593. doi:10.1001/archopht.1994.01090240096032

We describe the two oldest individuals with nodular granuloma annulare (pseudorheumatoid nodules) in the ophthalmologic literature and propose a unified classification scheme that recognizes pseudorheumatoid nodules to be granuloma annulare, nodular type. All lesions in both cases revealed so-called necrobiotic granulomas, characterized by an acellular central area containing mucin (hyaluronic acid) surrounded by palisading histiocytes (macrophages), diagnostic of granuloma annulare. These features are identical to those reported in the ophthalmologic and older general pathology literature as pseudorheumatoid nodules and the contemporary general and dermatologic pathology literature as granuloma annulare. We believe the diagnosis of nodular granuloma annulare should be employed for necrobiotic lesions displaying distinctive clinicopathologic features to unite the ophthalmologic, general, and dermatologic pathology literature. Granuloma annulare, nodular type, must also be considered in the differential diagnosis of ocular and periocular lesions at any age.

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