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ioles in dermis and subcutis

Figure 1 (A) Hyperpigmented subcutaneous nodules on the anterior shins. (B) Septal edema with mixed inflammation and hemorrhage [hematoxylin and eosin (H & E) stain, original magnification 40x]. (C) Higher magnification showing septal edema, septal inflammation composed of neutrophils, lymphocytes, eosinophils, and hemorrhage (H & E stain, original magnification 200x). (D) Septal inflammation composed of lymphocytes, macrophages, and giant cells in a fully developed lesion (H & E stain, original magnification 40x). (E) Miescher's radial granuloma (H & E stain, original magnification 200x).

Figure 1 (A) Hyperpigmented subcutaneous nodules on the anterior shins. (B) Septal edema with mixed inflammation and hemorrhage [hematoxylin and eosin (H & E) stain, original magnification 40x]. (C) Higher magnification showing septal edema, septal inflammation composed of neutrophils, lymphocytes, eosinophils, and hemorrhage (H & E stain, original magnification 200x). (D) Septal inflammation composed of lymphocytes, macrophages, and giant cells in a fully developed lesion (H & E stain, original magnification 40x). (E) Miescher's radial granuloma (H & E stain, original magnification 200x).

Figure 2 (A) Lobular expansion, scant inflammation [hematoxylin and eosin (H & E) stain, original magnification 40x]. (B) Variability in adipocyte size and enlargement of some adipocytes (H & E stain, original magnification 100x).

Figure 3 (A) Multiple erythematous papules on the back of an infant. (B) Lobular mixed inflammation [hematoxylin and eosin (H & E) stain, original magnification 40x]. (C) Needle-shaped clefts, radially arranged in giant cells and lipocytes (H & E stain, original magnification 100x). (D) High magnification of prominent needle-shaped clefts radially arranged in lipocytes (H & E stain, original magnification 200x).

Figure 3 (A) Multiple erythematous papules on the back of an infant. (B) Lobular mixed inflammation [hematoxylin and eosin (H & E) stain, original magnification 40x]. (C) Needle-shaped clefts, radially arranged in giant cells and lipocytes (H & E stain, original magnification 100x). (D) High magnification of prominent needle-shaped clefts radially arranged in lipocytes (H & E stain, original magnification 200x).

Figure 4 (A) Ulcerated plaques with unusual geographic shapes on the anterior thigh. (B) Suppurative lobular panniculitis [hematoxylin and eosin (H & E) stain, original magnification 40x]. (C) High magnification of intralobular neutrophils (H & E stain, original magnification 200x). Source: Lisa Cohen MD, Cohen Dermatopathology, Newton, Massachusetts, U.S.A.

Figure 4 (A) Ulcerated plaques with unusual geographic shapes on the anterior thigh. (B) Suppurative lobular panniculitis [hematoxylin and eosin (H & E) stain, original magnification 40x]. (C) High magnification of intralobular neutrophils (H & E stain, original magnification 200x). Source: Lisa Cohen MD, Cohen Dermatopathology, Newton, Massachusetts, U.S.A.

Figure 5 (A) Erythematous nodule on medial shin. (B) Lobular panniculitis composed of lymphoplasmacytic inflammation [hematoxylin and eosin (H & E) stain, original magnification 40x]. (C) Lymphocytes ring around necrotic adipocytes (H & E stain, original magnification 200x). (D) "Beanbag cell" with surrounding karyorrhexis (H & E stain, original magnification 400x). (E) Erythrophagocytosis (H & E stain, original magnification 400x). Source: Lisa Cohen, MD, Cohen Dermatopathology, Newton, Massachusetts, U.S.A.

Figure 5 (A) Erythematous nodule on medial shin. (B) Lobular panniculitis composed of lymphoplasmacytic inflammation [hematoxylin and eosin (H & E) stain, original magnification 40x]. (C) Lymphocytes ring around necrotic adipocytes (H & E stain, original magnification 200x). (D) "Beanbag cell" with surrounding karyorrhexis (H & E stain, original magnification 400x). (E) Erythrophagocytosis (H & E stain, original magnification 400x). Source: Lisa Cohen, MD, Cohen Dermatopathology, Newton, Massachusetts, U.S.A.

Figure 6 (A) Fluctuant erythematous nodules on anterior shins. Source: Lynn Goldberg, M.D., Boston University, Boston, Massachusetts, U.S.A. (B) Lobular panniculitis with fat necrosis and ghost cells in center of lobule and suppuration at the periphery [hematoxylin and eosin (H & E) stain, original magnification 40x]. (C) High magnification of "ghost cells" lined by basophilic granular calcium deposition (H & E stain, original magnification 100x).

Figure 6 (A) Fluctuant erythematous nodules on anterior shins. Source: Lynn Goldberg, M.D., Boston University, Boston, Massachusetts, U.S.A. (B) Lobular panniculitis with fat necrosis and ghost cells in center of lobule and suppuration at the periphery [hematoxylin and eosin (H & E) stain, original magnification 40x]. (C) High magnification of "ghost cells" lined by basophilic granular calcium deposition (H & E stain, original magnification 100x).

Figure 7 (A) Erythematous nodules on medial lower leg. (B) Septal neutrophilic inflammation with liquefactive necrosis and collagenolysis [hematoxylin and eosin (H & E) stain, original magnification 40x]. (C) "Splaying of neutrophils" between collagen bundles in the reticular dermis (H & E stain, original magnification 200x). (D) Dermal collagenolysis (H & E stain, original magnification 200x). (E) Numerous neutrophils destroying lobules (H & E stain, original magnification 200x).

Figure 7 (A) Erythematous nodules on medial lower leg. (B) Septal neutrophilic inflammation with liquefactive necrosis and collagenolysis [hematoxylin and eosin (H & E) stain, original magnification 40x]. (C) "Splaying of neutrophils" between collagen bundles in the reticular dermis (H & E stain, original magnification 200x). (D) Dermal collagenolysis (H & E stain, original magnification 200x). (E) Numerous neutrophils destroying lobules (H & E stain, original magnification 200x).

Figure 8 (A) Ulcerated nodules on calves. (B) Combined lobular and septal panniculitis with vasculitis [hematoxylin and eosin (H & E) stain, original magnification 40x]. (C) Vasculitis of medium-sized vessel (H & E stain, original magnification 100x). (D) Tuberculoid granulomas (H & E stain, original magnification 100x).

Figure 8 (A) Ulcerated nodules on calves. (B) Combined lobular and septal panniculitis with vasculitis [hematoxylin and eosin (H & E) stain, original magnification 40x]. (C) Vasculitis of medium-sized vessel (H & E stain, original magnification 100x). (D) Tuberculoid granulomas (H & E stain, original magnification 100x).

Figure 9 (A) Lipoatrophy involving forearm. (B) Septal and lobular lymphoplasmacytic inflammation and eosinophilic hyaline fat necrosis [hematoxylin and eosin (H & E) stain, original magnification 40x]. (C) High magnification of lobular lymphoplasmacytic inflammation (H & E stain, original magnification 200x). (D) Eosinophilic hyaline fat necrosis (H & E stain, original magnification 200x).

Figure 9 (A) Lipoatrophy involving forearm. (B) Septal and lobular lymphoplasmacytic inflammation and eosinophilic hyaline fat necrosis [hematoxylin and eosin (H & E) stain, original magnification 40x]. (C) High magnification of lobular lymphoplasmacytic inflammation (H & E stain, original magnification 200x). (D) Eosinophilic hyaline fat necrosis (H & E stain, original magnification 200x).

Figure 10 (A) Inverted champagne bottle deformity of lower legs. Source: Courtesy of Louis Fragola MD, Providence, Rhode Island, U.S.A. (B) Septal and lobular fibrosis and atrophy with mixed inflammation [hematoxylin and eosin (H & E) stain, original magnification 40x]. (C) Lipomembranous (membranocystic) fat necrosis and fatty microcysts lined by eosinophilic proteinaceous material with fine feathery projections (H & E stain, original magnification 200x). (D) Fuscia colored feathery projections highlighted with positive eosinophilic material (PAS) stain (PAS stain, original magnification 200x).

Figure 10 (A) Inverted champagne bottle deformity of lower legs. Source: Courtesy of Louis Fragola MD, Providence, Rhode Island, U.S.A. (B) Septal and lobular fibrosis and atrophy with mixed inflammation [hematoxylin and eosin (H & E) stain, original magnification 40x]. (C) Lipomembranous (membranocystic) fat necrosis and fatty microcysts lined by eosinophilic proteinaceous material with fine feathery projections (H & E stain, original magnification 200x). (D) Fuscia colored feathery projections highlighted with positive eosinophilic material (PAS) stain (PAS stain, original magnification 200x).

Figure 11 (A) Violaceous plaques with livedo reticularis-like pattern, flaccid bullae, and ulcerations. (B) Epidermal ischemic necrosis with prominent intradermal intraluminal fibrin thrombi mimicking a thrombogenic vacsulopathy [hematoxylin and eosin (H & E) stain, original magnification 100x]. (C) Medial calcification with intimal fibroplasia of small arterioles in the subcutis (H & E stain, original magnification 40x). (D) Higher magnification showing intravascular calcification and subcutaneous intraluminal fibrin thrombi (H & E stain, original magnification 200x).

Figure 11 (A) Violaceous plaques with livedo reticularis-like pattern, flaccid bullae, and ulcerations. (B) Epidermal ischemic necrosis with prominent intradermal intraluminal fibrin thrombi mimicking a thrombogenic vacsulopathy [hematoxylin and eosin (H & E) stain, original magnification 100x]. (C) Medial calcification with intimal fibroplasia of small arterioles in the subcutis (H & E stain, original magnification 40x). (D) Higher magnification showing intravascular calcification and subcutaneous intraluminal fibrin thrombi (H & E stain, original magnification 200x).

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