A necrobiotic granuloma may be seen in a number of conditions. It needs to be distinguished from other kinds of granulomas.


A necrobiotic granuloma shows:

(1) a periphery consisting of a granulomatous reaction

(2) central necrobiosis (hypocellular with loss of elastic fibrers and with variable amounts of fibrin, lipid and mucin)

(3) absence of acute, chronic or caseous necrosis


A necrobiotic granuloma can heal without scarring..


A pallisading necrobiotic granuloma has histiocytes with elongated nuclei arranged in a radial pattern.


Conditions that can cause a necrobiotic granuloma include:

(1) granuloma annulare

(2) rheumatoid nodule

(3) actinic granuloma (annuolar elastolytic granuloma)

(4) nccrobiosis lipoidica

(5) rheumatic fever papule

(6) injection site (drug, vaccine, collagen)

(7) necrobiotic xanthogranuloma


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