CUTANEOUS EXTRAVASCULAR NECROTIZING GRANULOMA (WINKELMANN GRANULOMA) - CONFIRMATION OF THE ASSOCIATION WITH SYSTEMIC-DISEASE

Background: An unusual palisading granuloma has been described in pati ents with immunoreactive diseases. Multiple names have been given to t his lesion. Objective: Our aim was to verify whether a distinct palisa ding granuloma can be used as a marker for systemic disease. We also p ropose unifying nomenclature. Methods: Thirty-four biopsy specimens fr om 22 patients were selected for study on the basis of histologic crit eria. The medical histories of these patients were subsequently review ed for clinical information. Results: At least 21 of the 22 patients w ith cutaneous extravascular necrotizing granuloma had evidence of an u nderlying immunoreactive systemic illness. In each, the systemic disea se preceded or was diagnosed concurrently with the cutaneous lesions. Conclusion: The cutaneous extravascular necrotizing granuloma has uniq ue clinical and histologic features. In a great majority of cases, a s ystemic immunoreactive disease is present.