Elastic fiber degradation in the development of pediatric granuloma annulare: Report of 39 cases

Figure 1 Elastic fiber staining was categorized into four grades according to the elastic fibers' dissolution degree and destruction. A: Grade I: Disorganized arrangement of elastic fibers in the lesion without significant dissolution (×200); B: Grade II: Partial breakage of elastic fibers in the lesion with mild dissolution (×200); C: Grade III: Partial dissolution of elastic fibers in the lesion, but small, discontinuous elastic fibers are still visible (×200); D: Grade IV: Complete dissolution and disappearance of elastic fibers in the lesion (×200).

Figure 2 Granuloma annulare was classified into four types: Palisading granuloma, histiocytic infiltrative, epithelioid nodular, and mixed histologic types. A: Histiocytic infiltration type granuloma annulare (GA): Progressive necrosis is mild with incomplete degeneration of collagen fibers (×100, HE); B: Palisading granuloma type GA: progressive necrosis is evident with complete degeneration of collagen fibers in the lesion (×100, HE); C: Epithelioid nodular type GA: histiocytes aggregate to form epithelioid nodules with multinucleated giant cells mixed in the nodules and surrounded by lymphocytes (×100, HE).