title: Cutaneous extravascular necrotizing granuloma (Winkelmann granuloma): confirmation of the association with systemic disease.
abstract: BACKGROUND
  An unusual palisading granuloma has been described in patients with immunoreactive diseases. Multiple names have been given to this lesion.
  
  
  OBJECTIVE
  Our aim was to verify whether a distinct palisading granuloma can be used as a marker for systemic disease. We also propose unifying nomenclature.
  
  
  METHODS
  Thirty-four biopsy specimens from 22 patients were selected for study on the basis of histologic criteria. The medical histories of these patients were subsequently reviewed for clinical information.
  
  
  RESULTS
  At least 21 of the 22 patients with cutaneous extravascular necrotizing granuloma had evidence of an underlying immunoreactive systemic illness. In each, the systemic disease preceded or was diagnosed concurrently with the cutaneous lesions.
  
  
  CONCLUSIONS
  The cutaneous extravascular necrotizing granuloma has unique clinical and histologic features. In a great majority of cases, a systemic immunoreactive disease is present.
authors.affiliation: Department of Dermatology, Mayo Clinic Jacksonville, FL 32224, USA.
authors.forename: G J
authors.initials: GJ
authors.lastname: Wilmoth
authors.forename: C
authors.initials: C
authors.lastname: Perniciaro
mesh_terms: D000328:Adult; D000368:Aged; D001491:Basophils / Q000473:pathology; D015415:Biomarkers; D001706:Biopsy; D015267:Churg-Strauss Syndrome / Q000473:pathology; D015331:Cohort Studies; D003094:Collagen; D005260:Female; D006099:Granuloma / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D016460:Granuloma Annulare / Q000473:pathology; D006801:Humans; D007154:Immune System Diseases / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009504:Neutrophils / Q000473:pathology; D012218:Rheumatoid Nodule / Q000473:pathology; D012871:Skin Diseases / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D009626:Terminology as Topic; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000473:pathology
chemical_list: D015415:Biomarkers; D003094:Collagen