Case Number : Case 1720 - 30 December - Dr Richard A Carr Posted By: Guest

Well friends this is the FINAL Spot Diagnosis Case of that wonderful (not) year that was 2016. Thankfully we go out with a great case from Dr Richard A Carr, enjoy, see you all next year.

Happy New Year, Geoff Cross - DermpathPRO Projects

Happy new year to all of you.

Thanks to our Admin_Dermpath Geoff for his great and nice contribution to this amazing website.

Thanks to our present and past Teachers U Sundram, R Carr, M Hurt, H Diwan, A Bakshi, L Yu, Ph McKee ( hope and waiting for on a new edition of His amazing book ), I Chaudry , A Bakshi...

Thanks to my Colleagues Mona, Raul, Robledo, Nitin,  Alice, Urmila, Romualdo...I learned a lot thanks to them!!!

Soon

Thinking of "Foreign Body Sarcoid-like reaction in lip piercing"...

I was thinking about an adnexal tumor, but at high power this looks granulomatous to me, with a few multinucleated histiocytes and globus; so I'm going to buy Histioid Leprosy. Happy New Year everyone!!!

Picture number 3 shows foreign material in the lower area (either rests of hair shaft, suture, tatoo, etc). This is a granulomatous reaction sarcoid like as our dear Italian friend remarked. It almost fooled me at first glance as I thought cellular neurothekeoma (similar clinical and morphological picture, and possibility of giant cells) however the presence of isolated lymphocytes among the granulomatous areas is a good clue (to exclude CNT). A very happy new year to all the friends and team of dermpathpro, what a wonderful site this is! Hope we will meet in real life someday!

Yes, sarcoidal gran reaction, possibly foreign body reaction

Happy new year to all of you..

Wish to see you all one day..

In keeping to what already has been said, I would have most likely signed this out, as:
Granulomatous dermatitis with multiple discreet sarcoid-ike granulomata and presence of birefringent foreign material (see comment).
Comment:
A sarcoid-like reaction can be elicited in association with foreign body material (just as Raul elaborately described); patients may have no clinical evidence of sarcoidosis at the time (and not all of them will develop it). CPC is crucial since a diagnosis of sarcoidosis on skin biopsies is one of exclusion. 

# Like most, I find linear scratches a helpful low-power hint for the presence of foreign material (on a good sections΄ day, so to speak)
# My very limited experience with ACE immunostaining was frustrating and inconclusive (what about you guys)

Last but not least, as a newcomer to the site (and a totally indulged one....) 
I have to congratulate ALL OF YOU for this amazing effort and the brilliant cases put on this spectacular site! 
It is a potent learning and brushing up experience for me; reading the ddx on the way, helps me keep a broad perspective. 

Well done and a Happy New Year to all!
Dimitris

Happy new year to ALL.

Sarcoidal granulomatous reaction, probably to foreign body (image 3).

Agree, sarcoidal granulomatous reaction. Image 3 has some pigmented, extraneous material. 

Happy new year to all.

Agree with my colleagues about birefringent foreign material producing sarcoidal granulomatous reaction pattern.

On behalf of our Editor-in-Chief Dra. Uma Sundram and of our administrator Geoff Cross, I wish a wonderful 2017 to all the editorial team, members and future friends on 14-day trial, plenty of superb cases and learning. Hope to meet you someday!

wishing all a new year full of peace and contentment...may we all keep learning and evolving.

sarcoid like granulomas...to exlcude infective aetiology, sarcoidosis.

Agree with foreign body material and sarcoid type granuloma.

Thanks to all dear colleagues who post beautiful cases.  personally i want to admit that after visiting this wonderful website my knowledge about dermatolopathology entered a new level.

me too wish to meet all you guys.is it really possible ??

3 hours ago, Arash Daryakar said:

Agree with foreign body material and sarcoid type granuloma.

Thanks to all dear colleagues who post beautiful cases.  personally i want to admit that after visiting this wonderful website my knowledge about dermatolopathology entered a new level.

me too wish to meet all you guys.is it really possible ??

I will be attending this year's isdp meeting in glasgow. Maybe this could be a chance for meeting and maybe tasting the scottish beer (or apple juice) after the scientific presentations

when is the meeting?

1 hour ago, manunoatay said:

when is the meeting?

 

28-30 September 2017

Great, i was trying to find a link to meeting... can you help please?

Very nice.if i find the link, i will try my best to participate.

Link

Link isdp

I congratulate you all but particularly Dimitris Chatzianastasiou who is a very welcome addition to our number. 

This is a sarcoidal foreign body reaction, nice artefactual scores in the section are of course a low power clue, but all sarcoidal granulomas should be carefully searched for non-polarising and polarising foreign material.

In this case I commented that there might be a prior history of local trauma (possibly as a child) and that sarcoidal reactions to foreign material may be a complication of sarcoidosis.  High resolution CT scanning confirmed nodules in the mid zones in keeping with sarcoidosis.  I have no experience with ACE immunohistochemistry but serum ACE was normal. 

Please remember that sarcoidal reactions may develop many years after the original insult / traumatic event in patients with underlying sarcoidosis. This patient had no memory of the presumed trauma.

I hope we all do meet in Glasgow.  I'm a co-organiser of the Self assessment sessions (50 cases that I'm sure will be spectacular) - suggest I organise us all to meet up - e-mail my secretary at susan.etheridge@nhs.net and we can set up an e-mail group of dermpathpro attendees.

A very happy new year to one and all.