In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 1882 - 15 Aug - Dr Uma Sundram

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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63 year old woman with lesion on vulva. No other history is provided.


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Anil Patki

Posted · Report

Islands of cells some of which are dark and some showing pale cytoplasm, along with the site of lesion (vulva) makes me think of syringoma showing clear cell change in some areas

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Raul Perret

Posted · Report

For me there is an acanthotic epidermis with areas of dysmaturation and premature keratinization overlaying a dermis with broad condensated collagen.  This is consistent with differentiated VIN and lichen sclerosus. The main problem of the biopsy is the bad orientation that can simulate invasive areas. But considering the highly pleomorphic cells and irregular nests with jagged edges from my point of view there are real areas suspicious of invasion.

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Cem Leblebici

Posted · Report

In Figure 4, epithelial cells showed enlarged nuclei with ground glass appearance. I suspect  pseudoepitheliomatous hyperplasia associated with herpes infection mimicking invasive carcinoma.

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Robledo F. Rocha

Posted · Report

Herpesvirus infection in the setting of lichen sclerosus.

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Uma Sundram

Posted · Report

Herpes mimicking invasive SCC.  The biopsy is misoriented which may make the dermis seem more sclerotic.

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Anil Patki

Posted · Report

A symptomatic herpes infection should show ballooning degeneration of epidermis, multinucleated keratinocytes and inflammatory infiltrate.

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Anil Patki

Posted · Report

Can it be Bowenoid papulosis? A clinician hardly ever biopsies a lesion of herpes on the genitals. The clinical features are so distinctive and we have serology and viral culture for confirmation.

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