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 1890 - 25 August Dr Carr

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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M45. Nodular lesion on the shin ?Dermatofibroma


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vincenzo polizzi

Posted · Report

I find this case very confusing if thinking of a single pathology...but thinking of a pathological association I might venture the spot diagnosis of an adamantinoid trichoblastoma/Lymphadenoma + ALHE. 

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Anil Patki

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A poorly circumscribed dermal tumour with dark cells, hyalinized cells and foci of calcification. Some islands of dark cells show palisading. Eosinophils in the infiltrate create some confusion. Pilomatricoma is the thing I can think of.

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vincenzo polizzi

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I want to correct ALHE with Kimura disease (is he an asian patient?).

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Raul Perret

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For me too this is a hard case. As Vincenzo I think there is a collision of pathologies, I would perform immunos for the lymphoid portion, could it be a B cell lymphoma (MALT) CD43, CD20, CD3, etc. The epithelial component is challenging too, on low power looks like pilomatricoma but I am less convinced at high power, I thought of BCC with prominent infundibular differentiation, follicular SCC? BerEP4, EMA, CEA, P53, ki67. Nice case

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Dr. Mona Abdel Halim

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Very dificult!

I am thinking of a pseudolymphomatous reaction surrounding an adnexal lesion. As for the nature of the adnexal lesion, it looks benign to me, not BCC and not fSCC. Definitly on high power, it is not pilomatricoma although it gives this impression on low power. There is epithelial mucin. I am thinking it could be inverted follicular keratosis??

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Dr. Richard Carr

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This is clearly a spot diagnosis except neither myself nor anyone else I shared the case with could give it a satisfactory name (I circulated it to about 20 friends and colleagues, many of national and some of international standing). My report favoured a low-grade follicular neoplasm (probably benign) with ALHE-like stromal reaction! If anyone sees another example we might publish a series!

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