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Building Blocks of Dermatopathology

BAD DermpathPRO Learning Hub: Special Stains

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Case Number : ST0009 Dr. Hafeez Diwan

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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39 year-old male with right shin lesion, clinically: rule out dermatofibroma.

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Raul Perret - My interpretation is that we see intra and extracellular deposits of a golden brown exogenous pigment with a macrophagic reaction and dermal fibrotic scarring. The pigment is positive with Perls prussian blue and the last two images I assume are Masson's Fontana? I thought this is either a reaction to a drug like minocycline/anti-malarial/amiodarone drug pigmentation or a reaction to a tattoo. 

Vincenzo Polizzi - Why not a hemosiderotic Dermatofibroma?
Nitin Khirwadkar - I would go with Raul's suggestion. Great site for pigmentation secondary to Quinolones.

Dr. Mona Abdel-Halim - Yes type II minocycline induced pigmentation is also my thought
Vincenzo Polizzi - Mynocycline induced pigmentation isn't usually a fibrous histiocytoma-like lesion...but I think you all are right, so I'm asking myself if it could be an odd mynocicline induced reaction on a preexisting histioid leprosy.. Edited September 1, 2016 by Guest

Guest Michelle Liang - Hi everyone! I've been stalking this site as I'm preparing for my ICDP exam. I was thinking of hemosiderotic dermatofibroma as well, but not sure about the last 2 stains. Minocycline induced pigmentation would be consistent with Perl's and Fontana Masson positivity but am puzzled as it should not present clinically similar to a dermatofibroma. Edited September 1, 2016 by Michelle Liang
Dr. Richard Carr - Welcome Michelle. Please do post your suggestions and don't just stalk!  Good luck with your exam. Siderotic DF for me but of course I never considered the other suggestions.  It is a bit odd looking though. If we have any other stalkers please post your thoughts too!  I believe you only need to register with the site to have posting rights.

Vincenzo Polizzi - Welcome on board Michelle and break a leg with your exam.
Sasi Attili - Siderotic DF 

Dr. Hafeez Diwan - Minocycline pigmentation.  Both melanin and iron stains are positive.

Dr. Mona Abdel-Halim - Welcome Michelle, good luck with ur exam. I just want to tell u that this site helped me a lot on my preparation for the ICDP. Do not hesitate, just write ur thoughts. We all are learning from each other... I encourage you to go for membership so as to be able to see all the archived cases... U should not miss that :-))
Guest Michelle Liang - Thanks everyone! Yes Mona, I am a member and have been ploughing through the amazing archives

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