Case Number : case 100 Posted By: Guest

Ruifeng Guo - (OK, USA) Wrote:

Somehow cutaneous Wegner's granuloma crosses my mind, although I don't have a very clear picture of it.

Submitted on 27/10/2010 20:09
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Phillip McKee - Overseas consultations (Sedona, Arizona, USA) Wrote:

Well done to all who diagnosed sarcoidosis although as you all know the differential diagnosis is huge and in particular you would have to exclude infectious causes. I put this slide in because it represents sarcoidosis as a reaction to interferon alpha treatment. The slide was shared with me by Nooshin Brinster from Virginia, USA

Submitted on 27/10/2010 20:09
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martin - (spain) Wrote:

sarcoidosis- fibrosing vasculitis

Submitted on 27/10/2010 19:51
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Dear Dr Carr, I saw the image on the link you mentioned, very beautiful and amazing. I raed about perifollicular foam cells in fox fordyce disease but never saw a picture of it, Thank u very much.

Submitted on 27/10/2010 13:39
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Marcela Saeb Lima - Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (Mexico City) Wrote:

There is fibrinoid necrosis associated with "sarcoidal" granulomata, however I do see neutrophils also. I can´t find pleomorphism or mitotic activity. I would also consider, besides what has been said, rheumatoid nodule or Churg Strauss granuloma.

Submitted on 27/10/2010 12:04
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Richard Carr - Warwick (UK) Wrote:

Hello all. Left a link for Fox Fordyce (great suggestion) on Case 96. Today we have sarcoidal granulomas with fibrinoid necrosis and I struggled to resolve all the cells but agree they do look like neutrophils. I can almost smell the foreign material here and will be getting the polariser out even if the patient does have "necrotising" sarcoid they may still be reacting to a foreign material. Given that Saleem and I pretty much think in a parallel fashion I also thought we should always just think of epithelioid sarcoma but the necrosis here looks more fibrinoid sarcoidosis-type. I have several ES in my collection and some of them really do mimic a granulomatous process quite well. So to summarise "necrotising" sarcoidal granulomas IKW sarcoidosis and / or foreign material reaction.

Submitted on 27/10/2010 11:37
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Rodrigo Restrepo - UPB/CES (Mdlln. Col) Wrote:

Sarcoidosis

Submitted on 27/10/2010 11:09
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Saleem Taibjee - Warwick () Wrote:

Looks granulomatous, and that in itself makes me consider epithelioid sarcoma as a knee-jerk reaction in case Philip is in a playful mood. However, naked granulomas would favour sarcoidosis, although this is a diagnosis of exclusion. We would need to polarise for foreign material and might still consider infectious aetiology in the right clinical context.

Submitted on 27/10/2010 08:22
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Sasi Attili - Department of Dermatology, Ninewells University Hospital (Dundee, UK) Wrote:

Ok. Lets try and see if I succeed in making a fool of myself again!!. Lobules composed of epithelioid to spindled cells with abundant eosinophilic cytoplasm and ovoid nuclei. Lobules seperated by compressed stroma. Agree looks granulomatous at first glance. The inflammatory cells (neutrophils and lymphocytes?)are slightly off-putting. Off-centered infl cells not really typical for a suppurative or tuberculoid granuloma. Lobules maybe too close to each other for an inflammatory process? Not really seen a neurothekeoma before but some of the pictures published look like this. Not sure if in a neurothekeoma there should be a bit more hyalanisation around the lobules though...

Submitted on 27/10/2010 06:17
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

Sarcoidosis.

Submitted on 27/10/2010 06:01
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

naked epithelioid cell tubercles, fibrin deposition, agree with sarcoidosis.

Submitted on 27/10/2010 05:59
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Good evening... my first impression.. almost "naked" granulomas... Sarcoidosis?

Submitted on 27/10/2010 00:22
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