Case Number : Case 68 Posted By: Guest

Phillip McKee - Overseas consultations (Arizona, USA) Wrote:

I have to go out shortly and so will put you out of your misery. A difficult case if you don't know the clinical history. The features are those of juvenile colloid milium. This condition which may be sun-light associated is characterized by massive apoptosis. The cytoid bodies contain transformed keratin filaments and amyloid K fibrils. There is therefpre overlap with the other forms of primary cutaneous (macular and lichenoid) amyloid

Submitted on 13/09/2010 19:31
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m singh - CCR, UK (London) Wrote:

could it be lentigo maligna?

Submitted on 13/09/2010 17:02
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galal el enany - cairo university (cairo egypt) Wrote:

interface dermatitis

Submitted on 13/09/2010 16:23
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

So wee need to think again. Could this eosinophilic material deposited mainly at the BMZ represent the caterpillar bodies of PCT?

Submitted on 13/09/2010 15:45
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Wayne Grayson - (Johannesburg, South Africa) Wrote:

A tough case in the absence of clinical details. I think I am seeing a pauci-inflammatory lichenoid reaction, which is accompanied by an apparent spongiotic reaction to the left of the field. Although the dermis appears to be devoid of eosinophils, I would nevertheless consider an adverse drug reaction.

Submitted on 13/09/2010 15:14
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Dear Dr McKee, If we all need to think again, then I think I have another explanation for the esinophilic bodies seen along the BMZ and in the papillary dermis and around the hair folliceles, If these bodies are not apoptotic bodies, then could they be the esinophilic hyaline material of Waldenstrom's macroglobulinemia. If so then this biopsy must be taken from the rare transluecent papular lesions (Macroglobulinosis cutis). I might be still wrong!!

Submitted on 13/09/2010 14:50
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Phillip McKee - Overseas consultations (Arizona, USA) Wrote:

Good morning all. This is a difficult case and you will all have to think again!

Submitted on 13/09/2010 13:52
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Marcela Saeb Lima - MSLDermatopato (Mexico City) Wrote:

Interface vacuolar dermatitis could be GVHD, however the diagnosis depends on the clinical setting. Great week to everyone!

Submitted on 13/09/2010 12:56
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Adrian Brockland - (England) Wrote:

Vacuolar interface change - agree with comments would add Lichen amyloidosis

Submitted on 13/09/2010 12:54
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Carlos - Trainee (Spain) Wrote:

Interface dermatitis; a number of differentials including lupus, dermatomyositis, drug

Submitted on 13/09/2010 12:53
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ANDREW DANCKWERTS - WITS UNIVERSITY (JOHANNESBURG, RSA) Wrote:

lICHENOID REACTION PATTERN WITH APOPTOTIC KERATINOCYTES (COLLOID BODIES) SEEN AT ALL LEVELS OF THE EPIDERMIS, BASAL VACUOLATION, LYMPHOCYTIC EXOCYTOSIS, ABSENCE OF EOSINOPHILS AND MILD LYMPHOCYTIC PERIVASCULAR INFLAMMATORY CELL INFILTRATE WITHIN THE PAPILLARY DERMIS : FAVOURED DIAGNOSIS: ACUTE GVHD. DIFFERENTIAL DIAGNOSIS: LICHEN PLANUS, EXANTHEMATOUS DRUG REACTION, ERYTHEMA MULTIFORME, ? EARLY MF (ALTHOUGH THERE ARE NO PAUTRIER MICROABSCESS FORMATION!!!!)

Submitted on 13/09/2010 12:46
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Marwa Fawzi - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

The presence of more than five apoptotic keratinocytes,predominantly involving adnexal keratinocytes & the absence of eosinophils,are said to favor GVHD.

Submitted on 13/09/2010 12:17
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Acute GVHD (Exanthematous eruption).

Submitted on 13/09/2010 06:03
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

Necrotic keratinocytes at all levels of the epidermis with follicular involvement, showing satellite cell necrosis, basal vacuolation, lymphocyte exocytosis,scant lymphocytic perivascular infiltrate: Acute GVHD.

Submitted on 13/09/2010 05:55
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