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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 4000! You can review the archived cases and read the suggested diagnoses by users and the final comment by the contributors.
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Case Number : Case 911 - 16th December Posted By: Guest

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The patient is a 39 year old man with four superficial erosions on the penis, present for 3 weeks. A biopsy is taken from the penis.

Case posted by Dr. Mark Hurt
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Go to records December 2013

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Guest Tiberiu Tebeica

Guest Tiberiu Tebeica

Posted

There is a dense lichenoid infiltrate of mononuclear cells (lymphocytes, histiocytes and possibly plasma cells, although I don't see them well in these photomicrographs) with deep extension, associated with epidermal hyperplasia. There is also prominent endothelial swelling. In the clinical setting provided, this is likely a chancre of primary syphilis. Correlation with serology and/or staining for T. pallidum would be helpful.

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Guest Maria George

Guest Maria George

Posted

Mycosis fungoides. namely pagetoid reticuloisis is important differtial here.

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Sasi Attili

Sasi Attili 85

Posted

I agree on clinical grounds syphilis is a differential. However, I do not see many plasma cells. What about LP?

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Guest Amira Tawdy

Guest Amira Tawdy

Posted

Can we add lymphomatoid drug eruption to D.D ?

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Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim 508

Posted

As Sasi said, what about LP (erosive type)

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Guest Maria George

Guest Maria George

Posted

LP classically has hyperkeratosis and not parakeratosis like this case.However, it can be drug-induced LP where you can see parakeratosis.But missing eosinophils though.
For me 2 horsesin the race till now $ and lymphoma or Scabies.

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Guest Romualdo

Guest Romualdo

Posted

The extensive parakeratosis speaks against lichen planus and the absence of plasma cells against syphilis. I think lymphomatoid drug eruption a good idea!

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Sasi Attili

Sasi Attili 85

Posted

Parakeratosis is not an exclusion criterion for erosive LP, though I agree that it is usually focal and not confluent like in this case. Drug reaction is a good idea, though this is not quite 'lymphomatoid' in my opinion. Forgot to mention - PAS essential to rule out primary/ secondary candidal infection in view of the extensive parakeratosis.

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Guest Rodrigo Restrepo

Guest Rodrigo Restrepo

Posted

[color=#1C2837][font=arial, verdana, tahoma, sans-serif][size=4]Drug-induced LP [/size][/font][/color]

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Robledo F. Rocha

Robledo F. Rocha 336

Posted

I favor lymphomatoid drug eruption due to prominent lymphocytic epidermotropism with minimal spongiosis, and to non-necrotic vascular reaction displaying transmural angiocentric infiltrate of lymphocytes.

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Dr. Richard Carr

Dr. Richard Carr 622

Posted

I suspect the plasma cells just have not had sufficient time to turn up! I am looking forward to seeing the T. pallidum stain.

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Sasi Attili

Sasi Attili 85

Posted

I guess Richard is right in spotting the late comers!!!!

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Robledo F. Rocha

Robledo F. Rocha 336

Posted

[color=#1C2837][font=arial, verdana, tahoma, sans-serif][size=4]Yes, this is chancre of primary syphilis.[/size][/font][/color]

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Dr. Mona Abdel-Halim

Dr. Mona Abdel-Halim 508

Posted

Then chancre of primary syphilis, nice case :-))

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