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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 824 - 14th August Posted By: Dr. Hafeez Diwan

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11-year-old female with posterior neck biopsy.


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Robledo F. Rocha

Posted

I think this is confluent and reticulated papillomatosis of Gougerot and Carteaud due to the presence of downgrowths of the epidermis from the bases between papillomatous areas. Age, gender and site also lend support to the hypothesis.

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The skin sample looks like a shave. It is probably an Epidermal nevus.

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Guest Rodrigo Restrepo

Posted

[color=#1C2837][font=arial, verdana, tahoma, sans-serif][size=4]Epidermal nevus[/size][/font][/color]

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Guest Maria George

Posted

[color=#1C2837][font=arial, verdana, tahoma, sans-serif]Epidermal nevus/acanthosis nigrican.[/font][/color]

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Guest Jim Davie MD

Posted

I think this is an epidermal nevus.
A superficially/partially represented nevus sebaceus is my second thought.

There is often abnormal, superficial sebaceous or folliculosebaceous adnexa in addition to epidermal nevus changes for NS, but such a clue might be absent, in a small superficial shave. My suspicion for a nevus sebaceus is increased for any head/neck biopsies from an early adolescent (as in this case, 11 year old female), since NS tend to suddenly grow and become an item of patient concern, prompting a visit.

Histology shows seborrheic keratosis-like hyperkeratosis and reticulated acanthosis with blunt papillomatosis. It lacks significant basal hyperpigmentation, dermal adnexa, or keratin cysts.

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Guest Romualdo

Posted

In Figure 3 I see epithelial lobules with rounded contours, peripheral cells arranged in palisades and epitelial basement membrane easily seen, at least in some areas. The queratinocytes forming the lobules are realatively small and clear. I think these findings are suggestive of a trichilemmoma. By the other side the acanthosis and papillomatosis seen at the suprajacent epidermis are much more prominent and horizontally arranged than that seen at the superficial part of trichilemmomas. Maybe the explanation would be a trichilemmoma arising in a nevus sebaceous of Jadassohn.

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Guest Jim Davie MD

Posted

[quote name='Romualdo' timestamp='1376498255']
In Figure 3 I see epithelial lobules with rounded contours, peripheral cells arranged in palisades and epitelial basement membrane easily seen, at least in some areas. The queratinocytes forming the lobules are realatively small and clear. I think these findings are suggestive of a trichilemmoma. By the other side the acanthosis and papillomatosis seen at the suprajacent epidermis are much more prominent and horizontally arranged than that seen at the superficial part of trichilemmomas. Maybe the explanation would be a trichilemmoma arising in a nevus sebaceous of Jadassohn.
[/quote]
I agree. Nevus sebaceous with trichilemmal and epidermal nevus features, but lacking sebaceous lobules, would make sense.

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Dr. Hafeez Diwan

Posted

Acanthosis nigricans. The clinical impression was acanthosis nigricans.

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