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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 828 - 20th August Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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The patient is a 74-year-old white man with punch biopsies of indurated and atrophic plaques on the legs, taken from the left leg.

Case posted by Dr. Mark Hurt.


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Guest Romualdo

Posted

Complete involvement of the dermis (absence of normal dermis), horizontal tiers of collagen degeneration alternating with bands of granulomatous inflamation, palisading and intersticial, absence of mucin, presence of plasma cells: these findings point to necrobiosis lipoidica.

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Guest Engin Sezer

Posted

Sclerotic collagen bundles as a clue for necrobiosis lipoidica

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Guest Saleem Taibjee

Posted

Yes, no doubt necrobiosis lipoidica is top of the list. However, I was struck by the patient's advanced age. I also did wonder if there is increased interstitial mucin? - difficult to assess from digital images. Hence I might keep in mind a paraneoplastic process, perhaps also recommend checking serum paraprotein, etc, if there are any atypical clinical features here.

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Robledo F. Rocha

Posted

Necrobiosis lipoidica is my preferable hypothesis, but there are some antagonistic microscopic features to this disease, to wit, presence of mucin amounts in necrobiotic areas and lack of prominent plasma cells, not to mention that age and gender are also uncommon for a typical patient.
Alternatively, I suggest interstitial granulomatous dermatitis with unusual presentation.

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Guest Graham Reilly

Posted

Necrobiosis lipoidica is my first diagnosis.However I thought there was mucin deposition in picture 6.

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Guest Maria George

Posted

In dealing with dermpath cases the approach and pattern is very very important.
This is a case with Busy dermis= Busy dermis can kill grandma's sweet niece
Blue nevus
DF/dermal Spitz
Cutaneous metastaisis
Kaposi (plaque)
Granuloma annulare
Scleromyxedem
Neurofibroma.

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Hanan Vaknine MD

Posted

NLD also may first impression, but I would also suggest the possibility of Necrobiotic Xanthogranuloma

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Guest Jim Davie MD

Posted

Agree with NLD. This one seems to have all the expected NLD features as described by Romualdo: 'parfait' horizontal tiers of chronic inflammatory cells and necrobiosis in both superficial and deep dermis, with plasma cells, and numerous foreign-body type giant cells; no significant mucin seen in the necrobiotic foci.
Clinical hx is consistent with NLD, given centrally atrophic plaques on lower extremities.

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Mark A. Hurt MD

Posted

My diagnosis was NLD. There were bilateral leg plaques, and NLD vs GA was the clinical diagnosis.

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