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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 800 - 11th July Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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58-year-old female with hyperpigmented, thickened lesions on arms. A prior biopsy from the shoulder was read by someone as “morphea.” The present biopsy is from the right arm.

Case posted by Dr Hafeez Diwan.


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Guest Saleem Taibjee

Posted

The additional interface element made me consider the following histological differential:
Sclerodermoid variant of dermatomyositis
Sclerodermoid graft-versus-host
Lichen sclerosus-morphoea overlap (I think there may be homogenisation of the superficial dermis here perhaps favouring the latter?).

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Sasi Attili

Posted

I agree with Saleem. The vacuolar interface and sclerosis made me wonder about sclerodermatoid GVHD. LS/ Morphoea overlap is a good differential but CPC required.

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Guest Rodrigo Restrepo

Posted

Agree Abdul Chronic lupus erythematosus.

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I think that serologic information is essencial, but the differential diagnosis could be LS/morphea overlap or even a Lupus erythematosus and morphea overlap. The clinical information would be mostly important for this last one.

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Guest Dr. Engin Sezer

Posted

Band of hyalinized collagen bundles in the upper dermis with epidermal interphase changes combined with sclerotic, thickened collagen with mucin between the bundles, consistent with LS/morphea overlap

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Robledo F. Rocha

Posted

[size=4][size=4]I think this is a scarring chronic lupus erythematosus. Microscopic pictures show an interface dermatitis with lymphocytic infiltrate around both superficial and deep vascular plexuses, and increased mucin between collagen fibers in reticular dermis.[/size][/size]
[size=4][size=4]An atrophic hair follicle can be found. It features vacuolar damage of the infundibular basal cells and an underlying fibrous tract. These findings, in addition to the presence of melanophages and sclerosis in upper dermis, explain the clinical characteristics of thickened and hyperpigmented lesions that probably also display alopecia.[/size][/size]

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Mark A. Hurt MD

Posted

I also favor chronic lupus in this case, based on the squamatization of the adnexa, the mononuclear infiltrate, the hyalinization at the BM zone, and the interstitial mucin.

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Guest Dr. Francisco Vílchez

Posted

Too much mucin and interface dermatitis...I think chronic lupus.

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Dr. Hafeez Diwan

Posted

Agreed. This is lupus. The patient has a positive ANA.

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