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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 883 - 6th November 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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80 year-old male with left knee lesion. Clinical differential: Rule out Kaposi, atypical mycobacterial infection, cutaneous metastases. No history of any prior malignancy.

Case posted by Dr. Hafeez Diwan.


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Guest Romualdo

Posted

DLCL. My preference is for anaplastic large cell lymphoma, based in the excentric horse-shoe nuclei in some large cells.

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DLBCL with mosaic stone- like arrangement of neoplastic cells prominent in figure 2, however, IHC is mandatory to exclude other large cell lymphomas as it will affect the management of the patient.

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Cutaneous lymphomas are very challenging.
Based on the very atypical cells and as a isolated clinical lesion, I would sugest 2 principal differential diagnosis: DLBCL, maybe leg-type, and PCALCL. I prefer this last one because of the very atypical cells, the isolated knee lesion and the kidney-shaped nuclei present in many cells.
The picture 3 shows a perivascular arrangement that woul make us speculate about the diagnosis of Extranasal NK/T cell lymphoma, but these lesions are very agressive, rare, admixed with necrosis and I really don´t see angioinvasion. EBV-hybridization would be important. If positive, but in the setting of a B cell lymphoma, I would think about EBV-positive DLBCL of the eldery.
Immunohistochemistry is essential for this case and, depending on the results, EBV-hibridization and T-cell receptor study.

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Guest Juan Carlos Garcés, Ecuador

Posted

Primary cutaneous diffuse large B-cell lymphoma, leg type

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Robledo F. Rocha

Posted

Primary cutaneous diffuse large B-cell lymphoma, leg type. Pleomorphic large lymphocytes predominate and there are some angiotropic foci. Immunohistochemistry is required.

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Guest Tiberiu Tebeica

Posted

DLBCL leg type versus ALCL. Favor the first one, but IHC mandatory. Also, testing for EBV would be indicated.

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Dr. Mona Abdel-Halim

Posted

Agree with the above DDx.... Nice case :-)

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Guest Saleem Taibjee

Posted

Agree with above differential diagnosis.
I would favour Primary cutaneous diffuse large B-cell lymphoma, leg type

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Dr. Hafeez Diwan

Posted

This is large B-cell lymphoma, leg type. MUM-1 and Bcl-2 were positive (in addition to CD20)

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