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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 874 - 24th October 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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Thumb biopsy from a 62-year-old male. The clinical is “rule out sarcoid vs Rosai-Dorfman.”

Case posted by Dr. Hafeez Diwan


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Guest Romualdo

Posted

I think this is neutrophilic dermatosis of the hands. It is necessary to exclude infectious causes.

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Guest Mazen charaf iddin

Posted

Histiocytes .. Xantomatous reaction, or mast cells .... mastocytosis??

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Sasi Attili

Posted

The neutrophilic infiltrate in my opinion is not dense enough for Neutrophilic dermatosis of the hands, BUt CPC needed. How about EED?

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I think the correct diagnosis is Erythema elevatum diutinum. I have seen cases of EED very similar and at the same location (extensor surfaces at acral location). As EED can show red to violaceous nodular configuration, It can be confused with RD and Sarcoidosis.

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Guest Romualdo

Posted

I did not remind EED, suggested by Dr. Sasi. It is an excellent possibility. The fibroblastic proliferation better shown in the last two images fits well with this diagnosis.

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Guest Juan Carlos Garcés, Ecuador

Posted

Agree with localized chronic fibrosing vasculitis

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Robledo F. Rocha

Posted

[font="Arial, sans-serif"][size="4"]Erythema elevatum diutinum characterized by granulation tissue containing neutrophilic-rich inflammatory infiltrate and vascular damage.[/size][/font]

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Guest Jim Davie MD

Posted

Agree with EED.
- Sarcoidosis and RD would be a common clinical consideration in EED, as Igor indicated.
- Mid-dermal inflammatory fibrosis, leukocytoclastic debris, neutrophil-predominant infiltrate without significant eosinophils, extravasated red cells, and hint of vasculitis in the first low-power image.

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Guest Saleem Taibjee

Posted

Agree EED, relatively acute stage. Associated paraproteinaemia should be excluded.

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