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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 843 - 10th September Posted By: Guest

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The patient is a 15-year-old girl with a punch biopsy of a scaly reticulated plaque taken from the abdomen.

Case posted by Dr. Mark Hurt.


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Guest Maria George

Posted

Features of Pityriasis Rubra Pilaris (PRP).Doubtful lymphocytes in the epidermis to make it Mycosis fungoides.

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Guest Saleem Taibjee

Posted

I must admit that I was thinking epidermal naevus on the low power. There do appear to be haloed nuclei in the epidermis, which my brain had initially registered as artefactual clefting of keratinocytes rather than lymphoid cells. But if these are lymphoid cells, this is presumably Pagetoid reticulosis (Woringer-Kolopp) despite the lack of atypia.

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Arti Bakshi

Posted

[i]Dont think these are lymphocytes, look more like keratinocytes with haloes.[/i]
[i]Not sure what the diagnosis is though![/i]

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Guest Romualdo

Posted

Early or late lesion of confluent and reticulated papillomatosis, with little papillomatosis?

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Robledo F. Rocha

Posted

Age and clinical presentation drive me to the diagnosis of confluent and reticulated papillomatosis of Gougerot and Carteaud.

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Dr. Mona Abdel-Halim

Posted

I believe no lymphocytes are detected, only tissue processing artefacts of keratinocytes. We have orthokeratosis, papillomatosis and some acanthosis, in view of clinical could be confluent and reticulated papillomatosis or may be just an EVN.

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Sasi Attili

Posted

Unusual presentation but could the perinuclear halo represent viral cytopathic change seen in EDV?

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Guest Jim Davie MD

Posted

Epidermal nevus seems reasonable. CARP is also a consideration, although a solitary plaque (rather than multiple lesions) is unusual.
.
I agree this is perinuclear clearing and ballooning artefact of processing, similar to the 'birdseye' keratinocytes of verruca plana. Notwithstanding, the keratinocytes appear slightly abnormal, with compact hyperkeratosis and hypergranulosis, and macular seborrheic-keratosis-like acanthosis and papillomatosis. Pigment appears preserved in basal keratinocytes. No pityrosporum/malassezia fungi I can see.

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Mark A. Hurt MD

Posted

Here is my diagnosis with comments:

[b]-- CONFLUENT AND RETICULATED PAPILLOMATOSIS (GOUGEROUT-CARTEAUD) [/b]
[b]COMMENT:[/b] Many times confluent and reticulated papillomatosis contains Pityrosporum in the cornified layer, but I don't see it here. The other differential that usually goes hand-in-hand with a confluent, reticulated papillomatosis is acanthosis nigricans, but in my opinion, this is not characteristic of acanthosis nigricans because in that condition, the papillomatosis component consists of very uniform thickness of the epidermis, which is not seen here. The other differential is epidermal nevus, which seems unlikely, given the clinical differential.

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The [u][i][b]full [/b][/i][/u]clinical diagnosis given was as follows: The patient is a 15-year-old girl with a punch biopsy of a scaly reticulated plaque taken from the abdomen. Clinical Diagnosis: TV vs CARP.

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The compact hyperkeratosis and follicular plugging in addition to lack of inflammatory and church spire appearance make mr in favor of pityriasis rubra pilaris , the atypical juvenile type , which is also has some resmblance to erythrokeratoderma variabalis

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Guest Tiberiu Tebeica

Posted

Confluent and reticulated papillomatosis of Gugerot and Carteaud. Although there is not much papillomatosis, the invagination of hyperkeratotic stratum corneum through the epidermis is a clue for CARP.

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