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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 4000! You can review the archived cases and read the suggested diagnoses by users and the final comment by the contributors.
Case are uploaded each week day by 10 am UK time with the correct diagnosis will generally be posted at 8 pm UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 843 - 10th September 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 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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Go to records September 2013

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Guest Maria George

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

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

Arti Bakshi 286

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

Guest Romualdo

Posted

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

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Robledo F. Rocha

Robledo F. Rocha 336

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

Dr. Mona Abdel-Halim 508

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

Sasi Attili 85

Posted

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

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Guest Jim Davie MD

Guest Jim Davie MD

Posted

Epidermal nevus seems reasonable. CARP is also a consideration, although a solitary plaque (rather than multiple lesions) is unusual.
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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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Guest nidal
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

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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