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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 855 - 26th 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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64-year-old male with lesions on the back, thought to be keloids.

Case posted by Dr. Hafeez Diwan.


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Guest Giovanni Falconieri

Posted

Mixed dermal lympho- mononuclear infiltrate. Some lymphoid cells are apparently sitting within larger elements. Wondering about cutaneous Rosai Dorfman disease, to start.

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Arti Bakshi

Posted

There certainly does appear to be emperipolesis supporting Rosai- Dorfman!
Would still do special stains to rule out an infective eitiology though.

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Sasi Attili

Posted

Wow! This is the first time since I started answering the spot diagnosis, I thought about [font="arial, verdana, tahoma, sans-serif"][color="#1c2837"][size=4]Rosai-Dorfman disease as soon as I saw the slide and this does seem to be the consensus. Hope that is the answer![/size][/color][/font]

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Robledo F. Rocha

Posted

[size=4][color=#000000][font=Palatino Linotype, serif]Engulfment of leukocytes by histiocytes with abundant pale cytoplasm depicted in a beanbag pattern is characteristic for Rosai-Dorfman disease when accompanied by infiltrate of lymphocytes, plasma cells and neutrophils. Probably massive cervical lymphadenopathy, fever and polyclonal hypergammaglobulinemia are also present.[/font][/color]
[color=#000000][font=Palatino Linotype, serif]To be fair, [/font][/color][color=#000000][font=Palatino Linotype, serif]this disease was described first by the [/font][/color][color=#000000][font=Palatino Linotype, serif]French pathologist Pierre-Paul Louis Lucien D[/font][/color][color=#000000][font=Palatino Linotype, serif]é[/font][/color][color=#000000][font=Palatino Linotype, serif]stombes [/font][/color][color=#000000][font=Palatino Linotype, serif]in 1965, four years before than Juan Rosai and Ronald F. Dorfman[/font][/color][color=#000000][font=Palatino Linotype, serif] published their famous paper. What a pity [/font][/color][color=#000000][font=Palatino Linotype, serif]D[/font][/color][color=#000000][font=Palatino Linotype, serif]é[/font][/color][color=#000000][font=Palatino Linotype, serif]stombes [/font][/color][color=#000000][font=Palatino Linotype, serif]wrote his article in French, [/font][/color][color=#000000][font=Palatino Linotype, serif]not in English like Rosai and Dorfman[/font][/color][color=#000000][font=Palatino Linotype, serif]![/font][/color][/size]

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Guest Jim Davie MD

Posted

Agree with DRD / RD. Alternatively known as "sinus histiocytosis with massive lymphadenopathy" although this is a poor synonym, given its potential for exclusively extra-nodal distribution. The clinical is non-classic for DRD ....which is most often a disease of young adults.

It would be interesting to see the immunostains and/or clinical workup, if confirmation was sought.

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Dr. Hafeez Diwan

Posted

Rosai-Dorfman disease. The histiocytic cells were S-100 positive.

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