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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 1004 - 29th April 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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The patient is a 76-year-old man with a shave biopsy taken from the right great toe.

Case posted by Dr. Mark Hurt.


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nick turnbull

Posted

Im still thinking, but I see acral skin, prominent vasculature and extravasated blood cells, amorphous material, but I wondered if i saw synovium and finally cartilage/bone? I was wondering about osteoma cuits related to the vascular changes or an old mucoid cyst...probably way off but would love some feedback/direction.

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Eman El-Nabarawy

Posted

I like the suggestion of osteoma cutis!! But what about the adult form of juvenile hyaline fibromatosis localized to the foot?

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Mark A. Hurt MD

Posted

See my diagnosis for yesterday's case (case [url="https://dermpathpro.com/spot-diagnosis-1/_/free-spot-diagnosis-april-2014/april-2014/case-1003-28th-april-r1042"]1003[/url]) [url="https://dermpathpro.com/spot-diagnosis-1/_/free-spot-diagnosis-april-2014/april-2014/case-1003-28th-april-r1042"]here[/url].

MAH

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Mark A. Hurt MD

Posted

Here are some special stains. My diagnosis after 20:00 GMT

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1004_Image%2007.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1004_Image%2008.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1004_Image%2009.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1004_Image%2010.jpg[/img]

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Mark A. Hurt MD

Posted

I'll give everyone more time to think about this one before I give my diagnosis and explain my reasoning.

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Dr. Richard Carr

Posted

I was thinking of digital mucus cyst too or metaplastic syonvial cyst. There is cartilage so assumed this must be close to a joint. I suppose it could be from the top of an osteochondroma but clinical correlation would be required and would be odd to have quite such a superficial biopsy.

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Mark A. Hurt MD

Posted

I thought this was a difficult case.

My diagnosis was as follows:

SKIN, RIGHT GREAT TOE , SHAVE BIOPSY :
[b]-- HYALINE CARTILAGE SURROUNDED BY GRANULOMATOUS INFLAMMATION [/b]
[indent=1][b]COMMENT:[/b] The differential diagnosis includes cartilaginous extension of an osseous lesion through the skin as well as the cartilaginous components of a benign mixed tumor (but I don't see any other elements of a mixed tumor), or possibly an enchondroma. Pure cartilaginous lesions of the skin are extremely rare, so it might be of some value, at this point, to have this area radiographed in order to make sure that there is no deeper component extruding from bone up to the skin. Certain conditions, such as Maffucci's syndrome, can have cartilaginous components close to the skin. At this point, I believe that correlation is necessary in order to resolve these questions.[/indent]


REFERENCE: Hsueh S, Santa Cruz DJ. Cartilaginous lesions of the skin and superficial soft tissue. J Cutan Pathol. 1982 Dec;9(6):405-16. PubMed PMID: 7161422.

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