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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 984 - 1st April 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 64-year-old white man with a shave biopsy of a pink papule taken from the middle aspect of the chest.

Case posted by Dr. Mark Hurt.

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Robledo F. Rocha


It’s a classic poroma with typical anastomosing trabeculae arising from the undersurface of the epidermis composed of small poroid cells and squamoid cuticular cells, the latter lining ductal structures. Areas of necrosis en masse can be found.
I confess I’m a bit confused about the mitotic index since the expression of Ki-67, which highlights proliferating cells in interphase and during mitosis, is not proportional to the expression of pHH3, which highlights cells in mitosis only.

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Mark A. Hurt MD


My diagnosis was poroma as well; some call these lesions acrospiromas. To address Robledo's confusion about Ki-67 and PHH3, it is common to see a Ki-67 index that is elevated [i]around [/i]the periphery of the lobules, but uncommon to see it positive [i]throughout [/i]the lobules. In this sense, it is somewhat like a seborrheic keratosis, at least in my own experience. PHH3 is much more limited, and I would expect it to have a low index, as it does in this case.

For those of you who are interested in articles on mitotic figures in poromas (acrospiromas in the article), the [url="http://www.ncbi.nlm.nih.gov/pubmed/3558913"]one by Cooper[/url] is a classic, and it is still relevant today.

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