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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 989 - 8th 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 57 year old woman with a biopsy of a lesion on the posterior neck.

Case posted by Dr. Mark Hurt.


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amiratawdy

Posted

I can see only some focal thickening of the collagen bundles and some sort of elastic tissue disturbance in the upper dermis so my d.d based as well on the site of the lesion together with the age and sex of the patient: white fibrous papulosis of the neck versus papillary dermal elastolysis for elastic tissue stain to differentiate

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I see low number of melanocytes, foci of pigmentary incontinence and rare necrotic keratinocytes. Maybe figure 5 represents a large melanocyte at the border of the lesion. I think this may be Vitiligo.

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Robledo F. Rocha

Posted

There are some signs of photosensitivity, namely, scattered necrotic keratinocytes, solar elastosis, and papillary dermis with stellate fibroblasts and telangiectatic vessels. Moreover, epidermis is atrophic, inflammatory infiltrate is minimal, subtle incontinence of melanin can be found (better seen in image 4), basement membrane seems to be thickened (better seen in image 7), and dermis on the left of image 1 appears clear (suggesting increased mucin). So, my first impression is dermatomyositis.

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Dr. Mona Abdel-Halim

Posted

Agree with Robledo that this could be DM

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Eman El-Nabarawy

Posted

[quote name='Robledo F. Rocha' timestamp='1396963346']
There are some signs of photosensitivity, namely, scattered necrotic keratinocytes, solar elastosis, and papillary dermis with stellate fibroblasts and telangiectatic vessels. Moreover, epidermis is atrophic, inflammatory infiltrate is minimal, subtle incontinence of melanin can be found (better seen in image 4), basement membrane seems to be thickened (better seen in image 7), and dermis on the left of image 1 appears clear (suggesting increased mucin). So, my first impression is dermatomyositis.
[/quote]
Agree.

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Mark A. Hurt MD

Posted

My diagnosis was erythema ab igne. This was, in fact, the clinical diagnosis also. I thought the histopathology fit the clinical, it having qualities of the effects of heat on the skin and at an "early" phase. I have to admit, if I had not had this clinical diagnosis, my differential would have been expanded considerably.

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Mark A. Hurt MD

Posted

The article by [url="http://www.ncbi.nlm.nih.gov/pubmed/3800415"]Hurwitz & Tisserand from 1987[/url] was useful to me. Thanks, everyone, for participating!

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