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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 1168 - 15th December 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 49 year old white man with excisions with margin exam if malignant of a mass taken from the right elbow.

Case Posted by Dr. Mark Hurt


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Guest Jim Davie MD

Posted

Agree with Pilar/Epidermal inclusion cyst, likely secondary to trauma, given extreme depth in the dermis, and absence of pilosebaceous units in the superficial dermis suggesting the glabrous aspect of the elbow). Not sure if it's artefact, but appears to be a foreign-body refractile crystalline needle in a multinucleate giant cell in the center medium-power images. CD34 highlights expected vascular bundles, negative in proliferation. The Ki67 is moderately elevated, but appears basal in distribution (taking into account some tangential orientation).

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Mark A. Hurt MD

Posted

My diagnosis was proliferative tricholemmal cystic acanthoma. This lesion is, in my opinion the benign analogue to a proliferative tricholemmal cyst(ic) carcinoma. There is more to it compared to most isthmus-catagen cysts (tricholemmal cysts), but it has relatively monomorphous cytology and almost no mitotic figures.

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