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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 948 - 10th February 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 69 year old woman with a shave biopsy of a lesion on the left upper lateral lip.

Case posted by Dr. Mark Hurt


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Guest Saleem Taibjee

Posted

My first thought is rather exuberant pyogenic granuloma / granulation tissue.
But I suspect that Mark would not submit that, so there is obviously a catch, and immunos will probably surprise.

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Guest Tiberiu Tebeica

Posted

The low power temptation is to call this a pyogenic granuloma. Although I am not convinced I see interstitial clumps of purplish material, since there are obvious neutrophils and nuclear dust in the deep aspect of the biopsy and not only confined to the ulceration, I cannot exclude bacillary angiomatosis. As my personal experience with Warthin-Starry is rather disappointing, I would ask also for GMS and maybe a Giemsa. Of course, IHC staining for Bartonella would be indicated. The clinical history might be of help.

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Guest Maria George

Posted

If not PG then Cutaneos angiomatous nodule (CAN)

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Robledo F. Rocha

Posted

Given the proliferation of blood vessels with prominent endothelial cells accompanied by interstitial inflammatory infiltrate, I favor bacillary angiomatosis or, if there is history of exposure to endemic areas, verruga peruana. Looking forward for Warthin-Starry stain.

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Guest Romualdo

Posted

Agree, bartonellosis, possibly bacillary angiomatosis in an immunocompetent individual.

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Mark A. Hurt MD

Posted

Here some immunos to consider. I will post my diagnosis and comments at 20:00 GMT.

MAH

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE948_Image%2008.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE948_Image%2009.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE948_Image%2010.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE948_Image%2011.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE948_Image%2012.jpg[/img]

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Mark A. Hurt MD

Posted

My diagnosis was lobular angioma (pyogenic granuloma), which was the clinical diagnosis.

I thank some of you raising the question of bacillary angiomatosis. I have just ordered a Steiner stain because of your querry, but I suspect it will be negative. I'll update this information when I review that marker. I don't have the IHC marker for BA. Does anyone here know of a good source?

Regards,

MAH

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Mark A. Hurt MD

Posted

I obtained a Steiner stain, which is negative.

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