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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 949 - 11th February 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 71 year old woman with generalized pink papules. A punch biopsy is taken from the chest.

Case posted by Dr. Mark Hurt


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Guest Romualdo

Posted

I do think there is a cornoid lamella in figures 1 and 2. I suggest some type of disseminated superficial porokeratosis, or disseminated superficial actinic porokeratosis , based on the presence of severe actnic elastosis, or inflammatory disseminated superficial porokeratosis, based on the presence of some eosinophils and neutrophils in the infiltrate.

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Sasi Attili

Posted

Epidermis- hypoer and focal parakeratosis with spongiosis and hypergranulosis. No epidermotropism

Dermis- Superficial and possibly deep (unclear on pictures) perivascular mixed infiltrates with a predominant population of lymphocytes. Some of the lymphocytes do look slightly larger and atypical, but the infiltrate is not dense enough to consider a lymphoma/ MF.

Viral exanthem/ Drug rash would be my favoured diagnosis. I am not convinced re the cornoid lamella. Even if there is one, it is not specific and the clinical is against the diagnosis of PK.

I did wonder if some of the cells were mast cells. However, I am not sure on H & E. Would do a Tol Blue if clinical fits.....

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Guest Dr.Yüksel Okumuş

Posted

Disseminated superficial actinic porokeratosis or DSAP like drug eruption.

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Dr. Mona Abdel-Halim

Posted

Interesting differential diagnoses, however I have not thought of porokeratosis at all. Clinically these r generalized pink papules, not keratotic macules of DSAP, obviously not the classic type of porokeratosis. Pathologically, I have perceived this parakeratotic area as focal angulated parakeratosis with hypogranulosis beneath, the epidermis is mildly hyperplastic and mildly spongiotic. The infiltrate contains few esinophils. Few dyskeratotic cells are seen also, two beneath the parakeratosis and one alone on the right side of image 2. I thought of pityriasiform drug reaction or papular rosea. I might be wrong anyway !!!

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Guest Romualdo

Posted

Besides the cornoid lamella (parakeratoic focus above invagination of epidermis associated with hypogranulosis and dyskeratotic cells beneath it) there are some dyskeratotic keratinocytes at the right side of figure 1. I think disseminated superficial actinic porokeratosis like drug eruption is a good possibility.

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Robledo F. Rocha

Posted

Disseminated superficial porokeratosis. Eosinophils may form [url="http://www.dermatol.or.jp/Journal/JD/full/032110890e.pdf"]a denser infiltrate[/url] than depicted above, without association with drug intake. [url="http://pdf.medrang.co.kr/Aod/021/Aod021-02-08.pdf"]Association with internal neoplastic disease[/url] was reported.

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Eman El-Nabarawy

Posted

I like the suggestion of DSAP like drug reaction.

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Mark A. Hurt MD

Posted

See my note on [url="https://dermpathpro.com/spot-diagnosis-1/_/free-spot-diagnosis-feb-2014/february-2014/case-948-10th-february-r987"]yesterday's[/url] case #948.

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Mark A. Hurt MD

Posted

Here are some additional photos. I think you'll find the answer here:

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE949_Image%2008.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE949_Image%2009.jpg[/img]

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Dr. Mona Abdel-Halim

Posted

OMG, so this mite was the cause of this whole confusion !!!!!!!

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Mark A. Hurt MD

Posted

Of course, this is scabies. This was the only organism found after sectioning through the entire block. Thus, I am an advocate for tenacity in pursuing such a diagnosis. Scabies was in the clinical differential.

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