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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 4000! You can review the archived cases and read the suggested diagnoses by users and the final comment by the contributors.
Case are uploaded each week day by 10 am UK time with the correct diagnosis will generally be posted at 8 pm UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 1582 - 19 July Posted By: Guest

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70 year old male with posterior calf lesion, found incidentally when coming in for abdominal surgery.

Dr Uma Sundram.


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Guest Arash Daryakarr

Posted

panniculitis with membranous fat necrosis?

 

ddx includes few conditions like EN & traumatic fat necrosis, etc

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Mixed pattern (lobular and septal) panniculite with lipomembranous alteration. I think this is probably a Facticial or Traumatic Panniculitis. I like to use polarised light in these cases to look for foreign body.

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Raul Perret

Posted

My interpretation was that this was mainly lobular panniculitis with membranous fat necrosis. I agree that there is important fibrosis of the septae. I also agree with the differentials considered and would like to add a late pancreatic panniculitis as ghost adypocytes can dissapear with time, the context of abdominal surgery (pancreatic cancer, chronic pancreatitis?) if adequate could also fit.

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vincenzo polizzi

Posted

Odd case of lipodermatosclerosis because of an associated giant cell reaction. Steroid injection induced granuloma in a background of membranous lipodystrophy/lipodermatosclerosis?

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Dr. Mona Abdel-Halim

Posted

Agree with different suggestions... Like Raul's correlation with the abdominal surgery..

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Nitin Khirwadkar

Posted

Agree with the differentials. Usually pancreatic panniculitis has multiple cutaneous nodules. Not sure if others have resolved completely/ not documented.

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Dr. Richard Carr

Posted

Difficult! Does not look like pancreatic.  Incidentally polarising can show small crystalline deposits in pancreactic fat necrosis.  These also don't look particularly like lipomembranous fat necrosis to me.  It reminds me more of Miescher's radial granulomas.  I think EN can have these giant cells and present with an apparently lobular predominance occasionally.  We can't really see the centre of the lobules in these images. Factitial panniculitis does need considering and agree with polarising.  My "gut" says EN.

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vincenzo polizzi

Posted

I'm sure there is a lipomembranous fat necrosis. Not sure about the giant cell foreign body like granulomatous component.

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Uma Sundram

Posted

Great discussion. Clinically the lesions fit with erythema nodosum and we thought the histology was fine for it as well as EN can have a variety of different appearances. No polarizable foreign material was identified. We thought factitial panniculitis remained in the differential but the clinician was not as convinced of this clinically.

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Arti Bakshi

Posted

Great case! have to admit that EN was not my high on my list of differentials! I think its a good learning point that EN can have quite a variable histology and not to dismiss it if pattern of inflammation is too lobulocentric.

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Dr. Richard Carr

Posted

May I suggest reviewing cases 552 and 1378 for examples of lipomembranous fat necrosis.

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