Jump to content
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 1037 - 13th June Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
   (0 reviews)

M66. Dorsum 1st MCP joint. 7/52 indurated purple - red large nodule / plaque. ?atypical mycobacterium ?Orf

Case posted by Dr. Richard Carr.


  Report Record

User Feedback


Eman El-Nabarawy

Posted

After exclusion of infective etiology by Gram and PAS stains, I suggest solitary erythema elevatum diutinum.

Share this comment


Link to comment
Share on other sites

I'm under the impression that EED is a bilateral, symmetrical process. I breifly thought about acral myxoinflammatory fibroblastic sarcoma, but most of the features of this are absent. My guess is that this is a suppurative process, caused by an infection of one sort or another.

Share this comment


Link to comment
Share on other sites

Mark A. Hurt MD

Posted

What about a cutaneous manifestation of Hodgkin's disease?

Share this comment


Link to comment
Share on other sites

Dr. Richard Carr

Posted

One half-like so far but needs more comments please. In Edinburgh today enjoying the lectures!!

Share this comment


Link to comment
Share on other sites

Dr. Mona Abdel-Halim

Posted

I favor infectious process, lots of eosinophils may point to a deep mycosis, ? Sporotrichosis... Further work with stains and culture is needed....

Share this comment


Link to comment
Share on other sites

Robledo F. Rocha

Posted

Agree with Dr. Hurt. Cutaneous Hodgkin's lymphoma. A reactive background of lymphocytes, eosinophils and neutrophils, and at least in the center of the Image 6 there is a classic Reed-Sternberg cell.

Share this comment


Link to comment
Share on other sites

Guest Romualdo

Posted

I would like to add eosinophil-rich or neutrophil/ eosinophil-rich type of primary cutaneous anaplastic large cell lymphoma. This variant simulates infectious/ inflammatory processes and may have atypical munonucleated and binucleated cells resembling Hodgkin's lymphoma.

Share this comment


Link to comment
Share on other sites

Dr. Richard Carr

Posted

I was hoping to have IHC posted by the dermpathpro team at 4pm (BST), hopefully it will appear soon.

Share this comment


Link to comment
Share on other sites

Guest Jim Davie MD

Posted

[size=4][font=arial,helvetica,sans-serif]I like Romualdo's suggestion that this might be a primary cutaneous T-cell lymphoma. I would add to the differential: p[color=#000000]rimary cutaneous CD4-positive small/medium T-cell lymphoma (which may have a proportion of larger pleomorphic cells). Also, a p[/color]rimary cutaneous [or metastatic] angioimmunoblastic T-cell lymphoma. Both can have a mixed inflammatory component with eosinophils, neutrophils, or plasma cells, resembling infectious process, as seen here. T-cell clonality studies might be helpful if the immunostains disappoint.

That said, an infectious process would be a more common diagnosis than these 'zebras', and needs to be excluded by stains and clinical history.

The infiltrate shows mixed eosinophils, neutrophils, rare plasma cells, and scattered small and large Reed-Sternberg like pleomorphic cells (some seem vacuolated). There is little mitotic activity. No reactive follicles. There may be some multinucleated giant cells and suspicious clear droplets. The solid extension into the deep dermis is impressive, but the biopsy doesn't give us epidermis to examine.[/font][/size]

Share this comment


Link to comment
Share on other sites

Dr. Mona Abdel-Halim

Posted

I like the suggestion of Romualdo, waiting for immunos....

Share this comment


Link to comment
Share on other sites

Dr. Richard Carr

Posted

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1037_RAC5986x10_CD30_Label.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1037_RAC5986x10_CD4_MR%20copy.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1037_RAC5986x10_CD8_Label.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1037_RAC5986x40_Granzyme_Label.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1037_RAC5986x40_Ki67_Label.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE1037_RAC5986x40_Perforin_Label.jpg[/img]

Share this comment


Link to comment
Share on other sites

Cytotoxic, CD30-positive T-cell lymphoma. ALCL, as Romualdo suggested.

Share this comment


Link to comment
Share on other sites

Dr. Mona Abdel-Halim

Posted

WAAAAAO,,, Chapeau Romualdo :-)). Anaplastic large TCL, the variant which is rich in esinophils and neutrophils mimicking an inflammatory/infectious process.... Amazing case,,, Thank u Dr Carr,,, this is a wounderful educational case....

Share this comment


Link to comment
Share on other sites

Dr. Richard Carr

Posted

Well done Romualdo. This is a primary cutaneous, eosinophil-rich anaplastic large cell lymphoma. I shared the case with Werner Kempf who kindly excluded Orf. Clearly the sheet-like growth of large CD30 positive cells highlighted on CD30 is against an inflammatory mimic. Learning point being eosinophils can be a clue to CD30 lymphoproliferative disorders. The lesion responded to local steroids and radiotherapy and there has been no recurrence.

Share this comment


Link to comment
Share on other sites



Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Add a comment...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...

×
×
  • Create New...