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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 968 - 10th March 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 33 year old man with a biopsy taken from the right side of the scrotum.

Case posted by Dr. Mark Hurt


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Eman El-Nabarawy

Posted

Lichenoid tissue reaction for DD. Favor PLEVA or drug reaction.

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I´m back. This is a vacuolar and lichenoid dermatitis. The differential diagnosis is broad. There is a lot of melanophages in the dermis, so I believe it could be a fixed drug eruption.

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Dr. Mona Abdel-Halim

Posted

I think it is fixed drug reaction

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Dr. Richard Carr

Posted

Acute ulcerating process. What about infections e.g. Herpes, syphilis etc. (needs clin-path correlation and perhaps a few levels for viral inclusions). I thought about pigmented bowen's, melanoma, paget's etc. but think the atypia is probably reactive here.

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Dr. Mona Abdel-Halim

Posted

I liked the suggestion of infection by Dr Carr :-))

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Mark A. Hurt MD

Posted

Here are the immunostains:

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE968_Image%2007.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE968_Image%2008.jpg[/img]

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Eman El-Nabarawy

Posted

So as Dr. Carr suggested it's syphilis, probably secondary type because of the pattern of staining of the organisms (mainly epidermal) while it is epidermal and perivascular in the primary type.

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Mark A. Hurt MD

Posted

I was impressed, by the way, of the fact that there were few plasma cells in the infiltrate - a "pearl" to file away for the future.

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Dr. Richard Carr

Posted

It was the lack of plasma cells that made me put syphilis 2nd but I seem to remember Mark mentioning it previously so I wanted to consider the diagnosis.

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