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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 1014 - 13th May 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 66 year old white man, who grew up in Afghanistan, with a punch biopsy taken from the left shoulder.

Case posted by Dr. Mark Hurt.

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Guest Jim Davie MD


Agree. Looks like scleroderma / morphea.

No definitive perineural/periadnexal targeting. Dermal sclerosis with non-specific, sparse, superficial and deep, perivascular lymphoplasmacytic with mildly increased mucin, no significiant increased mast cells, rare foamy histiocytes (some multinucleated). Epidermis equivocally flattened.

With that clinical hx, differential to include indeterminate leprosy or treated leprosy.
PCR may be useful to exclude mycobacteria. Fite may not be reliable.

[url="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3221209/"]CLUES TO HISTOPATHOLOGICAL DIAGNOSIS OF TREATED LEPROSY[/url]
(full article link, nice images) [color=#000000][font=arial, helvetica, clean, sans-serif]Indian J Dermatol. [/font][/color][color=#000000][font=arial, helvetica, clean, sans-serif]2011 Sep-Oct; [/font][/color][color=#000000][font=arial, helvetica, clean, sans-serif]56[/font][/color][color=#000000][font=arial, helvetica, clean, sans-serif](5)[/font][/color][color=#000000][font=arial, helvetica, clean, sans-serif]: 505–509.[/font][/color]

[url="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555390/"]Morphea Simulating Paucibacillary Leprosy Clinically and Histopathologicall[/url]y
(full article link, with images) [color=#000000][font=arial, helvetica, clean, sans-serif]Indian J Dermatol. [/font][/color][color=#000000][font=arial, helvetica, clean, sans-serif]2013 Jan-Feb; [/font][/color][color=#000000][font=arial, helvetica, clean, sans-serif]58[/font][/color][color=#000000][font=arial, helvetica, clean, sans-serif](1): 85.[/font][/color][/size]

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Robledo F. Rocha


Agree with morphea / scleroderma. Just like the overlying dermis, subcutaneous trabeculae are sclerotic and thickned, thus oblitering the fat lobules. A [url="https://dermpathpro.com/index.html/_/latest-news/perineural-in%EF%AC%82ammation-in-morphea-r52"]distinctive perineural inflammation[/url] is an important feature of morphea.

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