Case Number : Case 1527 - 02 May Posted By: Guest

Multiple differential diagnosis crossed my mind including pleomorphic fibroma, sclerotic fibroma, rare presentation of kaposi, atrophic dermatofibroma. But the clinical history suggests multiple lesions in an acral location, I dont see findings to support the proposed clinical diagnosis. I would perform some immunos to unveil the nature of those cells. The clínical setting of multiple lesions, unilateral acral, female with an histology showing dilated vascular vessels with some pericytes, fusiform hypercromatic cells some looking multinucleated as well as some fibrosis makes me consider in first place multinucleate cell angiohistiocytoma.

Scleromyxedema

Interstitial granuloma annulare vs. scleromyxoedema/lichen myxoedematosus. 

The only case that I ever saw on clinical practice was last year during residency training and the cells were exactly like here with hypercromasia and a degenerative type of atypia and just some dilated vessels, I guess the pictures we see on the books are sometimes the exception rather than the rule

Well done, Raul! 

Last Friday's was Lichen nitidus by the way with a typical clinical history. Apologies for delay - it was a national holiday in UK yesterday.