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 1152 - 21st November 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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M50. Cystic lesion left corner of the mouth. Nine years previously had lesions o the left and right chin that looked similar and reported as resolving abscesses.

Case Posted by Dr Richard Carr


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Dr. Richard Carr

Posted

Forgot to say the case kindly shared with me by Dr Chris Allen.

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Difficult case. I also think about Granuloma faliale, but I would perform special stains for atypical mycobacteriosis as this is a common location for aesthetic procedures.

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Robledo F. Rocha

Posted

Microscopic images are of granuloma faciale, but I feel a little confused about the clinical presentation as a cystic lesion.

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Granuloma faciale. Inflammatory myofibroblastic tumour is typically a visceral tumour of younger patients.

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Arti Bakshi

Posted

Granuloma faciale, typical storiform pattern of fibroblastic proliferation with evidence of leucocytoclastic debris, more neutrophils than eosinophils in this case though.

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Mark A. Hurt MD

Posted

Granuloma faciale. I looked at it blind (without history) and thought it was EED, so at this location, GF makes sense -- unless it's some type of infection, which I doubt.

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Dr. Richard Carr

Posted

My opinion as follows:
This is a fascinating case, and in my opinion shows histological
features typical of erythema elevatum diutinum. This is considered to
be a chronic leucocytoclastic vasculitis with fibrosclerosis.
The typical clinical picture is not present in your patient because
lesions normally present at acral sites and can resemble nodular keloids
in the fingers and toes. However, I have occasionally seen presentations
of EED at other anatomical locations. Traditionally, it is grouped with
granuloma faciale, but in my experience, the latter diagnosis is more
plaque-like and always histologically has an abundance of histiocytes
and eosinophils which is not present in your case. Therefore, I favour
an unusual location for EED rather than granuloma faciale in this case.

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