Case Number : Case 1660 - 4 November - Dr Richard A Carr Posted By: Guest

Folloculosebaceous cystic hamartoma

I don't nose if Mona is a newbie or trainee!

Oh sorry !!

Cystically dilated follicular infundibulum containg keratin, with attached sebaceous lobules. One area showing connection with epidermis. Sorrounding stroma containing fibrillar collagen, clefts, increased blood vessels and  single immature hair follicle (Fig 5). there is moderate to severe periadnexal lymphoplasmacytic infiltration with one focus showing granulomatous inflammation.

The differentilas are Folliculosebaceous cystic hammartoma and Sebaceous Trichofolliculoma.

Presence of Clefts and fibrillar collagen favours Folliculosebaceous cystic hammartoma

OK. Looks like I need to open this case up a little - I was hoping we'd get some new comers contributing.  I will keep trying to encourage trainees and newbies but hope our usual stalwarts will have a go too.  History is swelling of the nose (my comment relating to Mona was a pun and clue!).

What about a Rhinophima?

Yes, I thought it was on the rosacea spectrum all along. Several markedly dilated follicular infundibula, telangiectatic vessels, chronic inflammation including plasma cells and histiocytes and prominence of sebaceous glands, would all do very well for rhinophyma. 

Agree with Richard that we need more newcomers to actively contribute!

Agree with Arti. I started to learn pathology differential diagnosis thanks to my teachers, but I continued learning thanks to  the stimulating discussions with newcomers...

Thought of granulomatous rosacea with comedones. 

Swelling OF the nose !!!

then as Vincenzo, Arti and Raul said it is just Rhinophyma with comedones.. 

I missed a basic case :-(( 

Clinical was rhinophyma which is indeed listed as a variation of acne rosacea.  Clearly this case has significant comedonal changes. I think as anyone who has sat with me will know anyone can fall flat on their nose without clinical history (I frequently suggest things which are catastrophically wrong). Spot diagnosis is a bit of fun though and as we see from this site often works a treat.