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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 1183 - 5th January 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 an 81 year old man with a biopsy of a lesion on the upper aspect of the forehead.

Case posted by Dr Mark Hurt


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Mark A. Hurt MD

Posted

Thanks, everyone, thus far. Do these stains alter your diagnosis?

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/Case%201183%20-%20Image%2011.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/Case%201183%20-%20Image%2010.jpg[/img]

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Dr. Richard Carr

Posted

Having seen the CD34 I go with my first impression diagnosis of inverted follicular keratosis.

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Guest Romualdo

Posted

In the absence of CD34 positivity I think inverted folicular keratosis is a better choice.

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Dr. Mona Abdel-Halim

Posted

Negative CD34 favours IFK... It crossed my mind first but the clear cell changes deceived me :-((

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Mark A. Hurt MD

Posted

My diagnosis was inverted keratosis after the negative CD34. I have to admit, however, that the structure of this lesion is so close to many tricholemmomas, I don't think I can differentiate many of them on the H&E alone -- and I wonder if there is any [i]real [/i]difference between them -- other than immunohistochemical.

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Dr. Richard Carr

Posted

Agree with you Mark, if CD34 is positive I call lesions like this tricholemmoma if not I call IFK although I had favoured latter on H&E in this particular case (minimal palisade and lack of significant BM thickening). Whether this is morphological mimicry or differences at the molecular level remains to be seen.

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