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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 1317 - 10 July Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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F52. Multiple discrete lumps upper and lower limbs sparing head / neck & trunk.

Case posted by Dr Richard Carr


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Dr. Mona Abdel-Halim

Posted

Sarcoidal/palisading granulomatous reaction with ? capsulated (or pseudocapsulated) yeast structures in multinucleated giant cells (last image). Histoplasmosis with pseudocapsule is my first DDx. Less likely cryptococcosis (granulomatous reaction). Waiting for PAS and Mucicarmine/Alcian blue. Positive mucin stain will be with cryptococcosis and negative mucin stain will be with Histoplasmosis.

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Guest Romualdo

Posted

Subcutaneous sacoidosis is my first possibility. Of course exclusion of fungal infections is mandatory.

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Agree with Romualdo. I think this is Sarcoidosos, but before suggesting this I would perform special stains for infection.

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Eman El-Nabarawy

Posted

Subcutaneous sarcoidosis for exclusion of infection and foreign body.

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Dr. Richard Carr

Posted

Case kindly referred by Dr Kathleen Romain
My report:
There are extensive subcutaneous sarcoidal granulomas with a sprinkling
of lymphocytes. No lymphoid atypia. Areas of fibrinoid change are
noted. I would strongly suspect the diagnosis of sarcoid.

I have seen one previous case of subcutaneous sarcoid, and on reviewing
the literature at that time, note that this was commonly associated with
hilar lymphadenopathy but patients tended to resolve spontaneously over
a year or two.

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