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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 1230 - 11 March 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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14 year-old Hispanic female with verrucous papule in the oral commisure.

Case posted by Dr Hafeez Diwan


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biswanath behera

Posted

No parakeratosis, irregular acanthosis, anastmosing rete ridges, koilocytes and ??mitosoid bodies in figure

4 (one at lower part and one at the right side)---Heck's disease

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Guest Tiberiu Tebeica

Posted

I also think this is Heck's disease (focal epithelial hyperplasia) and was desperately looking for a mitosoid body, although I'm not sure I can spot a convincing one.

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Dr. Mona Abdel-Halim

Posted

Very nice case..
As AbdulKadir, I thought of viral wart (condyloma accuminatum) but after reading about Heck's disease, I think this is the better term for this case, given the Hispanic origin which is predominately affected. It is a HPV induced epithelial hyperplasia caused by specific types of HPV other than those causing condylomas (according to McKee's pathology of skin, condylomas do not contain HPV 13, 32, found in Heck's disease) Condyloma accuminatum is the clinical and histopathological differential diagnosis....
I am not sure I can c a mitosoid figure :-((
Thank you Romualdo, Biswanath and Tiberiu for letting us revise an entity read few years ago but was forgotten :-))

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Mark A. Hurt MD

Posted

It looks like lesions in the spectrum of Heck's disease, but I'm open to other ideas, too.

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Eman El-Nabarawy

Posted

Broad anastomosing rete ridges points to Heck's disease.

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Dr. Hafeez Diwan

Posted

Great discussion! Yes, this Heck's disease.

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