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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 1405- 11 November 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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Case History: 66 year-old female with left forearm lesion.

Case posted by Dr Hafeez Diwan


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Raul Perret

Posted

Find it quite hard but i will give it a go. I see a dermal interstitial histiocytic infiltrate with destruction of collagen (collgenolysis) and others with a more ropey collagen (keloid like). Deeper on the dermis there is a vein with histiocytic infiltrate on its Wall surrounded by numerous dilated low caliber vessels. It makes me think of necrobiosis lipoidica vs another granulomatous dermal reaction.

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Guest Romualdo

Posted

One image shows a cavity without an epithelial lining. Other images show some histiocytes or myofibroblasts maybe secondary to spillage of cystic contents. Ganglion cyst?

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Deep granulomatous and intersticial dermatitis with areas of collagen degeneration and cystic formation. I think this is a case of an old rheumatoid nodule with cystic degeneration.

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Arti Bakshi

Posted

Good suggestion by Igor. Either a rheumatoid nodule or a deep granuloma annulare (pseudorheumatoid nodule).

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Dr. Hafeez Diwan

Posted

I went with deep granuloma annulare. The top two images show what appears to be a necrobiotic focus, and the second row images show an interstitial pattern. The lower three images show some reactive vascular proliferation around fibrinous areas, with a blush of mucin (lowest image).

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Dr. Richard Carr

Posted

The cavity looks typical of a ganglion cyst or connection with the underlying joint. I think Romauldo is right. Probably pseudo-GA, certainly not typical of deep GA which would be a large well defined necrobiotic nodule.

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