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 1418- 30 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: The patient is a 51 year old white woman with a shave removal of a bleeding lesion present for one year taken from the mid lower back.

Case posted by Dr Mark Hurt


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Dr. Mona Abdel-Halim

Posted

Thinking of papillary intralymphatic angioendothelioma (PILA) or Dabaska's tumor. I am perceiving a large dilated vascular space with intraluminal proliferation of papillae lined by hob nail endothelial cells. Adjacent to it many dilated lymphatic like spaces are seen.

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Raul Perret

Posted

Yes I also think this is papillary intralymphatic angioendothelioma, with quite a massive quantity of papillae

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Dr. Mona Abdel-Halim

Posted

I have just thought of something else: hobnail hemangioma can have a focal papillary projections and is said to be characteristic, so may be due to the absence of lymphocytic infiltrate intra and extra vascularly, the better diagnosis is hobnail hemangioma, I propose it as a DDx.

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Dr. Mona Abdel-Halim

Posted

According to McKee's pathology of skin, hobnail hemangioma is likely to represent the benign end of the spectrum of a group of lesions characterized by hobnail endothelial cells including PILA and retiform hemangioendothelioma :-)

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Dr. Mona Abdel-Halim

Posted

Congratulations to our friend in DermpathPRO Arti Bakshi for passing the Royal College Diploma of Dermatopathology... Well done, you deserve the best :-)

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Dr. Richard Carr

Posted

I was thinking of hobnail haemangioma too but liked Mona's suggestion of PILA and the spectrum. I am guessing it is a lymphatic/venous malformation. 

 

Regarding the RCPath diploma just to be clear this exam is ridiculously hard - set at expert referral practice (i.e. a dermatopathologist who is centrally reviewing the cases of other colleagues).  So well done to Arti indeed.

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Guest Romualdo

Posted

In my opinion the lack of hemosiderin speaks against a hobnail hemangioma (targetoid hemosiderotic hemangioma). The anastomosing network of vascular channels tends to run horizontally and to me is suggestive of a benign lymphangioendothelioma (acquired progressive lymphangioma).

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Arti Bakshi

Posted

Thanks Mona! A big thank you also to the entire faculty and contributors of dermpathpro from whom I have learnt so much! Especially grateful to you, Richard, for also letting me view your phenomenal slide collection (an absolute must for anyone contemplating the diploma in the UK) and all your support.

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Arti Bakshi

Posted

Coming back to the case, I was thinking hobnail haemangioma too, but like Romualdo's suggestion of acquired progressive lymphangioma. There are no lymphocytes in the stroma though!

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Mark A. Hurt MD

Posted

My diagnosis was papillary endothelial hyperplasia in a hemangioma.  CD31 was positive throughout this lesion, but D240 was negative throughout.  HHV-8 was negative as well.

 

Congrats also to Arti.

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