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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 : 1509 - 06 April 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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39 year-old male with 7 cm upper back mass.

Dr Hafeez Diwan.


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Connective tissue nevus (collagenom)

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sorry: Connective tissue nevus (Collagenoma)

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Guest Romualdo

Posted

I think this is nuchal-type fibroma. If there is an association with FAP it should be called Gardner fibroma, but this last possibility is improbable, since Gardner fibroma tends to occur in children.

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Guest Arash Daryakarr

Posted

My impression is connective tissue nevus with abscence of elastic fibers(nevus anelasticus)

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Raul Perret

Posted

Favour nuchal-type fibroma due to clinical description and histology. If clinical information is not available, nuclear beta catenin expression would support Gardner fibroma

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vincenzo polizzi

Posted

Favor Nuchal Fibroma

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Here are my reasons for not favouring a nuchal fibroma: 

 

1.  Nuchal fibromas are subcutaneous; this lesion appears to be in the dermis, albeit a thick dermis. 

2.  Continuing from the first point, nuchal fibromas usually show entrapped islands of fat, which we do not have here. 

3.  Nuchal fibromas usually show entrapped traumatic neuroma-like nerves, which we do not have here. 

4.  Nuchal fibroma is a substitutive process, with collagen bundles that are abnormal (abnormally thick and dense); this process appears to be quantitative, with collagen bundles that are normal but in number. 

5.  Lastly, my impression of nuchal fibromas is that, although they are hypocellular, they are usually more cellular than this lesion (I think). 

 

Of course, I may be wrong.

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Raul Perret

Posted

Abdul, nuchal fibromas are tumors that arise on the dermis and subcutaneous tissue and entrapment of adipose tissue, adnexae and nerve twigs is variable. As you said collagen bundles are usually thickenned and they usually seem to intersect, this is what we see on the third picture on the left (to my point of view). Another important feature is that they usually extend Deep entrapping skeletal muscle (a feature we dont see here). Finally I think connective tissue nevus is usually seen in patients of postpuberal age and are rarely larger than 5 cm. While nuchal type fibroma has a wider age distribution and are usually large.

Of course me too I could be wrong but I guess is good to discuss our points

Ps: There is also a frequent association between nuchal type fibroma and diabetes ( i dont know if its the case)

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Dr. Mona Abdel-Halim

Posted

My first thought was scleredema but the clinical description is strange. It presents as an area of induration rather than a mass !!

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amiratawdy

Posted

I think of elastofibroma arises usually at back

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Dr. Hafeez Diwan

Posted

Collagenoma.  The last image on both the right and left sides is of elastin (VVG),

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