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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 1517 - 18 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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The patient is a 52 year old white man with an excision of a raised lesion on the right thumb.

Dr Mark Hurt.


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Raul Perret

Posted

I dont find this case that simple, at first glance i thought of a xanthoma (maybe tuberous) but after reviewing the majority of the cells are fusiform with a tendency to dispose in fascicles and in a storiform fashion, there is a grenz zone and is hard to tell but would like to see the epidermis adjacent to the lesión to compare as I think there is some epidermal induction. I think this is a case of dermatofibroma with cholesterol clefts (rare but can happen) and xanthomization the clinical impression could help

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I think this is a Giant cell tumor of tendon sheath. Here we can see the foam cells, some multinucleated cells and colesterol clefts.

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vincenzo polizzi

Posted

"I think this is a case dermatofibroma with cholesterol clefts"...Agree with Raul!!!  I don't see any dermal necrobiosis neither lesion comes from periorbital region. 

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Solitary spindle cell xanthogranuloma.  Dermatofibromas are rare on the digits and I don't see entrapped collagen bundles. 

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Nitin Khirwadkar

Posted

Favour a dermatofibroma. Agree with the differentials.

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Dr. Mona Abdel-Halim

Posted

Cellular fibrous histiocytoma (dermatofibroma) with xanthomatization and cholesterol clefts.

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Dr. Richard Carr

Posted

Agree with Raul, Mona et al.  Haemosiderin is a good clue too.

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Mark A. Hurt MD

Posted

Excellent ddx!

 

My diagnosis:

 

SKIN, RIGHT THUMB , EXICISON :

-- FIBROUS HISTIOCYTOMA, CHOLESTEROTIC

COMMENT:  The lesion is present in the peripheral surgical margin.  This is an unusual variation of dermatofibroma (fibrous histiocytoma) that contains cholesterol clefts.  Published reports have shown that some patients have associated hyperlipidemia, so correlation may be warranted at this point.

 

Reference:

 

Hunt SJ, Santa Cruz DJ, Miller CW.  Cholesterotic fibrous histiocytoma.  Its association with hyperlipoproteinemia.  Arch Dermatol. 1990 Apr;126(4):506-8.  PubMed PMID: 2157372.

 

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