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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 1702 - 6 December - Dr Uma Sundram Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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Clinical Details: A 14 year old boy with phimosis.

Case Posted by Dr Uma Sundram


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Admin_Dermpath

Posted

Here is your Tuesday fix of Spot Diagnosis from Dr Uma Sundram

 

Cheers, Geoff Cross - DermpathPRO Projects

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Raul Perret

Posted (edited)

There are some features suggesting lichen sclerosus but the lymphocytes are a bit irregular, there is some basal epidermal tagging and haloes. Although rare in the pediatric population, I would like to rule out mycosis fungoides before performing the diagnosis of lichen sclerosus.

Edited by Raul Perret

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vincenzo polizzi

Posted

BXO. There is the characteristic broad hyalinized collagen band between lymphocytic dermal infiltrate and epidermis (sandwich sign) (Fig 2 ). Moreover phimosis is a well known case mimicking MF

Arch Pathol Lab Med—Vol 138, October 2014 

But agree with Raul. IHC and CPC are recommended. 

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Nitin Khirwadkar

Posted

Agree with lichen sclerosus. In the early phase, one can get tagging of lymphocytes along the DEJ in LS.

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Lichen sclerosus. I see frequently lymphocytes tagging the basal epidermis on this location.

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Robledo F. Rocha

Posted

Mycosis fungoides-like lichen sclerosus. All those haloed lymphocytes within the lower layers of the epidermis really mimick mycosis fungoides, but correlation with clinical features will certainly rule out the hypothesis of lymphoma, even in cases that show monoclonality of the lymphocytic infiltrate (the reference cited above by Arti testifies this assertion), once solitary mycosis fungoides on genital skin is exceedingly rare to be considered as a reasonable diagnosis.

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Dr. Mona Abdel-Halim

Posted

Yes this is lichen sclerosus and I have seen in presentations in conferences cases really mimicking MF in their early phases. 

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Arash Daryakar

Posted

Agree with LSA mimicking MF. tricky case!

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Uma Sundram

Posted

You guys nailed it! LS (BXO) mimicking mycosis fungoides. As mentioned, LS can be a histologic mimic of MF at early stages and can have + clonality so have to be careful when doing work up. The characteristic clinical setting is a tip off: young boy presenting with phimosis.

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