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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 1710 - 16 December - Dr Richard A Carr 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: Back of hand lesion. On chemotherapy for Hodgkin’s.

Case Posted by Dr Richard A Carr


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Admin_Dermpath

Posted

As good preparation for the final weekend of shopping for the holiday season there is nothing better than one of Dr Richard A Carr's excellent and intriguing Spot Cases.

 

Cheers, Geoff Cross - DermpathPRO Projects

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urmilapandey

Posted (edited)

elastosis, elastic fibres in dermis, wonder if the the pink stuff in the histiocyte-like cells is engulfed elastotic material, irregularly hyperplastic epidermis. ?annular elastotic granuloma (have never seen one!) but the cells do have prominent nucleoli. would have done epithelial, histiocytic and some lymphoid markers to exclude a variant of SCC and Hodgkin's (given the history) and if that wouldn't have been conclusive, would have referred the case to Richard!!

Edited by urmilapandey

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Raul Perret

Posted

I share some of the appreciations of Urmila. I thought this was a case of eccrine squamous metaplasia (link) secondary to chemotherapy. I am not sure if there are some Hodgkin cells but as Urmila, I though it is worth performing immunos to check for the presence of neoplastic cells. As for the histiocytes I dont know the kind exactly, they made me think of the ones seen in crystal storing histyocitosis. 

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urmilapandey

Posted

31 minutes ago, Raul Perret said:

I share some of the appreciations of Urmila. I thought this was a case of eccrine squamous metaplasia (link) secondary to chemotherapy. I am not sure if there are some Hodgkin cells but as Urmila, I though it is worth performing immunos to check for the presence of neoplastic cells. As for the histiocytes I dont know the kind exactly, they made me think of the ones seen in crystal storing histyocitosis. 

thanks for sharing your expert comments Raul, get to learn so much from you guys

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Dr. Mona Abdel-Halim

Posted

Features of syringo-squamous metaplasia but need immunos to exclude neoplastic deposits of Hodgkin.

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vincenzo polizzi

Posted

what about a granular cell tumor, with chemio regressive changes?

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urmilapandey

Posted (edited)

i don't know if a granular cell tumour would respond to chemotherapy given for hodgkin's. and hence HD chemotherapy induced changes would seem unlikely. but a good suggestion I think (the epidermal changes would fit) and certainly worth considering.

Edited by urmilapandey

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vincenzo polizzi

Posted

Another thought is PEC-oma, but as second spot ( this because I don't know enough primary cutaneous PEComa... )

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Robledo F. Rocha

Posted

A very busy day, but at the end of the afternoon (my standard time is UTC–04:00) I save some minutes to take on the challenge of this Dr. Carr's intriguing spot case.

Eccrine squamous syringometaplasia is a well-known chemotherapy-associated eccrine gland reaction. Bleomycin-induced eccrine squamous syringometaplasia has already been described in patients undergoing ABVD regimen used in the first-line treatment of Hodgkin lymphoma. That said, I don’t know how to explain all those cells resembling eosinophils, including many atypical ones, which degranulate on collagen bundles to produce a flame figure-like area.

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Nitin Khirwadkar

Posted

I think I would go for eccrine squamous syringo metaplasia. However, what intrigues me are the uni and binucleate cells with granular cytoplasm. I would interpret these as degenerative. Focal necrosis is noted, which is fine for ESSM. Would do some IHC in real life, EMA, MUM-1, CD15, S-100 and CD163. 

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Dr. Richard Carr

Posted

Diagnosis: Odd elastolytic granuloma-like reaction with pseudoepitheliomatous hyperplasia and eccrine squamous syringometaplasia (?chemotherapy agent induced).

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