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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 1715 - 23 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 History: M50. Eyelid. ?Epidermal cyst.

Case Posted by Dr Richard A Carr


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Admin_Dermpath

Posted

Your pre-festive week is nicely rounded off with a neat case from Dr Richard A Carr

 

Geoff Cross - DermpathPRO Projects

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Robledo F. Rocha

Posted

On my cell phone screen, looks like gouty tophus.

Merry Christmas to all of my DermpathPRO colleagues!

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Raul Perret

Posted

For me it looks line a necrotizing granulomatous reaction to discard in first place infectious (tbc, leishmania etc.) and if negative also in culture start considering rheumatoid nodule and necrotizing sarcoidosis and other rarer entities. That said I find that the dx of gout based on pictures is rather confusing sometimes (at least for me). Wish you all guys and the team of dermpathpro a Merry christmas!

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Dr. Mona Abdel-Halim

Posted

Christmas Eve will be in the weekend, so Merry Christmas everybody.. wish u all happy holidays.

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My first thought was LMDF as well. But only after performing special stais for microorganisms.

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vincenzo polizzi

Posted

Merry Christmas dear Colleagues and thanks for your pleasant company in this amazing website.  

It's a granuloma with some fissures and clefts gouty like. But not sure. 

What about a filler cosmetic granuloma?

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Raul Perret

Posted

I also thought of LMDF (lupus miliaris disseminatus faciei) but the only case I have seen in a presentation was as multiple papules and I thought the clinical picture looked more like a single isolated lesion.

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Arti Bakshi

Posted

Favour gouty tophus....unusual site but described.

Merry christmas to all!!

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Dr. Richard Carr

Posted

Here is your Diagnosis: Granuloma, caseous (acne agminata-like lesion).

 

Merry Christmas - Richard

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Nitin Khirwadkar

Posted

I am too late today. Lovely case.

Merry Christmas everyone.

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Arash Daryakar

Posted

Thanks for the nice case.

Merry christmas to you all.

have a nice holiday guys!

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why did you favour acne agminate-like  granuloma over gouty tophous

and why we didnot think of caseating granuloma like tuberculosis

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Dr. Richard Carr

Posted

Thanks for the question.  Interestingly I did not even consider gout although I can see why you might as we do have a pink substance with macrophage response.  In gout (see case 1665) the delicate ghosted crystalline outlines can usually be appreciated, as slender rays in the matrix, and the granulomatous peripheral reaction is usually purely histiocytic i.e. lacking the prominent lymphocytic infiltrate of a tuberculoid (casesous) granuloma seen here. It seems the histopathology of acne agminata (AKA lupus miliaris disseminates facei) is pretty rarely described.  In this case I thought it showed the typical histology but as it was sent as a solitary lesion I referred to it as acne agminata-like lesion (assumed a reaction to a ruptured pilosebaceous unit in the delicate skin of the eyelid). The clinician will have to correlate to see if the patient has other lesions etc.  I prefer acne agminata to the longer name as I am not good with long names and in this instance it's awfully confusing!  I did not do special stains because it was a solitary lesion (and lacks suppuration) but I can imagine in other parts of the world where TB is more prevalent one probably would.

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