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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 1471 -12 February 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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Case History: M50. Insulin dependant diabetes. Enlarging subcutaneous lump.


Case posted by Dr Richard Carr


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Raul Perret

Posted

So far makes me think of nodular subcutaneous amyloid. Another differential could be a Deep burn out pilomatricoma but i think it is less likely. I imagine the other pictures will show a whole different story...

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Raul Perret

Posted

Found this report also of subcutaneous amyloid secondary to subcutaneous insulin: Pharmaceutical amyloidosis associated with subcutaneous insulin and efurvitide administration. Amyloid 2014 Jun; 21(2): 71-75

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Guest Romualdo

Posted

I was also thinking of amylodosis. As Raul said there are numerous references about insulin related amyloidomas/ amyloidosis.

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vincenzo polizzi

Posted

Agree with amyloid tumor. Not sure about insulin relation...thinking of plasmocytoid B-cell lymphoma related-amyloidosis.

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Sasi Attili

Posted

Looks like a amyloidoma. But wouldn't be surprised if this is secondary to a burnt our epithelial tumour as Raul mentioned.....

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Dr. Mona Abdel-Halim

Posted

Why the giant cells and the calcification if it is only amyloidosis/amyloidomas? I am thinking of a longstanding pilomatricoma (burn out as Raul said first) with secondary calcification, giant cell reaction and possible stromal perivascular amyloid deposits. Waiting for the rest of the images !!!!!!

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Raul Perret

Posted

I remember have seen one or two cases of amyloidoma during the residency with calcification and giant cell reaction. I wonder what is the others pathologists experience

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Raul Perret

Posted

Beautiful picture with apple-green birefringence

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Dr. Mona Abdel-Halim

Posted

Lovely.. So it is all amyloidoma. Well done Raul :-)

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Guest Tiberiu Tebeica

Posted

Amyloidoma. Still curious to know if it was located at an injection site.

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Dr. Richard Carr

Posted

Yes this could be either subcutaneous nodular amyloid (frequently AL type, usually not associated with systemic amyloidosis) but the calcification and giant cell reaction might be more in keeping with amyloidoma (of the extremities, usually AA type) according to Paternak et al Am. J. Dermpath. 2007;29:152-5.

 

I was not aware of diabetic injection amyloidomas (thank you).

 

This case was not local to me so I don't have follow-up and the anatomic location was not stated but the clinician did specifically state the lesion was NOT at the site of insulin injection.  There were scattered lymphoid aggregates and plasma cells appeared to be polytypic (within the usual technical limitations of the staining). I advised the patient should be worked up for consideration of systemic amyloidosis but commented this may be unlikely.

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