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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 1527 - 02 May 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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The patient is a 49 year old woman with a history of Raynaud's. A punch biopsy of brown, velvet-like plaques is taken from the right dorsal index MCP joint. Clinical Diagnosis: acanthosis nigricans vs post-inflammatory pigmentary changes vs lichenoid dermatitis.

Dr Mark Hurt.


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Raul Perret

Posted

Multiple differential diagnosis crossed my mind including pleomorphic fibroma, sclerotic fibroma, rare presentation of kaposi, atrophic dermatofibroma. But the clinical history suggests multiple lesions in an acral location, I dont see findings to support the proposed clinical diagnosis. I would perform some immunos to unveil the nature of those cells. The clínical setting of multiple lesions, unilateral acral, female with an histology showing dilated vascular vessels with some pericytes, fusiform hypercromatic cells some looking multinucleated as well as some fibrosis makes me consider in first place multinucleate cell angiohistiocytoma.

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vincenzo polizzi

Posted

Scleromyxedema

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Dr. Mona Abdel-Halim

Posted

This is very difficult..
The striking feature to me is the thick sclerotic collagen background together with the plump spindle cells, putting this with Raynaud's disease, I am thinking of a collagen disease. Thought of Fibroblastic rheumatism but the clinical is missing the arthritis and the contractures.. Also thought of Gottron's but there is no interface although there are few melanophages, but Gottron's do not show these plump fibroblasts which seems to be highlighted for a purpose. I did not perceive them as giant cells actually. Multinucleate cell angiohistiocytoma is different clinically also. It is difficult :-(

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Interstitial granuloma annulare vs. scleromyxoedema/lichen myxoedematosus. 

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Nitin Khirwadkar

Posted

Difficult case! Sclerosing dermopathy, favour scleromyxoedema. Occasional vessels slightly thick. Not sure what the scattered eosinophils mean. Could be totally off track!

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Arti Bakshi

Posted

Agree with dermal sclerosis being the main pathology. There appears to be increased pigmentation of the basal layer of epidermis And some telagiectasia. Coupled with history of Raynaud's, this could be a limited form of systemic sclerosis.( although 'velvety plaques' a bit odd). Scleromyxoedema is a good d/d.

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Mark A. Hurt MD

Posted

Thank you all for the discussion.  Other than Raynaud's, there was no other history available.  I was not impressed by any interstitial mucin when looking at the slides directly.  My colleagues (in my office) also agreed.

 

My diagnosis is below:

 

-- MULTINUCLEATE CELL ANGIOHISTIOCYTOMA
COMMENT:  In my assessment, the presentation of multiple plaques on extremities with this histology is characteristic of multinucleate cell angiohistiocytoma. These are not known to be associated with any systemic manifestations and are usually asymptomatic and slow-growing lesions.  Historically, some authors have regarded them as in the spectrum of fibrous histiocytomas.
 
Frew JW. Multinucleate cell angiohistiocytoma: clinicopathological correlation of 142 cases with insights into etiology and pathogenesis. Am J Dermatopathol.  2015 Mar;37(3):222-8. doi: 10.1097/DAD.0000000000000075. PubMed PMID: 25140659.

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Raul Perret

Posted

The only case that I ever saw on clinical practice was last year during residency training and the cells were exactly like here with hypercromasia and a degenerative type of atypia and just some dilated vessels, I guess the pictures we see on the books are sometimes the exception rather than the rule

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Arti Bakshi

Posted

Well done, Raul!...u were right all along!

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vincenzo polizzi

Posted

Well done, Raul! 

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Dr. Mona Abdel-Halim

Posted

👍🏻👍🏻 Raul :-)

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Dr. Richard Carr

Posted

Last Friday's was Lichen nitidus by the way with a typical clinical history. Apologies for delay - it was a national holiday in UK yesterday.

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