Case Number : Case 1659 - 3 November - Dr Arti Bakshi Posted By: Guest

Dr Arti Bakshi, who is a Consultant Histopathologist at Royal Liverpool University Hospital NHS trust will now be posting weekly Spot Diagnosis Cases, here is her post for this week.

Many thanks, Geoff

Thinking of Elastomas (thick broad elastic fibres). Buschke-Ollendorf  Syndrome?

What about juvenile hyaline fibromatosis? 

I thought it looks like a keloid, I found an article about multiple keloids not related to trauma (should consider syndromic association) article I think there are thick collagen bundles and cells that look fibroblastic/myofibroblastic. Other lesions that I have seen can show this pattern are keloidal dermatofibroma and more rarely sclerosing epithelioid fibrosarcoma.

I have read also some cases of nodular or keloidal scleroderma can show similar images. I think CPC is important here

In rare circumstances keloid can arise spontaneously. The sites are chest or shoulder. Back is an odd site. Another option, as Raul said, is a keloidal dermatofibroma. But why not a keloid?

I appreciated Raul’s suggestion of keloidal morphea / systemic sclerosis with keloidal nodules. Although no relevant inflammatory infiltrate can be found, other findings are present, including decreased adnexal structures, increased number of fibrocytes, and narrowing of the interstitial space between homogenized collagen bundles.

Looks like a keloid

Thought of juvenile hyaline fibromatosis.

Looks like keloid. Given multiple perhaps one of the rare syndromes cited in the link from Raul.

Great discussion and excellent differentials!

This is a case of Multiple Spontaneous Keloids. The morphology is typical of keloid with the glassy collagen. I was stumped by the history of multiple lesions and no previous trauma too, hence considered pretty much all of the d/d considered above. Keloidal/nodular scleroderma in particular, is a very good differential, but the patient does not have any other leisons or signs/symptoms of localised scleroderma or systemic sclerosis. 

A senior dermatologist reviewed the case and felt that the lesions were clinically typical of keloid (following the excision of this lesion, the patient has developed a large 8cm keloidal scar at the site). He suggested the diagnosis of multiple spontaneous keloids (an entity, which I have to confess, I wasnt aware of at that time) and I think the histology would fit. As far as I know, the patient does not have any syndromic association or any family history.