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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 1663 - 9 November - Dr Hafeez Diwan 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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Case History: 25 year-old female with pruritic, papular, bilateral axillary lesions.  This biopsy is from the left axilla.

Case Posted by Dr Hafeez Diwan

Edited by Admin_Dermpath


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Admin_Dermpath

Posted

Here in the North of England it is snowing so I have a challenging drive over the Pennines to Preston. I hope you don't find today's case from Dr Hafeez Diwan as challenging...

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vincenzo polizzi

Posted

It's snowing also here, but above these pictures, because this case is challenging for me...trying to arrange a spot opinion: granulomatous cutaneous manifestation of Crohn disease?

Or Granulomatous suppurative hidradenitis in a late stage? 

But I imagine a GSH as a inflammatory cell rich lesion , and this looks very cell poor also for a late stage..It could also be a Crohn associated GSH

??????

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Raul Perret

Posted

I thought of ectopic breast tissue (seen best in last picture)

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Raul Perret

Posted

Ah ok is papular and bilateral, probably hidradenitis supurativa as Vincenzo suggested

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I think that this may secondary to follicular obstruction with subsequently acrossiringial apocrine glandular obstruction seen in cases like Fox Fordyce. But we can´t see the follicular infundibula on these pictures. The clinical simptoms are compatible.

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Robledo F. Rocha

Posted

Clinical history fits on Fox-Fordyce disease. There are also some microscopic findings that strengthen this hypothesis, like dilation of the apocrine glands and peri-sweat gland inflammatory infiltrate. I’d better appreciate the follicular infundibulum to confirm this diagnosis.

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Dr. Mona Abdel-Halim

Posted

I also think that we are looking at the lower part of a Fox Fordyce biopsy with dilated apocrine glands, the characteristic findings in literature are described in relation to the follicular infundibulum which are no shown here, but clinically it is typically fitting.

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vincenzo polizzi

Posted

Yes. The above comments are best suited to clinical behavior and some pathological finding...but I see a peri acinar malformed granuloma ( probably reactive to apocrine material, but strongly Crohn - like). But am not sure now, and the above arguments are very convincing. Waiting for diagnosis. 

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Victor Delgado

Posted

I don't know if have a lot of imagination or what but there is some  secretion inside  the apocrine glands with a few foamy cells surrounding the ducts, aswell  as lymphocytes without granulomatous pattern... Looking forward to see more leves with some folicullar infundibular pluggin... Fox Fordyce disease.

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Dr. Hafeez Diwan

Posted

Very good discussion!  Fox-Fordyce disease.  I cut multiple sections but couldn't see the duct entering the follicle.

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