Case Number : Case 1663 - 9 November - Dr Hafeez Diwan Posted By: Guest

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...

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

??????

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

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

How about Fox Fordyce disease ? 

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.

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.

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.

Fox-Fordyce disease. 

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. 

Fox-Fordyce disease

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.

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