Case Number : Case 1648 - 19 October Posted By: Guest

A nice case from Dr Hafeez Diwan, the first of his two for this week.

Cheers, Geoff

First thought glomeruloid hemangioma, but really not sure... 

I think we have vascular thrombosis (best visualized in the last image), so I am thinking of reactive angioendotheliomatosis secondary to some sort of vsculopathy. CPC is mandatory.

I was thinking of a thrombotic vasculopathy now, cryoglobulinemy-like...

So many different pathologies! I was thinking of a vasculitis because I can see luminal and mural thrombi, focal mural infiltration by inflammatory cells and neutrophilic intersticial infiltration accompanied by some leukocytoclasis. The epidermis is also ulcerated, and that may be secondary to the vasculitis. CPC is needed.

I do not see all the criteria for considering this a vasculitis I think this is a case of reactive angioendotheliomatosis due to a thrombotic pathology as Mona suggested

I don't see the capillary-venous fibrin degeneration of LV but rather thrombotic organised material with a glassy appearance, like type I cryoglobulinemia. And an interstitial and perivascular granulocytic infiltrate as inflammatory reaction to vasculopaty. 

Reactive angioendotheliomatosis secondary to vasculopathy for clinical correlation. 

Atrophie blanche.

I vote for atrophe blanche