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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 1652 - 25 October 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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68 year old woman with pearly telangiectatic papule and psoriasform patch on forehead, rule out basal cell carcinoma.

Case Posted by Dr Uma Sundram


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Admin_Dermpath

Posted

A nice case from Dr Uma Sundram to test your skills.

 

Cheers, Geoff

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Dr. Mona Abdel-Halim

Posted

I am thinking of panfolliculoma. We have areas resembling TE (image 2), areas with infundibular keratinization (image 4), image 3 I think represents isthmic differentiation (cells with abundant esinophilic cytoplasm and a focus of abrupt compact keratin). The last image shows ghost cells reminiscent of pilomatricoma. So I think this fits with panfolliculoma. 

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Arti Bakshi

Posted

Why not a Trichofolliculoma?...Trichofolliculomas also show pan follicular differentiation,  but the first image also shows a central cystically dilated infundibulum with radiating elements, typically seen with TF. This feature helps to differentiate from panfolliculoma as also the predominance of follicular germinative cells in PF. ( not seen here and which is why panfolliculoma usually mimic Trichoblastomas) 

Ofcourse, there is a cystic variant of panfolliculoma, which some consider as a variant of trichofolliculoma itself!

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 I have similar case , looking for final diagnosis....

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Raul Perret

Posted

My impression was the same Arti had. I though of trichofolliculoma, it looks like an hamartomatous lesion centered on a dilated follicle surrounded and probably connected with smaller follicles. To diagnose a panfolliculloma I prefer to see well defined nodular tumors with solid lobules and more clear cut differentiation towards the different components of the hair follicle.

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vincenzo polizzi

Posted

I see secondary and tertiary follicles radiating from a central one...and sincerely the last fig seems a keratin granuloma for me, or something like.

So agree with Trichofolliculoma

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Robledo F. Rocha

Posted

There are rather follicular germinative buds than vellus hair follicles radiating from the central crateriform structure lined by both infundibular and isthmic follicular epithelium. Agree with panfolliculoma.

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Eman El-Nabarawy

Posted

What puzzeld me the clinical picture! Both TF or PF will be presented with a papule! Why this psoriasiform lesion with a pearly telangeictatic papule mimicking BCC! Parakeratosis inside the follicle with hypogranulosis. Looking again, could this be a case of Bowen (psoriasiform patch) that has been involved the pilosebacous follicle (the papule)? What about ki67?

Check this link.

https://www.ncbi.nlm.nih.gov/pubmed/17667180#

 

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Uma Sundram

Posted

Great discussion as always. We went with trichofolliculoma for reasons discussed by arti. The patient has a background of actinic keratoses in that area which muddled the clinical picture.

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