Case Number : Case 1895 - 01 Sept - Dr Richard Carr Posted By: Guest

would favour a benign fibroblastic/myofibroblastic lesion. given the lympho/plasmacytic component, would consider inflammatory myofibroblastic tumour of soft tissue, odd myofibroma..

Plasma cell granuloma?

Agree with Urmilapandey and Mona: Inflammatory Myofibroblastic Tumor, Plasma Cell Granuloma type.

agree with sclerosing type of inflammatory myofibroblastic tumor as spot diagnosis. Although I would perform some immunos before giving the dx, mainly in paucicellular lesions like this one

yes, inflammatory myofibroblastic tumour my first thought too.

I have put the final diagnosis for case 1894 (apologies for the delay!!)

Hmm!  How about infections? Lot's of plasma cells. 

wow!..did not think infection at all...could this be a juxta-articular fibrous nodule related to Borrelia??

This histology (a sclerotic juxta-articular located nodule with promoinent lymphoid containing abundant plasma cells) is very typical for a juxta-articular fibroid nodule of late Lyme disease, case s/b Professor Werner Kempf who agreed and kindly performed PCR which was negative. Prof. Kempf noted that late lesions of Lyme can be PCR negative but serology is usually positive (the reverse in early Lyme lesions). I'm still awaiting results of serology. Hope you all recognise the pattern of this rare manifestation/variant next time you see it.

Thanks for this very interesting case, Dr Richard!

Thumbs up for Arti - no like button these days it appears.

22 hours ago, Dr. Richard Carr said:

This histology (a sclerotic juxta-articular located nodule with promoinent lymphoid containing abundant plasma cells) is very typical for a juxta-articular fibroid nodule of late Lyme disease, case s/b Professor Werner Kempf who agreed and kindly performed PCR which was negative. Prof. Kempf noted that late lesions of Lyme can be PCR negative but serology is usually positive (the reverse in early Lyme lesions). I'm still awaiting results of serology. Hope you all recognise the pattern of this rare manifestation/variant next time you see it.

wow! thanks indeed for sharing

A big WOW!!!

chapeau Arti :-))