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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 1794 - 13 April - Dr Arti Bakshi 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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Clinical History: 56/M, erythematous patch lower leg couple of years.

Case Posted by Dr Arti Bakshi


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dermpath1

Posted

lichenoid pigmented purpuric dermatosis of Gougerot Blum

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vincenzo polizzi

Posted

Another PPD-like MF? Atypical cytological and architectural features are more subtle this time, and this diagnosis is harder to support, but..why not? Clinical history, long time and solitary lesion, fits well ( solitary MF-patches are well described as better prognosis cases ). 

There are lichenoid features, also, and lymphocytes aren't larger than dermal ones.

However the intradermal and demo-epidermal arrangement of lymphocytes seems a little linear, with halos and with very poor spongiosis. 

 

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Mariantonieta Tirado

Posted

Lichenoid purpura (1 lesion: lichen aureus?) or hemorrhagic MF are my 2 differentials.

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Raul Perret

Posted (edited)

I thought this was a case of lichenoid PPD (if the images we see here are completely representative of the lesion). I think our tolerance threshold for diagnosing MF has diminished lately due to the cases seen in dermpathpro. But for me this is PPD

Edited by Raul Perret
Forgot a word!

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Robledo F. Rocha

Posted

Agree, favor pigmented purpuric lichenoid dermatitis of Gougerot and Blum.

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Arti Bakshi

Posted

Yes, I called it lichenoid PPD too. Could well be a pigmented purpuric lichenoid dermatitis of Gougerot and Blum. (although the clinical history did seem to imply a single lesion).

I did not think there was lymphoid atypia and did not do any immunos, when I reported this case. However, when I was putting the case on dermpathpro, I did wonder if I should have....but I agree with Raul that this is likely to be the effect of this website!! Having said that, I think subtle forms of lymphoid atypia is one of the most subjective things in dermpath, and if you stare at a lymphoid cell long and hard enough, it does turn atypical!!. Sometimes its the associated epidermal reaction, which is more useful. There was clearly basal vacuolar damage, colloid bodies and spongiosis in this case all pointing to a reactive process.  If one compares this case to Richard's case of purpuric MF from last week, these epidermal changes were lacking in his case.

Thanks for all your comments. 

 

 

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