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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 Number : Case 1858 - 12 July - Dr Iskander Chaudhry (Invited) 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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66 M, lesion on left axilla.

Edited by Admin_Dermpath


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Admin_Dermpath

Posted

Morning all - new case added!

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urmilapandey

Posted (edited)

epidermal hyperplasia, suprabasal clefting. can't see any intraepidermal collection of eosinophils or polys. not sure if there is any definite dyskeratosis in the left hand field of image 3. so thinking on lines of pemphigus vegetans, Darier's (which may have a localised/segmental variant?)

Edited by urmilapandey

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vincenzo polizzi

Posted

SYRINGOCYSTOADENOMA PAPILLIFERUM. 

Axilla is an odd location, but I found this:

A case of zonal syringocystadenoma papilliferum of the axilla mimicking verruca vulgaris.
Xu XL, et al. Am J Dermatopathol. 2010.
 

 

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Clara Jaramillo

Posted

Acantholytic dyskeratotic acanthoma ?

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Raul Perret

Posted

I Am confused based on the these images. Some areas look papillary in pic 2 SCP-like but it is hard to interpretate. I think this is more consistent with acantholytic acanthoma,

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urmilapandey

Posted

given tha it is a solitary lesion, i agree, it would be in keeping with acantholytic acanthoma

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Robledo F. Rocha

Posted

Although the inflammatory infiltrate is not as intense and eosinophils-rich as it would be expected, pemphigus vegetans deserves consideration. Axilla is a typical site, and subtle suprabasal acantholysis of both pseudoepitheliomatous hyperplastic epidermis and infundibular follicular epithelium are characteristic microscopic features.

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Dr. Richard Carr

Posted

Pemphigus vegetans was my "spot". Liked some of the other suggestions.

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Nitin Khirwadkar

Posted

P Vegetans would be top on my list too.

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Dr. Mona Abdel-Halim

Posted

P vegetans my first thought

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Saman Fatah

Posted

Prominent acanthosis, suprabasal clefts and very few acantholytic cells within the lacunae. Lack of significant inflammatory infiltrate within the epidermis/superficial dermis is striking feature (especially eosinophilis) in otherwise well circumscribed flat based lesion. History mention a lesion rather than an eruption making acantholytic acanthoma or other benigin epidermal proliferations with acantholysis slightly more favourable to me. Immunobullous is in the differential including P. Vegetans but the latter is a rare disease and CPC is essential in this context. 

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Dr. Richard Carr

Posted

Good point about the "lesion" comment and lack of eosinophils!

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Admin_Dermpath

Posted

Thanks all !

 

It was in fact P. Vegetans - had supporting IMF and also lesions elsewhere.

 

Iskander

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Saman Fatah

Posted

Interesting update on this case, thanks. It reinforces some limitations of H&E patterns and pauci-cellularity was a good learning point for me or perhaps one need to beware of the sin of diagnostic greed!

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