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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 1769 - 9 March - 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: 45/M, indurated palques with surface erosion back, chest and arm.

Case Posted by Dr Arti Bakshi


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vincenzo polizzi

Posted

A Lupoid conjuration...

There are many sclerodermoid features, but no silhouette squaring and much dermal mucin with hyalinized fatty necrosis make me favour Lupus Profundus

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Mariantonieta Tirado

Posted

Superficial and deep infiltrate. At low magnification it seems mostly perivascular. Vacuolar change and necrotic keratinocytes at the DEJ. Some superficial neutrophils (I don't think I saw eos). Interstitial mucin. Lots of plasma cells. 

Lupus panniculitis

I would add ki67 to look for fat rimming, CD3, CD20, CD123

Always consider lymphoma in the differential 

Less likely but careful with syphilis unusual drug reaction 

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Alice Roberts

Posted

Doubt syphillis but serologic studies if clinical concern, VDRL/FTA

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Sasi Attili

Posted

Lupus profundus was my first thought, but the amount of plasma cells also warrant consideration of inflammatory morphoea. Can't comment much on cellular atypia but yes CTCL would be in the differential, if not for the numerous plasma cells

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Dr. Mona Abdel-Halim

Posted

LE profundus with lovely lymphoid follicle formations.

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Raul Perret

Posted

I also think this is lupus profundus. The hyaline fat necrosis is a good clue as well as the prominent germinal centers. Considering the former, here in France they call it the «gui sign» or  mistletoe sing for the resemblance to a parasited tree.Peuplier_noir_guite.jpg

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Josie Bisi

Posted

Lupus panniculitis. What about an IHC to exclude lymphoma?

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Arti Bakshi

Posted

Yes, lupus profundus it is!

The combination of interface change, dermal mucin, hyalin fat necrosis, plasma cells and lymphoid aggregates (some clearly with reactive germinal centres) is typical of lupus profundus. Thanks for the instructive photograph, Raul!

Remember, one may not see all the features in any one case, which is why an SPTCL often comes in the d/d with lupus profundus. However, given the classical morphology in this case, one could debate if there really is a need for immunos. I'm sure the more experienced and braver dermatopathologists amongst us (such as Dr Carr!) would not do immunos. But I have to admit I have ordered a panel and although I dont expect to change my diagnosis, I await the stains....

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