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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 1775 - 17 March - Dr Richard A Carr 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: F70. Intermittent skin rash on breast previously treated for cancer by local excision and radiotherapy.

Case Posted by Dr Richard A Carr


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Admin_Dermpath

Posted

As we all celebrate St Patricks day why not take a few minutes out and have a look at this great set of images from Dr Richard A Carr.

 
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Raul Perret

Posted

 My impression in this case is that we see epidermal atrophy as well as some tagging of the basal layer and a sclerotic band pushing down inflammatory cells. On the other had in the dermis we see mainly a lymphocytic infiltrate that has a tendency to surround nerves as well as some macrophages surrounding some elastic fibers in last pict (elastophagocytosis?). I favour lichen sclerosus based on the images, which can be induced by radiation and can show elastophagocytosis (mainly in non genital sites), the clinical description is weird though. Probably would do some immunos to rule out lymphoproliferative and serial cuts as perineural inflammation can be a clue to a hiding neoplastic infiltrate. 

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Fathia bayoumi

Posted

It could be postradiation lymphangiosarcoma as i can see vascular spaces with prominent endothelial cells plus perineural invasion by weired lymphocytes

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Sasi Attili

Posted

This I find quite difficult. There are a few atypical cells there.  Given the Hx- high suspicion of cutaneous met from previous breast ca. Would like IHC please!

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Dr. Mona Abdel-Halim

Posted

Difficult!

Thinking lymphoproliferative first (may be angioimmunoblastic lymphoma) which can present with intermittent rash... need IHC, will definitly do markers to exclude metastasis but feel it less likely because I can c some tagged lymphocytes and the dermal infiltrate looks more like atypical lymphocytes to me...

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Mariantonieta Tirado

Posted

I was thinking about subacute radiation dermatitis. Tagging of lymphocytes along DEJ, subtle vacuolar change a few eos. However those perineural infiltrates are suspicious. I would do Pancytokeratin, D240, CD31 and a recut

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Nitin Khirwadkar

Posted

I think radiation recall dermatitis is a great possibility. Not sure if this results in perineurial inflammation. 

Would also like to add a differential of extra genital lichen sclerosus- morphoea overlap.

 

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vincenzo polizzi

Posted

I see a lichen sclerosus et atroficus. The above comments are very convincing and appropriate, but I don't know what thinking about in this case. So my spot diagnosis is: "I don't know"!

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MONICA HERRERO

Posted

Caso complicado. Propuesta como diagnostico diferencial poiquilodermia.

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Dr. Richard Carr

Posted

Excellent discussion. I reported this as post-irradiation (early) morphoea (LS overlap). I did not do IHC. I have seen peri-neural involvement in morphoea several times now.  I don't think it's in the text-books but have not looked it up recently.

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Guillermo García

Posted

Postirradiation pseudosclerodermatous panniculitis can be histologically confused with both morphea profunda and lupus erythematosus profundus. 
 

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