Case Number : Case 1934 - 27 Oct - Dr Richard Carr Posted By: Guest

Hobnail hemangioma, possibly post- traumatic

Not sure I can arrive at a specific diagnosis. Dermis appears scarred with a few inflammatory cells and dilated capillaries (site related/ post-inflammatory)

Ulceration? History says- lesion?

7 hours ago, Admin_Dermpath said:

On behalf of Dr Richard Carr:

 

Diagnosis: ?Decubital / pressure ulceration

Well this is the sort of case you have to do some lateral thinking. This is how my brain worked it through. Reactive appearing epidermal hyperplasia with focal ulceration. Prominent vascularity in the upper dermis with a few extravasated RBC. Slight endothelial swelling and a prominent stromal fibroblast or two. Rather sclerotic appearing mid dermis. Elderly patient on the back of the thigh - I wonder if this is near the hip joint?  Could all this be secondary to local pressure akin to chondrodermatitis or so-called atypical decubital fibroplasia.

My Report: "Reactive/benign ulceration with vascular proliferation and sclerotic deeper collagen resembles morphoea or radiodermatitis but in view of anatomic location, could this be pressure related (atypical decubital fibroplasia/ischaemic fasciitis)?"

I often phrase my report conclusion in the form of a question as in this case and offer some indication as to my train of thoughts even if they don't quite fit. In this case clinical feed-back indicated it could be secondary to the effects of local pressure.

Tinea?