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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 1895 - 01 Sept - Dr Richard 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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M50. Big toe. Ganglion.


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urmilapandey

Posted

would favour a benign fibroblastic/myofibroblastic lesion. given the lympho/plasmacytic component, would consider inflammatory myofibroblastic tumour of soft tissue, odd myofibroma..

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vincenzo polizzi

Posted

Agree with Urmilapandey and Mona: Inflammatory Myofibroblastic Tumor, Plasma Cell Granuloma type.

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Raul Perret

Posted

agree with sclerosing type of inflammatory myofibroblastic tumor as spot diagnosis. Although I would perform some immunos before giving the dx, mainly in paucicellular lesions like this one

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Arti Bakshi

Posted

yes, inflammatory myofibroblastic tumour my first thought too.

I have put the final diagnosis for case 1894 (apologies for the delay!!)

 

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Dr. Richard Carr

Posted

Hmm!  How about infections? Lot's of plasma cells. 

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Arti Bakshi

Posted

wow!..did not think infection at all...could this be a juxta-articular fibrous nodule related to Borrelia??

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Dr. Richard Carr

Posted

This histology (a sclerotic juxta-articular located nodule with promoinent lymphoid containing abundant plasma cells) is very typical for a juxta-articular fibroid nodule of late Lyme disease, case s/b Professor Werner Kempf who agreed and kindly performed PCR which was negative. Prof. Kempf noted that late lesions of Lyme can be PCR negative but serology is usually positive (the reverse in early Lyme lesions). I'm still awaiting results of serology. Hope you all recognise the pattern of this rare manifestation/variant next time you see it.

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vincenzo polizzi

Posted

Thanks for this very interesting case, Dr Richard!

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Dr. Richard Carr

Posted

Thumbs up for Arti - no like button these days it appears.

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urmilapandey

Posted

22 hours ago, Dr. Richard Carr said:

This histology (a sclerotic juxta-articular located nodule with promoinent lymphoid containing abundant plasma cells) is very typical for a juxta-articular fibroid nodule of late Lyme disease, case s/b Professor Werner Kempf who agreed and kindly performed PCR which was negative. Prof. Kempf noted that late lesions of Lyme can be PCR negative but serology is usually positive (the reverse in early Lyme lesions). I'm still awaiting results of serology. Hope you all recognise the pattern of this rare manifestation/variant next time you see it.

wow! thanks indeed for sharing

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