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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 4000! You can review the archived cases and read the suggested diagnoses by users and the final comment by the contributors.
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Case Number : Case 1909 - 21 Sept - Dr Hafeez Diwan Posted By: Guest

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64 year-old female with metastatic renal cancer. This biopsy is from an erythematous lesion on the right hand.

Edited by Admin_Dermpath


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Hyperkeratosis, acanthosis, parakeratosis, apoptotic keratinocytes and metastatic cells in dermis. Acrokeratosis paraneoplastica or malignant acanthosis nigricans

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Raul Perret

Posted

Agree mostly with Anil. However, I do not see metastatic cells in the dermis and I thought we also see eccrine squamous syringometaplasia in the last four pictures? sunitinib (usually used for treating renal carcinoma) is frequently associated with this condition

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Cem Leblebici

Posted

Hyperkeratosis, acanthosis, parakeratosis, keratinocyte necrosis, and mild spongiosis accompanied by a hint of interface change.  Also, There is papillary dermal edema, and obvious syringosquamous metaplasia.

For me, chemotherapy-induced acral erythema with syringosquamous metaplasia is the best suggestion.

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vincenzo polizzi

Posted

Glad to share the same thought with Raul. This is indeed a chemiotherapy (?sorafenib) hand foot syndrome for me (or something similar). Maybe a neutrophilic hidradenitis in the last 2 pictures, with , together to an obvious squamous syringometaplasia, is much consistent with PalmoPlantar Erythrodysestesia/Hand Foot syndrome. See: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4071713/

and here

 

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Nitin Khirwadkar

Posted

Changes highly suggestive of chemotherapy induced acral erythema. Both, eccrine squamous syringometaplasia and isolated necrotic keratinocytes (noted in this case) are present in CIAE.

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Dr. Hafeez Diwan

Posted

Indeed. This patient is on pazopanib, and the changes (squamous syringometaplasia, epidermal changes) are secondary to chemotherapy.

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