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?

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Case Number : Case 2127 - 3 August 2018 Posted By: Dr. Richard Carr

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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M90. Angle of mandible. Indurated patch ?indurated bowen’s ?early SCC in bowen’s.

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Anil Patki

Posted

Fibroepithelioma and foreign body reaction may be to some dermal filler.

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I was thinking of something as IgG4-related sclerosing disease, but there are many giant cells and other morphological findings not fitting. So my first spot is "Pulse Granuloma".

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Anil Patki

Posted

Fibroepithelioma of Pinkus with a foreign body granuloma around the keratin of a ruptured cyst

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To me, looks like there is a syringofibromatous reaction in the epidermis. Congo red?

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Dr. Richard Carr

Posted

Yes this is some reactive eccrine syringofibroadenomatous hyperplasia but the main point is to see the innumerable colloid bodies that extend in to the mid dermis on H&E (highlighted by a pan-keratin or in this case CK5) associated with prominent inflammatory infiltrate. Note the foreign body type giant cells (part of "keratin granulomas").  All these features point to complete regression of a squamoproliferative lesion possibly superficially invasive e.g. actinic keratosis, superficial SCC, KA, inflamed seborrhoeic keratosis etc. BCC may regress fully leaving colloid bodies too.

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