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 2128 - 6 August 2018 Posted By: Limin Yu

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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33F, lesion to face

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Anil Patki

Posted

A keratinous cyst with trichilemmal keratinization. Around the main cyst are islands of basaloid cells with papillary mesenchymal bodies. I think this is a solitary trichoepitheioma. Alternative differential diagnoses are cutaneous keratocyst and milia.

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John Zhang

Posted

Central dilated hair follicle surrounded by many small hair follicles - trichofolliculoma. I think the last photo represents a reaction to ruptured hair follicles, rather than a fibrous and myxoid stromal component.

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This is a cystic lesion with epithelial and stromal components, sort of a biphasic cystic lesion. I usually put these types of cystic lesion in the category of fibrofolliculoma / trichodiscoma / folliculosebaceous cystic hamartoma. I do not see sebaceous units attached to the cyst, so i do not think it' s a FCH. The epithelial components look kind of mature so I favor trichodiscoma over fibrofolliculoma. But I think they all represent the opposite ends of the same type of lesion. I would agree with Vincenzo.

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Limin Yu

Posted

Thank everyone for the insightful discussion.  This is a trichofolliculoma for me -- a central cystic lesion with secondary radiating vellus hair follicles.  If this is more fibrous stromal changes, I would entertain the idea of fibrofolliculoma.  Thanks!

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