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 2231 - 31 December 2018 Posted By: Limin Yu

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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76F, lesion on vulva


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John Zhang

Posted

I'll take a stab at it: there is background lichen sclerosis. The center has acanthosis, slight elongation of the rete ridges, and mild basal keratinocyte atypia. P53 stain is basal and parabasal, and p16 is only focally positive. This central portion probably has differentiated vulvar intraepithelial neoplasia. Although the findings on the H&E is rather subtle I was also wondering if this can just be lichen sclerosis.

 

Happy New Year to the faculty and all friends that participate the spot discussions at dermpathpro. This is a wonderful learning site and has become my favorate internet hangout. 

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Anil Patki

Posted

Hyperkeratosis,  hypergranulosis, necrotic keratinocytes higher up in the epidermis, vacuolar interface dermatitis and pigment incontinence are the salient features. I wonder whether this could be a fixed drug eruption especially a recurrent one. 

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Dr. Richard Carr

Posted

Agree hypertrophic lichen sclerosus. No far not convinced by dysplasia. I tend to run Ki67, p53 & p16. Ki67 should be limited to basal/suprabasal. I the you can allow some elevated dyskeratosis in lichen sclerosis. In any case watchful waiting. 

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