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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 2010 - 19 Feb 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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73 yo man right arm


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Keratin-filled crater, buttressing, pseudoepitheliomatous hyperplasia with glassy keratinocytes, hypergranulosis and dense lichenoid infiltrate of lymphocytes with a few eosinophils indicate a keratoacanthoma

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I had thought of hypertrophic lichen planus like Vincenzo but decided against it because 1. The site - very unusual on the arm .2. epidermal hyperplasia is too massive and narrow. 3, keratin plug in the centre is too big and the crater has buttressing

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Dr. Richard Carr

Posted

Agree follicular pseudoepitheliomatous hyperplasia with a background follicular lichenoid infiltrate. Certainly hypertrophic lichen plano-pilaris would be top of the list and needs CPC. You don't usually see a solitary lichenplano-pilaris-like (lichenoid) keratosis but I suppose it could happen. KA are rarely this small and usually reach deeply and highly invasively into the deep reticular dermis to the level of the sweat gland coils in the proliferative stage.  Weedon did however draw attention to occasional so-called abortive KA but they are small and rather rounded in low power, typically infiltrative on close inspection of he borders that are rather overwhelmed by the inflammatory (predominantly lymphocytic) infiltrate, innumerable colloid bodies and striking individual cell necrosis in my small experience of them.

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vincenzo polizzi

Posted

Thanks Anil and Richard for your very useful comments. 

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This is getting interesting! Too small for a KA, too big for hypertrophic lichen planus and too innocuous for a SCC!

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All the comments are very insightful.  I had the exactly same thoughts and differential diagnoses as you.  The clinical diagnosis is hypertrophic LP, so it was signed out as HLP. 

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Dr. Richard Carr

Posted

You can get very large clinical lesions with PEH including HLP.

 

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