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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 2016 - 27 Feb 2018 Posted By: Iskander H. Chaudhry

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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81F. Mid back biopsy excision of nodule.
Patient dermal nodules 4/12 on trunk- mild itch. Ultrasound suggests enlarged spleen.

Edited by Admin_Dermpath


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Leukemia cutis in a patient with chronic myeloid leukemia ?

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Saman Fatah

Posted

Cutaneous plasmacytosis vs Cutaneous Castleman's disease if one consider them separate entities. Need IHC plus close CPC. 

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Dr. Richard Carr

Posted

Grey infiltrate, granulomatous with lymphocytes and plasma cells. Think the following (Lues, Lymphoproliferative, Lyme, Leish, Leprosy, Lupus vulgaris). LPD looks a runner consider lymphomatoid granulomatosis, angioimmunoblastic T-cell and pseudolymphoma.  Systemc lymphomas (B- and T- ) can present with vaguely granulomatous infiltrate in the skin. Consider another histiocytosis like RDD. IHC & PCR will probably be required including Kappa & Lambda.

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Admin_Dermpath

Posted

Thank you 

 

Dr Chaudhry has provided some more history:

 

Mid back biopsy excision of nodule. Patient dermal nodules 4/12 on trunk- mild itch. Stage 4 lymphoplasmacytoid T-Cell lymphoma 2009. Failed Chemo Etopocide in 2010 for 6/12 for symptom relief. Improved. Discharge in 2016 ?Recurrent lymphoma Patient thinks spleen enlarging in last few days.

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Uma Sundram

Posted

It would be difficult to comment further without a full immunohistochemical work up since the cells here look relatively bland.

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Admin_Dermpath

Posted

Dr Chaudhry's response:

 

Granulomatous pseudolymphoma - awaiting regional MDT review. Mixed T and B cells, Mature plasma cells and Granulomas. 

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