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 2109 - 6 July 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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F30. Back. Infected sebaceous cyst.

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Anil Patki

Posted

The lesion in the epidermis looks like a dilated pore of Winer. The dermis shows a foreign body granuloma possibly around suture material remnants from a previous surgery.

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vincenzo

Posted (edited)

10 hours ago, Anil Patki said:

The lesion in the epidermis looks like a dilated pore of Winer. The dermis shows a foreign body granuloma possibly around suture material remnants from a previous surgery.

...or a synus pilonidalis if in sacral area

Edited by vincenzo

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Admin_Dermpath

Posted

New images added!

 

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vincenzo

Posted

?DFSP with epidermal cystic induction. Waiting for the final diagnosis...

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Alice Roberts

Posted

I was considering a dermatomyofibroma.  But staining weird.  The lesion on H&E didn’t seem classic for DFSP.  A bit less cellular and not pinwheel.  The CD 34 is pretty diffuse at the base, though which speaks against DMF and SMA is only focal. Plaque stage DFSP? I’m really not sure about this one.  The cyst could be separate process.

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Anil Patki

Posted

Dual pathology - FB granuloma and DFSP.

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I still think it's just a scar to a ruptured cyst. But now that the immunos were done, every pathologist would be worried.

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Raul Perret

Posted

This is not DFSP. There is a scar, granulomatous inflammation and a dilated follicle but no neoplasm here

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Dr. Richard Carr

Posted

Thanks for all the responses. This appeared to be a straightforward reaction to a previously ruptured epidermoid cyst or comedone.  I was a little perturbed by the slightly lace like hypercellular process involving the subcutis, resemblind DFSP. I thought the SMA was commensurate with the more cellular active myofibroblastic proliferation in the scar and peripheral CD34 probably reflecting more mature scarring. The loss of elastic supported scarring rather than and DFSP (or dermatofibroma) which in my experience have well preserved if not accentuated elastic staining. Apologies for the late post. I had a computer crash last week and have been on hols. We're walking the dog in Ayreshire, Scotland.

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Dr. Mona Abdel Halim

Posted

On 16/07/2018 at 11:39, Dr. Richard Carr said:

Thanks for all the responses. This appeared to be a straightforward reaction to a previously ruptured epidermoid cyst or comedone.  I was a little perturbed by the slightly lace like hypercellular process involving the subcutis, resemblind DFSP. I thought the SMA was commensurate with the more cellular active myofibroblastic proliferation in the scar and peripheral CD34 probably reflecting more mature scarring. The loss of elastic supported scarring rather than and DFSP (or dermatofibroma) which in my experience have well preserved if not accentuated elastic staining. Apologies for the late post. I had a computer crash last week and have been on hols. We're walking the dog in Ayreshire, Scotland.

Brilliant as usual :-)

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