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 2024 - 08 March 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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55 year old Male. Left cheek 4mm punch biopsy. Non-healing ulcer following insect bite. Southern Spain last October.

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User Feedback


Anil Patki

Posted

Superficial and deep dense lymphocytic infiltrate with a few eosinophils. Persistent insect bite reaction or lymphocytoma cutis. Silver stain to detect borrelia may be tried. Nodular scabies will appear similar but won't be seen on the face.

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Dr. Richard Carr

Posted

Always challenging cases. Frank ulceration is not seen. In this instance nodular B-cell pattern (mixed cells) but also quite prominent epidermotropism & Pautrier-like microabscesses.  Can't see granulomatous features that might suggest Leishmaniasis. Given the eosinophils a persistent arthropod reaction (pseudolymphoma) is a good possibility. I'd probably run a Kappa and Lambda and a limited B-cell panel. Think I'd also like to see the clinical images and suggest MDM discussion is an clinical concerns.

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Uma Sundram

Posted

I agree with Dr. Carr, but am less worried about a B cell lymphoma; the presence of epidermal involvement and the clinical are reassuring. The thing about true cutaneous lymphomas is that the really horrible ones never go away. Over treatment is usually more of a problem than under treatment. Pseudolymphoma/insect bite reaction is my diagnosis. Pretty impressive, though.

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Raul Perret

Posted

My first hypothesis is also pseudolymphoma. I think I would have performed a small panel of immunos like Richard remarked

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Anil Patki

Posted

"Real" pathologists don't like the terms 'pseudolymphoma' and 'lymphocutoma cutis' that are used by dermatologists. (Ref Ronald Rapini's book).They use the term 'reactive lymphoid hyperplasia' instead. What do the "real" pathologist in this forum say ?:--))

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vincenzo polizzi

Posted

Favour a "Reactive lymphoid Hyperplasia", insect-byte induced.

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Admin_Dermpath

Posted

Dr Chaudhry's comment:

 

The final diagnosis was Pseudolymphoma likely secondary to insect bite; MDT discussion. 

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Dr. Richard Carr

Posted

I'm a surreal histopathologist and probably a bit lazy at times with my terminology.  Happy to be corrected though!

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