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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 2207 - 22 November 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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M55. Multiple adult type juvenile xanthogranulomata. Face, knee

Edited by Admin_Dermpath


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S100?  This is a very nice example of Rosaj Dorfmann Disease. 

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Differential includes generalized reticulohistiocytoma and rosai dorfman disease. IHC helps

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Krishnakumar subramanian

Posted

xanthomatous lesions, I am not seeing Touton cell

like to get IHC done and lipid profile to see whether it is normolipemic xanthomas and consider xanthoma disseminativum as the histopathology can show only xanthogranuloma more clinical information needed

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Alex-Ventura-Leon

Posted

Agree whit Vincenzo, it looks like Rosai-Dorfmann. But the clinical scenario is quite odd for me. Maybe Multicentric Reticulohistiocytosis is a better diagnosis.

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I would definitely do S-100. Every time I see a histiocytic lesion in which the histiocytes a vesicular nucleus with a relatively prominent nucleolus like in the last 2 pictures, I always think of Rosai-Dorfman because most histiocytes have a rather dark, small pyknotic nucleus. But agree, reticulohistiocytosis would be my second guess.

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vincenzo

Posted (edited)

Aberrant(but well known) positivity for CD30. 

The ALCL lymphohistocytic variant is whole another thing ( morphology is still important in our job). Nice case of RDD. Thanks Richard. 

Edited by vincenzo

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Krishnakumar subramanian

Posted

is it ALCL then or rosai dorfman with aberrant CD30

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It really looks like RDD; I was not aware of this aberrant CD30 positivity in RDD

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Dr. Richard Carr

Posted

Agreed for Rosai Dorfman. Well done. I did not over interpret the CD30!

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