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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 2460 - 6 December 2019 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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Blind case with no history given!

Edited by Admin_Dermpath


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Krishnakumar subramanian

Posted

dermal perivascular plasma cells

can I have serology done. would like to r/o SYphilis

then other causes for plasma cell infiltrate

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A difficult granuloma annullare-like interstitial dermatitis, plasma cell rich. ?Erythema migrans

?Inflammatory morphea 

 

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Eman El-Nabarawy

Posted (edited)

Favor erythema migrans with interstitial granulomatous infiltrate.

Erythema migrans: a reassessment of diagnostic criteria for early cutaneous manifestations of borreliosis with particular emphasis on clonality investigations.

Böer A, et al. Br J Dermatol. 2007.

https://www.ncbi.nlm.nih.gov/m/pubmed/17535225/

Edited by Eman El-Nabarawy

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Dr. Mona Abdel-Halim

Posted

Hemosiderin deposits are there too! HHV-8??

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Eman El-Nabarawy

Posted

Clinical picture of pigmented patch, lymphocytic vasculitis, hemosiderin, few extravasated RBCs. ? PPD? Lichen aureus. Plasma cells are reported. 

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The pathology in lichen aureus is mainly in the papillary dermis. Here, the changes are in deeper dermis. 

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Eman El-Nabarawy

Posted

7 hours ago, Anil Patki said:

The pathology in lichen aureus is mainly in the papillary dermis. Here, the changes are in deeper dermis. 

Agree with u Sir. Thought of atypical presentation. As NL is a very good idea but I can't explain the hemosiderin in view of it. Also the clinical is not that typical of NL for my eyes at least. Thank u.

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Krishnakumar subramanian

Posted

mid dermal perivascular plasma cells. Lichen aureus is more more lichenoid with hemosiderin pigments, lymphocytes and histiocytes. 

 

could it be something like Lymphoplasmacytic plaque in children happening in this age group

serology any data sir

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Meenakshi Batrani

Posted (edited)

Isolated benign primary cutaneous plasmacytosis and erythema migrans are my differentials.

Edited by Meenakshi Batrani

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The pigmented lesion looks worrisome clinically. Does the patient get any immunotherapy or anti BRAF therapy for malignant melanoma which might explain the interstitial granulomatous dermatitis?

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On 14/12/2019 at 02:16, anh said:

The pigmented lesion looks worrisome clinically. Does the patient get any immunotherapy or anti BRAF therapy for malignant melanoma which might explain the interstitial granulomatous dermatitis?

...other spot: Desmoplastic Melanoma.

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Eman El-Nabarawy

Posted

31 minutes ago, vincenzo said:

...other spot: Desmoplastic Melanoma.

It was one of my thoughts also especially with this worrisome clinical but why so many plasma cells?! Never seen an interstitial granulomatous dermatitis in setting of melanoma yet!

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Dr. Richard Carr

Posted

This is spindle cell melanoma. I've not seen a case with so many plasma cells. I guess we can all add it to our differential of interstitial granuloma annulare-like pattern with plasma cells!!! I'll arrange to post the IHC so you can enjoy it. A great learning case. Phillip Mckee used to say at the beginning of every sign out say to yourself "desmoplastic melanoma". I looked at this case blind twice and each time I forgot this aphorism!  

 

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Dr. Mona Abdel-Halim

Posted

Wao, clinically definitely it is melanoma but could not relate with histology! Thought Dr Carr is tricking us and hiding something.... great case! Love it :-)

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