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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 2266 - 19 February 2019 Posted By: Uma Sundram

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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31 year old female with friable hemorrhagic papule on left upper arm. R/o pyogenic granuloma


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Alex-Ventura-Leon

Posted

Nice suggestion by Vincenzo. I also think in an infecction process and Pseudotumoral Leprosy could look like this.

Let me add to the differential Histoplamosis, Im not sure, but i think there is some little round structures inside those histiocytes.

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Krishnakumar subramanian

Posted

spindle cells and vacuolated histiocytes close to the epidermis

special stains PAS/Fite needed

if leprosy-it must be histoid to be ruled out

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Clinical description doesn't fit with leprosy. It could be a sporadic cutaneous myxoma if the patient has only one lesion. 

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Dr. Mona Abdel-Halim

Posted

Will R/O leprosy first (histiocytoid type) although clinically does not fit...

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Uma Sundram

Posted

Yes, my apologies. What a week! I'm still recovering from the movement of my offices.

Fite is negative.

The lesion is CD68+ SOX10-. Given that the clinical is not a good fit for something infectious, we favored an unusual cellular neurothekeoma (other possibilities include an unusual histiocytic dermatofibroma). The patient has had this solitary lesion for a long time and it had been repeatedly traumatized. Clinically, r/o traumatized nevus. The lesion was removed and the patient has had no recurrences or new lesions. 

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