Case Number : Case 2266 - 19 February 2019 Posted By: Uma Sundram

Leprosy?

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.

spindle cells and vacuolated histiocytes close to the epidermis

special stains PAS/Fite needed

if leprosy-it must be histoid to be ruled out

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

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

can we have the diagnosis Please

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. 

Forgot to mention that NKI/C3 was positive.

nice case！