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 2356 - 28 June 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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M55. Right calf. Excision


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John Zhang

Posted

Hemangioma compressed by a cyst. If it is congenital or developed in early infancy, then verrucous hemangioma is favored. If it is acquired later, then angiokeratoma is favored. I also considered microvenular hemangioma, which often shows collapsed lumen; and acquired elastotic hemangioma, which usually occurs in women, on the arms.

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Krishnakumar subramanian

Posted

epidermoid cyst with surrounding capillary type blood vessels. there is no inflammation and no siderophages, focal epidermal hyperplasia

? capillary type angioma around a cyst

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Meenakshi Batrani

Posted

Although, mucin is not quite obvious, but I would still consider superficial angiomyxoma, which contains epidermal component incuding keratin filled cysts in >50% cases. 

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Dr. Richard Carr

Posted

Thanks. This is descriptive but fairly novel entity actually. I picked up around 12 cases over the years and I don't think it can be that rare. It's very distinctive histologically.

Seems to be located mainly at sites overlying bony prominences (knee, elbow, hip including greater trochanter) and comprising lichenification, microvenular like reactive vascular proliferation. In some cases there have been preceding inflammatory process (including lichenoid). The infundibular cyst formation is probably secondary. There is a striking loss of elastic in the lesion which I would not expect in solar elastotic (microvenular) haemangioma.

For me it's a reactive process with possible several co-factors but most likely local tissue ischaemia playing a role.

For a reference: 

https://www.ncbi.nlm.nih.gov/pubmed/28374436

 

J Cutan Pathol. 2017 Jul;44(7):605-611. doi: 10.1111/cup.12945. Epub 2017 May 16.

Acquired elastotic hemangioma-like changes and eccrine sweat duct squamous metaplasia in lichen simplex chronicus/prurigo nodularis-like lesions of the knee and elbow.

 
 
 
I'm a minor co-author of a paper just out that describes a similar (if not identical) "entity":
 
 
"Poikilodermatous plaque-like hemangioma: case series of a newly defined entity"

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