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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 2291 - 26 March 2019 Posted By: Iskander H. Chaudhry

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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F33. Biopsy right lower leg


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lupus panniculitis vs. T-cell lymphoma. Favor lupus panniculitis based on the nuclear debris. But definitely one of the most difficult subjects in dermatopathology, even with immunohistochemical studies and T-cell gene arrangement testing, in my opinion.

Clinicopathologic correlation needed.

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Krishnakumar subramanian

Posted

necrosis and mixed inflammatory cells/vascular damage seen-panniculitis

rule out erythema induratum/TB suggest PCR for MTB on the sections.

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Alex-Ventura-Leon

Posted

Difficult indeed, but favor Subcutaneous Panniculitis-Like T Cell Lymphoma (SCPLTCL)

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7 hours ago, anh said:

lupus panniculitis vs. T-cell lymphoma. Favor lupus panniculitis based on the nuclear debris. But definitely one of the most difficult subjects in dermatopathology, even with immunohistochemical studies and T-cell gene arrangement testing, in my opinion.

Clinicopathologic correlation needed.

Agree...favor Lupus Panniculitis because the lobular necrosis with neutrophils looks like an early hyalinization.

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Victor Delgado

Posted (edited)

Very interesting case. There is some superficial and deep perivascular and periadnexal mixed infiltrated with lobular paniculitis, at high power there are neutrophils, fat necrosis with nuclear debris and vasculitis changes mainly in the arterioles with fibronoid necrosis. This is highly suspicious of Erythema Nodosum Leprosum to me.

Edited by Victor Delgado
orthography

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lobular panniculitis. favor lupus profundus( lupus panniculitis)

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Anil Patki

Posted

I would agree with Krishnakumar. Panniculitis with vasculitis suggests erythema induratum of Bazin. There are no lymphoid follicles to support lupus nor is there a clear cut rimming to support SPTCL. As far as ENL is concerned,  there should be background lepromatous granulomas of foamy cells which are not seen here. However, clinicopathological correlation is vital as any of these conditions is likely. 

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Dr. Mona Abdel-Halim

Posted

Favor LE Profundus, will do CD3, CD20, CD123, Ki67, CD4 and CD8

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Alice Roberts

Posted

E induratum, rule out lupus maybe.

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Krishnakumar subramanian

Posted

sir final diagnosis

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