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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 2329 - 21 May 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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63 year old male with lesion on finger

Edited by Admin_Dermpath


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John Zhang

Posted

I favor dermatofibroma, especially given the overlying epidermal hyperplasia. I also thought about interstitial granuloma annulare. Krishnakumar's idea of angiofibroma is interesting. But angiofibromas are usually subcutanous.

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Alex-Ventura-Leon

Posted

What about Multinucleated Giant Cell Angiohistiocytoma?

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IgorSC

Posted

Agree with Alex Ventura, this is a multinucleated giant cell angiohistiocytoma. Some argues that dermatofibroma does not exist in the fingers, but I have seen one or two cases very similar to it. I would like to know the opinion of the collegues about this.

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John Zhang

Posted

Ha ha, I thought about multinucleated cell angiohistiocytoma, too. But I shied away from it because I thought there was only one possible multinucleated cell (in the center of the last photo). Not enough multinucleated cells! 

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Uma Sundram

Posted

Yes, a case with numerous possibilities. We finally decided on scar like dermatofibroma. Digital DF has been described. This one is unusual because lesional cells are really scarce. There's no wrong answer here; if you can defend it, you can diagnose it! I was also interested in what you all thought about this case.

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vincenzo

Posted

I was thinking of superficial acral fibromyxoma. 

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Neil Catterall

Posted

Not sure if you can get acquired elastotic haemangioma on acral skin but the plaque-like spread of vessels can look like this.

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Uma Sundram

Posted

Great additional points. CD34 is negative, arguing against superficial acral fibromyxoma (but the histology is really good for it). I'm not sure how common acquired elastotic hemangiomas are on acral sites, but I think the vessels tend to be bigger and more prominent (perhaps more clearly a vascular process than this lesion seems to be?). 

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Uma Sundram

Posted

 I should say, CD34 is negative, somewhat arguing against the diagnosis of superficial acral fibromyxoma, since up to 30% of cases are negative. So, this is a possibility as well.

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