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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 2427- 18 October 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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M65. Left hand. ?granuloma annulare


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Nice case. PAS is a very useful stain in Dermatopathology.

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Arif Usmani

Posted

Agree but whats that catch! Is there associated keratoderma and Sezary syndrome? 

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There's abrupt decrease in the thickness of stratum corneum. I think there is associated circumscribed palmar hypokeratosis. 

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Dr. Richard Carr

Posted

The H&E were intended to be posted separately (not with the PAS).

Anil - I suggested in my provisional report (it was an outside case from a "backlogs" company) appearances are suggestive of focal acral hypokeratosis and I was quite pleased with myself but in view of location (PAS to follow). The PAS was a surprise. Not sure if it's dual pathology or just a mimic but agree it is most definitely tinea manuum. Sadly no Sezary as well! Although I remember well a case that Heinz Kutzner shows in his wonderful lecture on infections disease of tinea nigra with a subtle accompanying lentigo maligna!!!!!

Incidently a small anecdote. While giving his [Kutzner] lecture I touch typed his words into a powerpoint of my own notes. When Heinz Kutzner sat down after one of the best lectures I'd ever had the pleasure to witness he looked at me quizically. I said :"I hope you don't mind I just typed out your talk".  He had never met me before and did not know I was a speaker too. He handed me his memory stick and said "take it". I was almost speechless, the culture elsewhere and particularly in London was always very "protective" over one's lectures (although Eduardo Calonje and I always shared talks we'd done with great pleasure). Anyway I somehow blurted out "thank you I'll only use it for local teaching" to which he said "you can publish on the internet if you want". Well if that is not a great human I don't know what is. Since then I have always tried to be open and share whenever I can. It's always tremendously dissappointing when one gets a negative reaction to request like "Do you mind if I take a copy of your talks for local teaching". I remember one organiser of a meeting who shall remain nameless when he overhead me make the request (to a close friend in dermatopathology) who was far from impressed.. Fortunately the friend, also a great speaker who has made a massive contribution in dermatopathology, kindly said "no it's okay Richard and I always share our talks." Incidently Kutzner invited me and Saleem Taibjee to visit his lab in Friedrichschafen, and we did go, and I will say it was a wonderful and career changing experience .

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