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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 2519 - 03 March 2020 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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20 year old woman with enlarging lesion behind left ear.


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Krishnakumar subramanian

Posted

granulomatous inflammation - no necrosis with dense collections of lymphocytes

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Krishnakumar subramanian

Posted

I was wondering whether we need to consider  lymphoepithelioid variant of peripheral T-cell lymphoma old term lenient lymphoma

I need PCR for MTB or IHC to know the clonality of the cells. please suggest

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Difficult. Granulomatous or lipogranulomatous lymphadenitis, with some toxoplasmosis-like finding ( but there aren’t hyper plastic lymphoid follicles). It needs CPC. 

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Dr. Mona Abdel-Halim

Posted

The lymphoid component is so dense and made me think like Krishnakumar in Lennert's lymphoma. Needs work up both for infectious causes as well as lymphoproliferative processes associated with granulomatous reaction. 

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Uma Sundram

Posted

I really liked all of your suggestions! It's very subtle, but the first picture has an epidermal inclusion cyst/dilated hair follicle in it. This is an exuberant cutaneous lymphoid hyperplasia in response to rupture. Although the lymphocytes are dense, they have many architectural features of a reactive process. Special stains are negative for organisms. Cultures are negative and T cell PCR is polyclonal.

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