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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 2915 - 08 September 2021 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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65 year old male with long standing lesions on the lower legs.


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Richard Logan

Posted

This looks like an old, dried-out slide.  There are lots of fissures in the dermis which I suspect are artefactual, and some tinctural changes in the connective tissue which may also be due to aging of the slide.  The third image shows a cluster of atypical, hyperchromatic cells, possibly endothelial.  Is this angiosarcoma, possibly Kaposi's?

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vincenzo

Posted

Difficult. The second img shows microthrombosis.  The atypical cells could be pc. ?? IgM-related( Waldenstrom) DIC. 

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John Zhang

Posted

The last photo shows plasma cells. Features in the background dermis are difficult to tell but I was thinking amyloidosis associated with plasma cell dyscrasia such as multiple myeloma. Vincenzo has a great point this can be Waldenstrom. May we have some stains please (PAS, congo red, kappa and lambda)?

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vincenzo

Posted

14 hours ago, John Zhang said:

The last photo shows plasma cells. Features in the background dermis are difficult to tell but I was thinking amyloidosis associated with plasma cell dyscrasia such as multiple myeloma. Vincenzo has a great point this can be Waldenstrom. May we have some stains please (PAS, congo red, kappa and lambda)?

Oh yes. What seems to me microthrombs could be amyloid!!!

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Uma Sundram

Posted

Nodular amyloidosis. Congo red is positive and the plasma cells are kappa light chain restricted. 

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