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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 3066 - 07 April 2022 Posted By: Saleem Taibjee

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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39M Punch biopsy left thigh: Papular / macular rash on body for decades


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Shawn

Posted

Looks like cutaneous mastocytosis. special stain/IHC confirmation + work up to exclude systemic mastocytosis suggested.

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Anil Patki

Posted

Telangiectasia macularis eruptiva perstans

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vincenzo

Posted

Yeahhh!  Totally Agree. Found this case very difficult, but last pictures show nice spindle mast cells...

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Saleem Taibjee

Posted

Well, what can I say - you guys are so impressive. You made short work of a difficult case. I did not disclose this in the original clinical information provided, but mastocytosis was suggested in the differential diagnosis. The difficulty in this case is increased because there is spongiosis in the overlying epidermis which could lead one towards the wrong diagnosis. (such as when I first looked at the slides blind of the clinical, as is my practice). However, when I then saw the clinical differential diagnosis on the request form, I took another look at the slide, and I could then appreciate the mast cells. Of course, the accompanying eosinophils are also a clue. I think we can call this 'eczematised' mastocytosis.

Immunohistochemistry for CD117 shown below is confirmatory.

21661_20.0x CD117 labelled.jpg

 

 

21661_10.0x CD117 labelled.jpg

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