Circulation F

Case 85  Female aged 34, previous gyn surgery. Painful lump in middle of scar.  ?fat necrosis.

 Diagnostic category: Popularity:Score:  1 Endometriosis

Case 86  Male aged 81.  Cystic lump on the chin enlarging over a few weeks.

 Most popular diagnosis:  1 Metastatic adenocarcinoma (+/- GI) 7.34

Case 87  Female aged 57.  Breast carcinoma in 2006 treated by excision and radiotherapy.  Multiple papules and nodules on left breast  ?skin meastases ?angiosarcoma ?radiation injury ?irritaed seborrhoeic keratoses

 Case submitted as Atypical Vascular Proliferation after Radiotherapy

Case 88  Female aged 50 years.  Scarring alopecia  ?DLE ?LP.  No DIF done - no tissue sent for DIF

 Most popular diagnosis:  (+/- discoid) Lupus erythematosus 9.231

Case 89  Male aged 64.  Papular eruption elbow.  Pruritus scalp and upper body.  Immunofluorescence:Granular IgA in papillary dermis. No significant fluorescence for IgG, IgM, C3 or fibrinogen

 Diagnostic categories: Popularity: Score:  Dermatitis herpetiformis

Case 90  Male aged 32.  Gets rash on fingers when hands wet (periodically works at sea). Comes and clears over 2 weeks - sore not itchy.  Clinically erythema multiforme or chilblains.

 Most popular diagnosis:  Classic perniosis / Chilblains 9.46

Case 91  Male aged 17.  Lesion on right little finger.  Had from birth - catches.

 Most popular diagnosis:  Supernumerary digit 8.59

Case 92  Female aged 62.  Pigmented lesion left forearm, ?lentigo maligna.  Macro: Ellipse of skin, 24x15x13mm with a pigmented macule, 11mm diameter. It has an irregular margin and uniform pigmentation.

 Most popular diagnosis: Lentigo maligna melanoma 6.75 Lentigo maligna melanoma 6.75

Case 93  Female aged 83.  Ulcerated lesion on scalp ?SCC ?BCC

 Most popular diagnosis:  Metastatic adenocarcinoma 5.56

Case 94  Female aged 30.  Localised infiltrative plaque anterior abdomen.

 Most popular diagnosis:  Morphoea 9.30

Case 95  Male aged 34.  4cm firm subcutaneous plaque left buttock. Multiple other papules on trunk and limbs.  ?subcutaneous sarcoidosis.  Immunohistology: cells are -  Positive - CD4, CD11c, CD15, CD33, CD43, CD45, CD68, HLA-DR  Negative- CD2, CD3, CD5, CD7, CD8, CD10, CD20, CD23, CD34, CD56, CD123, CD128, TdT, MPO, MNF

 Case submitted as :  Acute myeloid leukaemia of myelomonocytic lineage

Case 96  Female aged 3.  Subungal lesion, little toe right foot.

 Case submitted as :  Tungiasis

Case 97  Male aged 32.  One year history of swelling behind the nail plate of the right thumb.  Immunohistochemistry:  Vimentin and CD34 - positive,  S100, Desmin and Actin - Negative.

 Case submitted as:  Superficial acral fibromyxoma

Case 98  Female aged 50.  Groups of papules and nodules, purple/red. Previously normal skin.  Initial differential diagnosis sarcoid versus nodular prurigo versus lymphoma cutis.  Biopsied (first biopsy not submitted).  Three month follow up, nodules resolve and scar with newer groups appearing, re- biopsied. No systemic disease.

 Immunohistochemistry:  tumour cells CD2, CD4 positive, CD30 diffuse and strong positivity.  CD3, CD5, CD8, CD20, CD45RA, ALK-1, EMA, CD56, TIA-1, Granzyme all negative.  MUM1 positive in most tumour cells.  MIB1 staining shows high proliferation fraction.

 Case submitted as :  CD30+ lymphoproliferative disorder and came with a history strongly suggesting LyP

Case 99  Male aged 27.  Very itchy blisters on shins and dystrophic nails ?Epidermolysis bullosa

 Case submitted as :  Dystrophic epidermolysis bullosa pruriginosa.

  The End