Circulation FCirculation F

Case 85Case 85

Female aged 34, previous gyn surgery. Female aged 34, previous gyn surgery. Painful lump in middle of scar. Painful lump in middle of scar.

?fat necrosis. ?fat necrosis.

Diagnostic category: Popularity:Diagnostic category: Popularity:Score:Score: 1 Endometriosis 10.001 Endometriosis 10.00 1.01.0

Case 86Case 86

Male aged 81. Male aged 81. Cystic lump on the chin enlarging over a Cystic lump on the chin enlarging over a

few weeks. few weeks.

Most popular diagnosis:Most popular diagnosis: 1 Metastatic adenocarcinoma (+/- GI) 1 Metastatic adenocarcinoma (+/- GI) 7.347.34

Case 87Case 87

Female aged 57. Female aged 57. Breast carcinoma in 2006 treated by Breast carcinoma in 2006 treated by

excision and radiotherapy. excision and radiotherapy. Multiple papules and nodules on left Multiple papules and nodules on left

breast breast ?skin meastases ?angiosarcoma ??skin meastases ?angiosarcoma ?

radiation injury ?irritaed seborrhoeic radiation injury ?irritaed seborrhoeic keratoseskeratoses

Case submitted as Atypical Vascular Proliferation after Case submitted as Atypical Vascular Proliferation after RadiotherapyRadiotherapy

Case 88Case 88

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

Most popular diagnosis:Most popular diagnosis: (+/- discoid) Lupus erythematosus (+/- discoid) Lupus erythematosus 9.239.23 11

Case 89Case 89

Male aged 64. Male aged 64. Papular eruption elbow. Papular eruption elbow. Pruritus scalp and upper body. Pruritus scalp and upper body. Immunofluorescence:Granular IgA in Immunofluorescence:Granular IgA in

papillary dermis. No significant papillary dermis. No significant fluorescence for IgG, IgM, C3 or fibrinogenfluorescence for IgG, IgM, C3 or fibrinogen

Diagnostic categories: Popularity:Diagnostic categories: Popularity: Score: Score: Dermatitis herpetiformis 10.00 Dermatitis herpetiformis 10.00 11

Case 90Case 90

Male aged 32. Male aged 32. Gets rash on fingers when hands wet Gets rash on fingers when hands wet

(periodically works at sea). Comes and (periodically works at sea). Comes and clears over 2 weeks - sore not itchy.clears over 2 weeks - sore not itchy.

Clinically erythema multiforme or Clinically erythema multiforme or chilblains.chilblains.

Most popular diagnosis:Most popular diagnosis:

Classic perniosis / Chilblains 9.46Classic perniosis / Chilblains 9.46

Case 91Case 91

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

Most popular diagnosis:Most popular diagnosis: Supernumerary digit Supernumerary digit 8.598.59

Case 92Case 92

Female aged 62. Female aged 62. Pigmented lesion left forearm, ?lentigo Pigmented lesion left forearm, ?lentigo

maligna.maligna.

Macro: Ellipse of skin, 24x15x13mm with a Macro: Ellipse of skin, 24x15x13mm with a pigmented macule, 11mm diameter. It has pigmented macule, 11mm diameter. It has an irregular margin and uniform an irregular margin and uniform pigmentation.pigmentation.

Most popular diagnosis:Most popular diagnosis:

Lentigo maligna melanoma Lentigo maligna melanoma 6.756.75

Case 93Case 93

Female aged 83. Female aged 83. Ulcerated lesion on scalp ?SCC ?BCC Ulcerated lesion on scalp ?SCC ?BCC

Most popular diagnosis:Most popular diagnosis: Metastatic adenocarcinoma Metastatic adenocarcinoma 5.565.56

Case 94Case 94

Female aged 30. Female aged 30. Localised infiltrative plaque anterior Localised infiltrative plaque anterior

abdomen. abdomen.

Most popular diagnosis:Most popular diagnosis: Morphoea Morphoea 9.309.30

Case 95Case 95

Male aged 34. Male aged 34. 4cm firm subcutaneous plaque left buttock. 4cm firm subcutaneous plaque left buttock.

Multiple other papules on trunk and limbs. Multiple other papules on trunk and limbs. ?subcutaneous sarcoidosis. ?subcutaneous sarcoidosis. Immunohistology: cells are - Immunohistology: cells are - Positive - CD4, CD11c, CD15, CD33, CD43, Positive - CD4, CD11c, CD15, CD33, CD43,

CD45, CD68, HLA-DR CD45, CD68, HLA-DR Negative- CD2, CD3, CD5, CD7, CD8, CD10, Negative- CD2, CD3, CD5, CD7, CD8, CD10,

CD20, CD23, CD34, CD56, CD123, CD128, CD20, CD23, CD34, CD56, CD123, CD128, TdT, MPO, MNF TdT, MPO, MNF

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

Case 96Case 96

Female aged 3. Female aged 3. Subungal lesion, little toe right foot. Subungal lesion, little toe right foot.

Case submitted as :Case submitted as : Tungiasis Tungiasis

Case 97Case 97

Male aged 32. Male aged 32. One year history of swelling behind the One year history of swelling behind the

nail plate of the right thumb. nail plate of the right thumb. Immunohistochemistry:Immunohistochemistry: Vimentin and CD34 - positive, Vimentin and CD34 - positive, S100, Desmin and Actin - Negative. S100, Desmin and Actin - Negative.

Case submitted as:Case submitted as:

Superficial acral fibromyxomaSuperficial acral fibromyxoma

Case 98Case 98

Female aged 50. Female aged 50. Groups of papules and nodules, Groups of papules and nodules,

purple/red. Previously normal skin. purple/red. Previously normal skin. Initial differential diagnosis sarcoid versus Initial differential diagnosis sarcoid versus

nodular prurigo versus lymphoma cutis.nodular prurigo versus lymphoma cutis. Biopsied (first biopsy not submitted). Biopsied (first biopsy not submitted). Three month follow up, nodules resolve Three month follow up, nodules resolve

and scar with newer groups appearing, re-and scar with newer groups appearing, re-biopsied. No systemic disease.biopsied. No systemic disease.

Immunohistochemistry: Immunohistochemistry: tumour cells CD2, CD4 positive, CD30 diffuse tumour cells CD2, CD4 positive, CD30 diffuse

and strong positivity. and strong positivity.

CD3, CD5, CD8, CD20, CD45RA, ALK-1, EMA, CD3, CD5, CD8, CD20, CD45RA, ALK-1, EMA, CD56, TIA-1, CD56, TIA-1, Granzyme all negative. Granzyme all negative.

MUM1 positive in most tumour cells. MUM1 positive in most tumour cells.

MIB1 staining shows high proliferation fraction. MIB1 staining shows high proliferation fraction.

Case submitted as : Case submitted as :

CD30+ lymphoproliferative disorder and came with a CD30+ lymphoproliferative disorder and came with a

history strongly suggesting LyPhistory strongly suggesting LyP

Case 99Case 99

Male aged 27. Male aged 27. Very itchy blisters on shins and dystrophic Very itchy blisters on shins and dystrophic

nails ?Epidermolysis bullosa nails ?Epidermolysis bullosa

Case submitted as :Case submitted as : Dystrophic epidermolysis bullosa pruriginosa. Dystrophic epidermolysis bullosa pruriginosa.

The End