Dermatologist/Dermatopathologist, Opinions are my own.
Denver, CO
Joined August 2017
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40 y/o F. Finger papules.
BEST answers.
Dx:
A) giant cell tumor
B) granuloma annulare
C) reticulohistocytoma
D) xanthogranuloma
IHC + in cells of interest:
A) CD1a
B) CD3
C) CD68
D) Sox10
Important to ? pt about:
A) arthritis
B) DM
C) HTN
D) NHL
#Dermquiz #Dermpathquiz #Derm
Young man (<30 y/o). Noted lesion for several years. Dx as pyogenic granuloma at some point, but continued to grow. Bx performed.
The best dx is:
A) cavernous hemangioma
B) Kaposi sarcoma
C) melanoma
D) pyogenic granuloma
#Dermquiz, #Dermpathquiz, #ConjunctivalLesion
Things learned from case:
T/F - pT criteria for conjuctival MM differ from those of skin
T/F - evidence re: utility of PRAME for conjuctival melanoma is similar to skin MM
T/F - there are several case reports in idex med lit. of conjuctival MM being confused (clinically) with PG
Hints:
(1) Fam Med focused on CTD, but in limited pics, there is not photodisribution and a "boiled ham" color to pap squamous rash.
(2) There are granulomatous elements (uncommon in CTD), but also tracking of inflammation down N/V bundles and curious number of plasma cells.
Last week CDC stated syphilis infections at highest rate since 50's!
Here is what was done:
1) asked for pics of palms/soles - none
2) obtained IHC for spiros (Steiner is other option)
3) I recommended RPR/VDRL and FTA-ABS (+/+)
#syphilis,#dermpathquiz, #dermquiz
34 y/o. Papule on scrotum. "R/O condyloma." No other history known. What is the best diagnosis?
A. Condyloma acuminatum
B. Condyloma lata
C. Epidermolytic hyperkeratosis of the genitalia
D. Verruciform xanthoma
#Dermpathquiz,#Dermquiz
Yes, verruciform xanthoma. Common on oral mucosa and genitalia. Histo features:
1) papillomatous architecture
2) "crypt-like" parakeratosis
3) neutrophils in parakeratosis
4) lipid laden foamy histiocytes in shallow dermis
Associated in literature with CHILD syndrome.
For MCQ examination purposes:
Which of the following syndromes is most strongly associated with the presence of verruciform xanthomas?
A. CHILD syndrome
B. LAMB syndrome
C. PHACE syndrome
D. SAPHO syndrome
IHC below represents "Adipu" stain (or combination of Pu.1 (brwn) - a histiocytic marker, and adipophilin (red) - a lipid marker). It highlights the lipid laden histiocytic cells in the shallow dermis.
There are 3 proposed mechanisms for lipid accumulation.
Yes, I do wish the clin photo was more "diagnostic" or "telling," but at least it shows you: 1) the sundamage is modest, 2) it is in the shadow of the nose, and 3) it is in a place where pressure from a canula or whatnot can be imagined. Thanks for looking.
69 y/o. Bx in Derm Clinic by APP. Only info- "Right columella. Pink papule 3 x2 mm. AK vs NMSC."
Best dx is:
A) AKH, ulcerated
B) BCC, with squamous metaplasia
C) chondrodermatitis nodularis "columellis"
D) SCC, ulcerated
Any history wanted? Photo help?
#Dermpathquiz,#derm
I, personally, wanted more data, and so I asked for the clinical photo (which was taken for purposes of site location - not optimal).
I asked "By chance, does the patient use CPAP?"
Answer - "Every night... and it 'hits' right there."
#dermpathquiz, #dermquiz