QUIZ SECTION
165 Advances in dermatology and venereology
ActaDV Acta Dermato-Venereologica ActaDV
Dome-shaped Papules on the Left Flank : A Quiz
Sophie ROENNEBERG 1 , Ivan HEGYI 2 , Werner KEMPF 2 , 3 , Katrin KERL 3 and Emmanuella GUENOVA 3 *
1
Department of Dermatology and Allergy , Technical University of Munich , Munich , Germany , 2 Kempf & Pfaltz , Histologische Diagnostik , Zürich , and 3 Department of Dermatology , University Hospital Zurich , University of Zürich , Gloriastrasse 31 , CH-8091 Zurich , Switzerland . E-mail : emmanuella . guenova @ usz . ch
A 60-year-old woman presented with a distinct , sharply demarcated plaque on her left flank . The plaque measured approximately 8 cm in diameter and consisted of confluent , brownish-erythematous dome-shaped papules , with a partially verrucous surface ( Fig . 1A ). In addition , she reported a subcutaneous nodule on the left upper arm . The lesions first appeared 4 months earlier with mild itching and pain . Physical examination revealed no further involvement of the skin or palpable lymph nodes . Beside arterial hypertension and a dyslipidaemia , her medical history , familial medical history and routine laboratory tests were unremarkable . A punch biopsy specimen from the lesion on the flank and an excision biopsy of the nodule on the upper arm were obtained .
What is your diagnosis ? See next page for answer .
Fig . 1 . ( A ) Sharply demarcated plaque on the left flank , consisting of confluent , brownish-erythematous dome-shaped papules , with a partially verrucous surface . ( B ) Haematoxylin and eosin ( H & E ) staining with dense dermal infiltrate of histiocytes admixed with inflammatory cells : plasma cells , lymphocytes and eosinophils ( original magnification × 2 ). ( C ) Aggregates of large histiocytes with slightly eosinophilic cytoplasm containing inflammatory cells within their cytoplasm : emperipolesis ( original magnification × 40 ).
This is an open access article under the CC BY-NC license . www . medicaljournals . se / acta Journal Compilation © 2018 Acta Dermato-Venereologica . doi : 10.2340 / 00015555-2765 Acta Derm Venereol 2018 ; 98 : 165 – 166