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