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QUIZ SECTION Advances in dermatology and venereology
ActaDV Acta Dermato-Venereologica ActaDV
Subcutaneous Nodule on the Right Palm of a Young Boy: A Quiz
Takuya MAEDA 1, Yasuyuki FUJITA 1 *, Keisuke IMAFUKU 1, Shinichi NAKAZATO 1, Hiroo HATA 1, Toshifumi NOMURA 1, Tomoko MITSUHASHI 2, Takashi ANAN 3, Tadashi HASEGAWA 4, Shuji HAMAOKA 5 and Hiroshi SHIMIZU 1
1
Department of Dermatology, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo 060-8638, 2 Department of Surgical Pathology, Hokkaido University Hospital, 3 Sapporo Dermatopathology Institute, 4 Department of Surgical Pathology, Sapporo Medical University School of Medicine, and 5 Hamaoka Dermatology Clinic, Sapporo, Japan. * E-mail: yfujita @ med. hokudai. ac. jp
A 16-year-old Japanese boy presented to our hospital with a subcutaneous nodule on the right palm that had developed over 4 months. He reported a history of“ ganglion cyst” in the same area that had been treated with drainage at another clinic 3 years earlier.
Clinical examination revealed a tender, mobile subcutaneous nodule 12 × 12 mm on the right palm near the antithenar eminence. Slight, poorly demarcated pigmentation was observed on the surface of the nodule( Fig. 1). Ultrasonography confirmed that there was no blood flow inside the tumour. Surgical excision was performed under the clinical diagnosis of recurrent ganglion cyst. The excised specimen revealed the proliferation of atypical cells with vesicular nuclei and mild myxoid areas( Fig. 2A), mixed with prominent inflammatory cell infiltrates of lymphocytes and plasma cells( Fig. 2B). Large cells with atypia were also noted, part of which resembled Reed – Sternberg cells( Fig. 2C). Immunohistochemically, these atypical cells were
Fig. 1. Clinical presentation. A tender, mobile subcutaneous nodule on the right palm( arrow).
positive for CD68( KP-1, PGM-1) and negative for alphasmooth muscle actin, CD34 and AE1 / AE3.
What is your diagnosis? See next page for answer.
Fig. 2. Histopathology of the excised nodule.( A) Fibrous areas with mucin deposition surrounded by inflammatory cells( haematoxylin and eosin staining, original magnification × 100).( B) Inflammatory cells composed of lymphocytes, plasma cells and eosinophils( original magnification × 200).( C) Large cells with atypia( arrows) are noted, with Reed – Sternberg-like cells( arrowhead)( original magnification × 400).
doi: 10.2340 / 00015555-2712 Acta Derm Venereol 2017; 97: 1150 – 1151
This is an open access article under the CC BY-NC license. www. medicaljournals. se / acta Journal Compilation © 2017 Acta Dermato-Venereologica.