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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 .