Richard Carr

RAC9358. M40s Bilateral giant pigmented lesion. Biopsy from chest. #Dermpath @rishiagrawal.bsky.social

Granuloma Annulare Mimicking Sarcoidosis: Report of Patient With Localized Granuloma Annulare Whose Skin Lesions Show 3 Clinical Morphologies and 2 Histology Patterns - PubMed Granuloma annulare, a benign dermatosis of undetermined etiology, typically presents in a localized or generalized form. It has 3 distinctive histologic patterns: an infiltrative (interstitial) pattern, a palisading granuloma pattern, and an epithelioid nodule (sarcoidal granuloma) pattern. A man wh …

I thought interstitial palisading granulomatous pattern & collagen necrobiosis = GA. Unusual 2C well-formed granulomas and Langhan-type giant cells!! Suspect nerve, lacks intra-neural inflammatory cells, incidental. pubmed.ncbi.nlm.nih.gov/25140662/

I asked for follow-up. Incidentally there is a small nerve closely associated. You can see a neuritis in morphoea (that is not due to leprosy - Eduardo Calonje showed a lovely case at an Anglo-Belgium-French meeting a few years ago.

I think I might have requested alcian blue. No bug stains. History was what I had.

Positive - it's very good at staining the inner aspect of ORS at all levels up to isthmus and sebaceous duct linings.

The role of skin trauma in the distribution of morphea lesions: a cross-sectional survey of the Morphea in Adults and Children cohort IV - PubMed Of patients in the MAC cohort, 16% developed initial morphea lesions at sites of skin trauma. If these findings can be confirmed in additional series, they suggest that elective procedures and excessive skin trauma or friction might be avoided in these patients.

I thought this was typical for morphoea. I've asked for follow-up. Not much literature but looks like patients with morphoea can get lesions incited by trauma or friction. PMID: 24880663. pubmed.ncbi.nlm.nih.gov/24880663/

Checked database only ~5 cases only. None wiht IHC. Expect CD34 negative usually a feature of mid-stem/lower outer ORS as in tricholemmoma although does stains about 50% of proliferating pilar tumours. Calretinin definitely. But it would be academic.

Yes well done. Not common. Usually cells pinker (isthmic). Ackerman made points - better classified as tumour of follicular isthmus part of upper ORS. Usually incidental.

RAC9356: Not my diagnosis. A few more images.

RAC9356. M60s. Re-excision of thin melanoma (7 weeks from prior excision). What's going on? @rishiagrawal.bsky.social #dermpath

Nice one Charles. I would have accepted your case as myrmecia (can you take another look - seems to have pretty substantial inclusions to me).

RAC9355 F60s. Lower back. ?BCC for opinions please. Also what type of giant cell? @rishiagrawal.bsky.social #Dermpath

Sorry for @rishiagrawal.bsky.social

RAC9352. M70s. Cheek. BCC excised. Adjacent lesion. #dermpath @iyengarish.bsky.social

Agree. This case has a lot of mosaic p16 in the reactive follicular hyperplasia. Cases like this are why KA and FSCC-KAL can't be reliably distinguished on H&E. IHC is a game changer.

RAC9342: This was outsource case with no other clinical information. Top 2 are p16 bottom 2 are p53.

RAC9342: M70s Base of thumb. SCC excision. @rishiagrawal.bsky.social #dermpath

RAC9339: How about these two stains: MSH6 & PMS2?

Agree. Anything else to consider regarding the patient?

Sorry RAC9339

RAC9340 Excellent: It was ~7mm in clinic at 7 weeks increased to 11mm at 13 wks when shaved. Clinically ?KA ?SCC. Here p16 & p53 x2 each.

RAC9339. M50 ish. Nasal bride. Started as a spot. Grew to nodule centrally keratotic, shaved at 13 weeks. Clin photo at 7wks. @rishiagrawal.bsky.social #Dermpath

Good, she had best paper on cerebral malaria BTW! You might have got Maria Magdalena Dąbska. I missed Georgina Hogg a pathologist (of Birt-Hogg-Dube). Others either Clinicians e.g. Liliane Schnitzler - derm, Katherine Krom Merritt - paed (Kasaback-Merritt); Sister Mary Joseph (Nodule)

Correct. Can be confused with colloid bodies (necrotic keratinocytes). Kamino tend to be pale pink and scalloped & ltd to DEJ. Colloid bodies stronger stained, rounded & drop below DEJ - keratin +ve. Latter are common in bulky & atypical Spitz. Any other female eponyms in Dermpath?

Any info on RB1 loss?

Agree. Follow-up. No AI/Google. Who was Kamino? What are Kamino bodies?

RAC9338: Spot Diagnosis @rishiagrawal.bsky.social #Dermpath PLEASE DISCUSS

My Copy I have given away at least 20 of these to smokers or their spouse. Best Book ever on Quitting Here is his son @racarr51.bsky.social...

I mentioned your hilarious post to Robin (CEO, Easyway) & perhaps you read the apparently hilarious self-help spoof book he knew about:

Brilliant & well done. Funny thing though it really is EASY to stop if you know psychological aspect. Physical addiction is minimal (no cold turkey). Cunning trick : smokers believe +/- they enjoy & / or r hopelessly addicted. My dad's book explains all (I'm a doctor BTW - don't get royalties😇).