dr.azza fouda Comments: ithink this is keloid
Hussein Fahmy (Kingdoom of Saudi Arabia) Comments: Thank you prof.Soliman for this intresting case which is TB as I have mentioned befor(from the pathology). Waiting for your new teaching cases.
Mohsen Soliman Comments: Dear Colleagues Thank you for the cooperation. This was a case of lupus vulgaris, she is still under treatment, and is showing very good imrovement under antituberculous drug therapy for the last 2 months. The pitty thing in this case, she had got this lesion for the last Twenty Two Years, with raising any suspicion in any of treating physicians of the etiology, and no one asked for biopsy, just antihistamines and local steroids, No one questioned the Apple Jelly character of the nodules in this ganuloma. Detailed reports about skin tuberculosis are previously published in the ESDV journal 1997 issues.Thank you all and see you in next case. Mohsen Soliman
Dr Khaled Bahgat Comments: Lupus vulgaris
zeinab abdel azim mansoura Comments: HP is consistent with lupus vulgaris
islam m n Comments: Keloid Angiotropic lymphoma
Amr Gohar Comments: DD would include TB and other diseases in the order written previously.
Hussein Fahmy (Kingdoom of Saudi Arabia) continuation Comments: caseation and the unclear cells as granuloma of (T.B)However in angiolymphoid hyperplasia we may see pinkish acid mucopolysaccaride around blood vessles when staind with mucicarmin
Hussein Fahmy (Kingdoom of Saudi Arabia) Comments: The biopsy is not clear,we have to see scan magnification to see the pattern of the lesion(very important) and high magnification to seee the details.However ,I can see annular pinkish material around whitish space,there is also very unclear inflammatory cells,there is also one hair follicle.If this slid stain wih (H and E) I may cnsider this pinkish material as
Amr Gohar Comments: HP would be useful to study the lining of the vascular channels that are lined by large endothelial cells (epithelioid endothelial cells) in Angiolymphoid hyperplasia with eosinophilia (hence the name epithelioid haemangioma). Together with surrounding inflammatory cell infiltrate (lymphocytes, eosinophils and histiocytes) and lymphoid follicles. It would be interesting to know whether there is peripheral blood eosinophilia or not. In Kimura’s variant, there is lack of epithelioid endothelial cells and there are large areas of stromal sclerosis. In bacillary angiomatosis, there are abundant neutrophils and nuclear dust and basophilic clumps of bacteria.
Dr. Mohammed Raihan Comments: Angiolymphoid hyperplasia, Bacillary angiomatosis, Hiotiod leprosy.
Mohsen Soliman Comments: Dear All, I am waiting to know the clinical impression of the case, the histopathology will be shown soon.
Hussein Fahmy (Kingdoom of Saudi Arabia) Comments: Please Prof.Soliman: I think it will be better if you make it clinical with the pathology
hussein fahmy Comments: Your presentation last week about cutaneous lymphoma was excelent and this is the difference which make the difference. About this case I want to see the pathology to confirm the diagnosis of angiolymphoid hyperplasia with eosinophilia
Hazem Seif El Nasr Comments: lupus vulgaris.........possible.....mesaa el fol ya basha ....
dr.zeinab abdel azim. mansoura Comments: DD: 1-angiolymphoid hyperplasia with eosinophilia 2-lymphocytoma cutis 3-lupus vulgaris
Amr Gohar Comments: Red-brown papules and nodules affecting the ear lobe. DD: Angiolymphoid hyperplasia with eosinophilia and its Kimura s variant - bacillary angiomatosis - lymphocytoma cutis - Jessner s lymphocytic infiltration - angiosarcoma. Angiolymphoid hyperplasia with eosinophilia has also been called "epithelioid haemangioma - pseudopyogenic granuloma". It would be intersting to know whether there is peripheral blood eosinophilia or not.
Dr. Mohsen Soliman Comments: Please comment on this photo.