Virtual Slidebox
Presented by the MGH Pathology Service

Clinical summary
58 y/o female with right breast lesion. Clinical impression: irritated nevus.

No history

53 y/o male with a right hand mass

67 yo female with 1cm painful nodule on the left thigh

30 yo female with non-tender purpuric lesion of left medial thigh with associated left inguinal lymphadenopathy

48 yo female with axillary rash consisting of linear clusters of tiny papules, some with scale, many with hyperpigmentation

23 year old woman with a history of dysplastic nevi, presents for a reexcision of dysplastic nevus on her back. Back skin can sometimes be confused with scar, keloid or even scleroderma because of the thick abundant collagen bundles.

Read more on Back skin, normal…

6 year old girl with a nodule on the lower lip.

Woman in her 60’s with a subcutaneous mass

37 y/o male in the ICU following a severe fall, cutaneous blisters

13 y/o with a 7 mm irregular pigmented nevus on the right abdomen

52 year old woman with erythematous scaly plaques on her right leg.

50 yo with a lesion superior to patella

40 y/o female, status-post bone marrow transplant, with maculopapular rash

36 y/o with a lesion on the right ear antihelix

No history

No history

77 y/o male with a red plaque on the left arm

34 year old woman with bilateral inflamed axillary nodules. Hydradenitis suppurativa is most commonly found in the axillary region but can also be found in the groin.

81 yo female with 5mm papule with 3mm keratotic core on left arm

No history

50 y/o male from the middle east.

40 year old woman from India with multiple small macules, plaques and nodules with poorly defined borders, giving a bovine appearance of the face. Characterized by groups and sheets of macrophages with a sparse lymphocytic infiltrate. The macrophages are

Read more on Lepromatous leprosy…

49 y/o female with palpable purpura on the legs

25 year old woman with erythematous palpable purpura on the lower legs. The extensive eosinophilic infiltrate is unusual and raises the differential diagnosis of erythema elevatum diutinum and possibly a reaction to arthropod assault.

Read more on Leukocytoclastic vasculitis…

This woman had a history of SLE and the clinician was wondering if it was cutaneous lupus. This is a very early manifestation of LE, and shows a vacuolar interface with extravasated erythrocytes and very faint blue mucin.

52 yo female with multiple 3-4cm scarred hypertrophic red scaly plaques on face, ears, and scalp

Clinical summary

Read more on Lymphomatoid drug eruption…

Clinical summary
69 yo male, NFD/NFS vs. morphea.

34 yo female with cafe au lait macules

51 year old man with red papules in an urticarial base on extensor forearms and upper back. He also has fever, uveitis and aseptic meningitis. The differential for a neutrophilic dermatosis with this history includes Sweet’s syndrome, Behcet’s syndrome,

Read more on Neutrophilic dermatosis…

44 year old female with two yellow papules on right thigh for one year; asymptomatic but increasing in size. Xanthoma vs. xanthogranuloma.

Clinical summary
2.0 cm pedunculated papule; DDX: nevus, neurofibroma.

Clinical summary
White female with two yellow papules on right thigh x 1 year, increasing in size, asymptomatic. Xanthoma vs. xanthogranuloma.

Clinical history: 27 year old man with a suspicious pigmented papule on his right upper back.

Description: This lesion is nevoid appearing and can be confused for other benign nevi.  One trick is to perform a reticulin stain.  If the reticulin fibers are highlighted surrounding large groups of melanocytes but not single cells a high suspicion for malignancy should be raised.

Read more on Nodular melanoma…

Woman in her 40’s with an indurated subcutaneous mass

GMS stain highlights branching hyphae

Fontana-Masson stain highlights pigment in the fungal forms, defining this as a dematiaceous species

Read more on Pheochromomycosis, c/w Alternaria sp….

66 year old man with recurrent 3-4 mm itchy papules on his legs that heal with post-inflammatory hyperpigmentation. There is a superficial perivascular lymphocytic infiltrate with capillary proliferation and red blood cell extravasation, dyskeratotic keratinocytes, pigmented macrophages, and excoriation.

Read more on Pigmented purpuric dermatosis…

23 yo with a pigmented lesion

Clinical summary
13 y/o female with a left arm pigmented lesion. Clinical impression: Rule out dysplastic nevus.

61 y/o female with arm lesion

ddx: intraepidermal cyst

Clinical summary
60 y/o male with a non-healing chest wound. History of local radiation therapy for lymphoma.

Clinical summary
56 y/o male with 10 days of fever, headaches, HAS, confusion, and rash. Now has diffuse erythematous macules with petechia on trunk and extremities with petechia on palms and soles.

Read more on Rocky Mountain spotted fever rickettsial infection…

55 year old woman with a red-brown nodule on her right anterior thigh.

47 year old man with a history of seborrheic dermatitis, now with a cheek lesion, rule out BCC.

46 year old woman with irregular pigmented macule.

50 y/o female with a rash on the palm

79 year old man with erythema of the lower legs.

Clinical summary
93 y/o male with a left ear nodule. Clinical impression: cyst.

70 y/o male with papules on cheek and lip. Clinical impression: hyperplasia vs. fibrous papule

73y/oF with a possible wart on right superonasal skin