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Clinical Problem Solving: Pathology
June 20, 2011

Pathology Quiz Case 2: Diagnosis

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Copyright 2011 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2011

Arch Otolaryngol Head Neck Surg. 2011;137(6):639-640. doi:10.1001/archoto.2011.72-b

Given the indolent nature of the discolored soft-tissue lesion on the nasal ala and sidewall, the differential diagnosis included neoplasms, such as basal cell carcinoma or melanoma; vasculitides, such as GF; and autoimmune or inflammatory processes, such as sarcoidosis or lupus erythematosus. The biopsy specimen (Figure 3) demonstrated multiple well-spaced vessels associated with a dense mixed inflammatory infiltrate of plasma cells, eosinophils, and neutrophils, with a focal neutrophilic vasculitis. Reactive endothelial changes were seen without evidence of epithelioid endothelial cells. The trichrome stain (Figure 4) highlighted collagen fibers and nicely demonstrated sclerotic vessels with a distinctive lamellar perivascular fibrosis. The results of immunohistochemical staining together with in situ hybridization for light chains confirmed a mixed lymphocytic population, with CD3 and CD20 positivity and polytypic light-chain expression by plasma cells, and excluded the possibility of cutaneous lymphoma. Focal IgE-positive cells were seen within the germinal centers.

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