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SKINDIA QUIZ
Year : 2017  |  Volume : 8  |  Issue : 2  |  Page : 153-154  

SkIndia Quiz 34: Asymptomatic swelling over an old forehead scar


Department of Dermatology and Sexually Transmitted Diseases, Sucheta Kriplani Hospital, Lady Hardinge Medical College, Delhi, India

Date of Web Publication16-Mar-2017

Correspondence Address:
Pravesh Yadav
RZ-97, Phase-III, Prem Nagar, Najafgarh, New Delhi - 110 043
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5178.198809

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How to cite this article:
Yadav P, Singh P, Chander R. SkIndia Quiz 34: Asymptomatic swelling over an old forehead scar. Indian Dermatol Online J 2017;8:153-4

How to cite this URL:
Yadav P, Singh P, Chander R. SkIndia Quiz 34: Asymptomatic swelling over an old forehead scar. Indian Dermatol Online J [serial online] 2017 [cited 2017 Aug 17];8:153-4. Available from: http://www.idoj.in/text.asp?2017/8/2/153/198809

A 25-year-old man presented with an asymptomatic slowly progressive swelling over the forehead for the past three months. He gave a history of trauma at the same site at 5 years of age that healed leaving behind a linear scar. There were no lesions elsewhere in the body. There was no history of pain, itching, discharge, or ulceration over the scar. There was no history of breathlessness on exertion, eye complaints, joint pain, fever, weight loss, or loss of appetite.

Cutaneous examination revealed a single circumscribed, skin-colored, firm, nontender nodule of size 2 × 2 cm on the left side of the forehead underlying a linear, dark brown-colored, depressed scar of size 1.5 × 0.5 cm. The nodule was not adherent to the underlying bone. No regional lymphadenopathy was appreciated [Figure 1].
Figure 1: Single circumscribed, skin-colored, nontender nodule of size 2 × 2 cm, on the left side of the forehead underlying a linear dark brown depressed scar of size 1.5 × 0.5 cm

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Hematological examination, liver and kidney function tests, radiographs of chest and skull, Mantoux test, serum ACE levels, and ophthalmologic examination were within normal limits.

Histopathologic examination revealed a normal epidermis with the deep dermis showing presence of numerous noncaseating epitheloid cell naked granulomas lying back to back and reaching up to the subcutis. Asteroid bodies were seen in a few cells [Figure 2] and [Figure 3]. Ziehl–Neelsen, Fite–Faraco, and periodic acid-Schiff stains revealed no organism.
Figure 2: Photomicrograph showing numerous noncaseating epitheloid cell naked granulomas and multinucleate gaint cells lying back to back and reaching up to the subcutis. (hematoxylin and eosin, ×10)

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Figure 3: High-power view showed noncaseating epitheloid cell naked granulomas with asteroid bodies. (hematoxylin and eosin, ×100)

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   What Is the Diagnosis? Top




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   References Top

1.
Braverman IM. Sarcoidosis. In: Feedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, editors. Fitzpatrick's Dermatology in General Medicine. 6th ed. New York: McGraw Hill; 2003. p. 1777-83.  Back to cited text no. 1
    
2.
Kerdel FA, Moschella SL. Sarcoidosis: An updated review. J Am Acad Dermatol 1984;11:1-19.  Back to cited text no. 2
    
3.
Mañá J, Marcoval J, Graells J, Salazar A, Peyrí J, Pujol R. Cutaneous involvement in sarcoidosis. Relationship to systemic disease. Arch Dermatol 1997;133:882-8.  Back to cited text no. 3
    
4.
Caro I. Scar sarcoidosis. Cutis 1983;32:531-3.  Back to cited text no. 4
    
5.
Katta R. Cutaneous sarcoidosis: A dermatologic masquerader. Am Fam Physician 2002;65:1581-4.  Back to cited text no. 5
    
6.
Minus HR, Grimes PE. Cutaneous manifestations of sarcoidosis in blacks. Cutis 1983;32:361-3, 372.  Back to cited text no. 6
    
7.
Bachelez H, Senet P, Cadranel J, Kaoukhov A, Dubertret L. The use of tetracyclines for the treatment of sarcoidosis. Arch Dermatol 2001;137:69-73.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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