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SKINDIA QUIZ
Ahead of print publication  

SkinIndia Quiz 50: Solitary growth on the arm


1 Department of Dermatology, Jorhat Medical College and Hospital, Joerhat, Assam, India
2 Department of Dermatology, Base Hospital, Delhi Cantt, New Delhi, India

Correspondence Address:
Debdeep Mitra,
Department of Dermatology, Base Hospital Delhi Cantt, New Delhi - 110 010
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2229-5178.250101



How to cite this URL:
Talukdar K, Mitra D, Saraswat N, Chopra A. SkinIndia Quiz 50: Solitary growth on the arm. Indian Dermatol Online J [Epub ahead of print] [cited 2019 Feb 17]. Available from: http://www.idoj.in/preprintarticle.asp?id=250101

A 28-year-old lady presented with an erythematous sessile and slightly pedunculated firm nodule measuring approximately 5 Χ 3 cm over the left upper arm with ulceration at points of pressure for one year [Figure 1]. The growth was initially very minute, pinhead-sized, which gradually increased with time. It was associated with dull aching intermittent pain, mild intermittent itching, and few episodes of bleeding. There was no history of trauma on the affected area or any discharge from the growth. The growth was excised 7 months ago but it reappeared with the initial symptoms. There was no significant weight loss. The nodule was tender to touch, mobile in vertical as well as in horizontal directions, not fixed with skin or any underlying structures, and there was no local rise of temperature. The entire lump was excised and sent for histopathological examination.
Figure 1: Clinical photograph showing an erythematous sessile and slightly pedunculated firm nodule about 5 × 3 cm over left upper arm

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Histopathology revealed a well-circumscribed tumor composed of proliferative cuboidal cells that extended from the basal epidermis into the dermal layer as cords and nests of small keratinocytes attached to the epidermis. These were sharply delimited from the adjacent epidermis under low power view [Figure 2]. These cords were strictly intraepidermal along with extension to superficial dermis, and the dermis showed reactive blood vessels and inflammatory infiltrate which was appreciated under higher magnification [Figure 3]. No mitotic figures, foci of necrosis en-masse, or any clear cell change with small nuclei surrounded by a pale cytoplasm was noted. The aggregates of keratinocytes did not show any ductal or tubular formation.
Figure 2: H and E stain (×40) showing cords and nests of small keratinocytes attached to the epidermis which are sharply delimited from adjacent epidermis under low power view

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Figure 3: H and E stain (×100) showing intra-epidermal nests of cells extending onto upper dermis and the dermis shows reactive blood vessels and inflammatory infiltrate which is appreciated under higher magnification

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    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

 
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