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Ahmednur Sheikabdurahman
Ahmednur Sheikabdurahman
Posted by Ahmednur Sheikabdurahman  |  7 Oct 2025
7 Oct 2025

The best answer for this question is none of choices

Although the clinical presentation of the patient, neutrophilic infiltration and RBC leakage may go with those of Dermatitis Herpetiformis and Vasculitis respectively, the histopathologic findings of the case rules out both Dermatitis Herpetiformis & standard Vasculitis!.

The most critical and unique features in the biopsy are:

  1. ​Foci of dermal collagen degeneration (Necrobiosis).
  2. ​Palisading granulomas surrounding the degenerating collagen.

And the most likely diagnosis based on the full clinical and pathological picture is: Necrobiosis Lipoidica (NL).

Question:
A 52 year old female presents with flat, purple skin lesions on her lower legs that are itchy but not painful. The patient has a history of pernicious anemia and malabsorption syndromes. A biopsy of one of the lesions reveals foci of dermal collagen degeneration covered with a fibrin cap, accompanied by an infiltration of neutrophils. Red blood cells are seen to leak out from small vessels, surrounding the degenerating collagen. Palisading granulomas are noted around the degenerating collagen. What is the most likely diagnosis?
Options:
A)Vasculitis
B)Scleroderma
C)Erythema multiforme
D)Livedo reticularis
E)Dermatitis herpetiformis
→ View this question

The best answer for this question is none of choices

Although the clinical presentation of the patient, neutrophilic infiltration and RBC leakage may go with those of Dermatitis Herpetiformis and Vasculitis respectively, the histopathologic findings of the case rules out both Dermatitis Herpetiformis & standard Vasculitis!.

The most critical and unique features in the biopsy are:

  1. ​Foci of dermal collagen degeneration (Necrobiosis).
  2. ​Palisading granulomas surrounding the degenerating collagen.

And the most likely diagnosis based on the full clinical and pathological picture is: Necrobiosis Lipoidica (NL).

Question:
A 52 year old female presents with flat, purple skin lesions on her lower legs that are itchy but not painful. The patient has a history of pernicious anemia and malabsorption syndromes. A biopsy of one of the lesions reveals foci of dermal collagen degeneration covered with a fibrin cap, accompanied by an infiltration of neutrophils. Red blood cells are seen to leak out from small vessels, surrounding the degenerating collagen. Palisading granulomas are noted around the degenerating collagen. What is the most likely diagnosis?
Options:
A)Vasculitis
B)Scleroderma
C)Erythema multiforme
D)Livedo reticularis
E)Dermatitis herpetiformis
→ View this question