Qap (Anatomical Pathology) 

QAP Peer Review

AP286
Case History: M/72 Right heel fungating skin lesion for many years. Excised to rule out carcinoma by orthopedic surgeon
Intended diagnosis: Lapromatous leprosy. Contributed by:PC
Code Diagnosis Comment Score
anonymous Lepromatous leprosy (100%) To confirm with Wade-fite stain. Grocott and PAS stains to rule out fungal infection.  100
anonymous infectious granulomatous inflammation nil  70
anonymous Infection with pseudoepitheliomatous hyperplasia, favour lepromatous leprosy (100%). Perform histochemical stain Wade-Fite to confirm presence of acid fast bacilli in the foamy macrophages in the dermis.  100
anonymous Lepromatous leprosy, with scarring and pseudoepitheliomatous hyperplasia, 100%. Wade-Fite stain  100
anonymous Histiocytic inflammatory lesion. 100%. To look for infective agents such as leprosy, Mycobacterium avium intracellulare, fungi, Mycobacteria etc. by special stains like Wade-Fite, ZN, Grocott etc. and also culture and PCR for some microorganisms. nil  100
anonymous Lepromatous leprosy Confirming the diagnosis by highlighting Mycobacteria leprae (Wade-Fite positive; Ziehl-Neelsen negative). Correlate clinically and microbiologically.  100
anonymous Right heel skin lesion - Dermal inflammation with histiocytic reaction, suspect infection (?fungi, ?parasite) and marked epidermal hyperplasia 50%, Atypical squamous proliferation 30%, Verrucous carcinoma 20% To do special stains  50
anonymous 1) Histiocytic inflammatory reaction in dermis. Need to rule out infection - 90% 2) also need to rule out infiltrative malignancy eg desmoplastic melanoma and spindle cell carcinoma - 10% Stains for leprosy, fungi, melanoma and carcinoma  100
anonymous Granulomatous inflammation 100% Ziehl-Neelsen, Grocott and PASD to reveal any micro-organisms present.  90
anonymous Chronic inflammatory granulomatous process with presence of histiocytes containing bacillary bacteria that favoring 1) Mycobacterium avium intracellulare 2) Leprosy, lepromatous pole or lepromatous type. NO evidence of malignancy. nil  100
anonymous Chronic inflammatory granulomatous process with presence of histiocytes containing bacillary bacteria that favoring 1) Mycobacterium avium intracellulare 2) Leprosy, lepromatous pole or lepromatous type. NO evidence of malignancy. nil  100
anonymous SKIN lesion, right heel, excision - LEPROMATOUS LEPROSY nil  100
anonymous Fibrohistiocytic inflammation with epidermal hyperplasia Need to rule out infection including leprosy and atypical mycobacterium  100
anonymous lepromatous leprosy (100%) nil  100
anonymous VERRUCOUS CARCINOMA, with underlying chronic inflammation and laden macrophages, need to exclude underlying specific infection with special stain. (100% probability) nil  20
anonymous Lepromatous leprosy 100% Has to be confirmed by Wide-Fite stain  100
anonymous Chronic infection suggestive of leprosy (90%), cannot exclude Penicillium marneffei (10%) Order ZN, Wade-Fite, Grocott.  100