Need some advice!

[clearmeridian]

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Hi, I cannot for the life of me solve this clinical picture based off the histology findings. Here is the case, with the involved images. What is the lesion and what are the associated findings (shown below in yellow arrows)? Please help! all I can think of is maybe a nevus?

PLEASE HELP!

 

[Entgegen]

Fungus?

 

[clearmeridian]

Fungus isn't a benign tumor 🙁

 

[Entgegen]

Oh, I see the case text now. The text picture wasn't showing up the first time I saw the original post.

 

[KluverB]

Fungus isn't a benign tumor 🙁

Why not?

 

[deleted314957]

hi, i cannot for the life of me solve this clinical picture based off the histology findings. Here is the case, with the involved images. What is the lesion and what are the associated findings (shown below in yellow arrows)? Please help! All i can think of is maybe a nevus?

please help!

looks like a nevus with pityrosporum (malassezia)

 

[sbp]

looks like a nevus with pityrosporum (malassezia)


I agree

 

[lipomas]

Fungus can too be a tumor. Tumor is just a growth of tissue. A "swelling" in the original sense. Tumor does not imply cancer. Tumor does not imply autonomous growth of cells/neoplasm.

 

[zao275]

Also agree with mikesheree. Intradermal nevus with pityrosporum yeast in the stratum corneum.

Lipomas, although you are technically correct that "tumor" in the classical sense was a word for swelling, I believe that most pathologists and pathology texts today use the word as a synonym for neoplasm. It may be incorrect, but it is the "standard of practice" so to speak.

 

[KluverB]

...Lipomas, although you are technically correct that "tumor" in the classical sense was a word for swelling, I believe that most pathologists and pathology texts today use the word as a synonym for neoplasm. It may be incorrect, but it is the "standard of practice" so to speak.

Well, then they are incorrect. Just because you believe it's "standard of practice" (which it's not) doesn't make it right. It's bad enough that clinicians don't know the difference between tumor, neoplasm, carcinoma, cancer, malignancy, carcinoma in situ, etc. and just use the terms interchangeably; that doesn't absolve our role as educators to set them straight. If clinicians are "confused", how do you think patients feel? Most of my attendings would ream you out if you're guilty of such a faux pas.

 

[deleted314957]

Well, then they are incorrect. Just because you believe it's "standard of practice" (which it's not) doesn't make it right. It's bad enough that clinicians don't know the difference between tumor, neoplasm, carcinoma, cancer, malignancy, carcinoma in situ, etc. and just use the terms interchangeably; that doesn't absolve our role as educators to set them straight. If clinicians are "confused", how do you think patients feel? Most of my attendings would ream you out if you're guilty of such a faux pas.

certainly zao grammatically correct,but i think kluver's point is that it archaic---part of the quartet of the signs of inflammation as described by the ancient Greeks; rubor, calor, dolor and tumor (redness, pain, heat and swelling)

 

[lipomas]

Lipomas, although you are technically correct that "tumor" in the classical sense was a word for swelling, I believe that most pathologists and pathology texts today use the word as a synonym for neoplasm. It may be incorrect, but it is the "standard of practice" so to speak.

Standard of practice shouldn't define language if it goes contrary to existing definitions. A tumor is a tumor. Even the dictionary says it's just a "new mass of tissue." That doesn't mean it's autonomous growth. Just a mass. I am not in the business of perpetuating fallacies. I die a little inside each time I hear someone describe themselves as "nauseous" when they mean they are feeling nauseated, and then someone else justifies it as OK because everyone knows what they mean. NO!!!

Tumors are usually called "mass" anyway these days. Patients use the word tumor. Doctors call everything, neoplastic or not, a mass.

 

[Euchromatin]

From the Merriam-Webster online dictionary:

Definition of NAUSEOUS

1
: causing nausea or disgust : nauseating
2
: affected with nausea or disgust
— nau·seous·ly adverb
— nau·seous·ness noun
See nauseous defined for English-language learners »
Usage Discussion of NAUSEOUS

Those who insist that nauseous can properly be used only in sense 1 and that in sense 2 it is an error for nauseated are mistaken. Current evidence shows these facts: nauseous is most frequently used to mean physically affected with nausea, usually after a linking verb such as feel or become; figurative use is quite a bit less frequent. Use of nauseous in sense 1 is much more often figurative than literal, and this use appears to be losing ground to nauseating. Nauseated is used more widely than nauseous in sense 2.

 

[earmuff]

From the Merriam-Webster online dictionary:

Definition of NAUSEOUS

1
: causing nausea or disgust : nauseating
2
: affected with nausea or disgust
— nau·seous·ly adverb
— nau·seous·ness noun
See nauseous defined for English-language learners »
Usage Discussion of NAUSEOUS

Those who insist that nauseous can properly be used only in sense 1 and that in sense 2 it is an error for nauseated are mistaken. Current evidence shows these facts: nauseous is most frequently used to mean physically affected with nausea, usually after a linking verb such as feel or become; figurative use is quite a bit less frequent. Use of nauseous in sense 1 is much more often figurative than literal, and this use appears to be losing ground to nauseating. Nauseated is used more widely than nauseous in sense 2.

Wikipedia:

some writers have argued that linguistic prescription is foolish or futile; Samuel Johnson, commented as follows on the tendency of some prescription to resist language change:

When we see men grow old and die at a certain time one after another, from century to century, we laugh at the elixir that promises to prolong life to a thousand years; and with equal justice may the lexicographer be derided, who being able to produce no example of a nation that has preserved their words and phrases from mutability, shall imagine that his dictionary can embalm his language, and secure it from corruption and decay, that it is in his power to change sublunary nature, and clear the world at once from folly, vanity, and affectation.
With this hope, however, academies have been instituted, to guard the avenues of their languages, to retain fugitives, and repulse intruders; but their vigilance and activity have hitherto been vain; sounds are too volatile and subtile for legal restraints; to enchain syllables, and to lash the wind, are equally the undertakings of pride, unwilling to measure its desires by its strength. The French language has visibly changed under the inspection of the academy; the stile of Amelot's translation of Father Paul is observed, by Le Courayer to be un peu passé; and no Italian will maintain that the diction of any modern writer is not perceptibly different from that of Boccace, Machiavel, or Caro.

— Preface to a Dictionary of the English Language (Project Gutenberg)

​

 

[zao275]

Lipomas and KluverB: I concede to your linguistic purity! Perhaps I should be more strict in using neoplasm instead of tumor. That extra syllable can't be that much of an inconvenience. Thank you for the correction!

Jerad

 

[malchik]

Nice discussion, but . . . the above lesion is a nevus, which is a tumor and a neoplasm by strict definitions. Unless it's congenital.

 

[clearmeridian]

Just got the answer:
Compound melanocytic nevus and the fungal infection is tinea capitis.

 

[lipomas]

From the Merriam-Webster online dictionary:

Definition of NAUSEOUS

1
: causing nausea or disgust : nauseating
2
: affected with nausea or disgust
— nau·seous·ly adverb
— nau·seous·ness noun
See nauseous defined for English-language learners »
Usage Discussion of NAUSEOUS

Those who insist that nauseous can properly be used only in sense 1 and that in sense 2 it is an error for nauseated are mistaken. Current evidence shows these facts: nauseous is most frequently used to mean physically affected with nausea, usually after a linking verb such as feel or become; figurative use is quite a bit less frequent. Use of nauseous in sense 1 is much more often figurative than literal, and this use appears to be losing ground to nauseating. Nauseated is used more widely than nauseous in sense 2.

Hey man, just because so many people misuse the term NAUSEOUS that the dictionary now acknowledges it doesn't make it right. I know language changes and all that, but still. It stinks!

 

[LADoc00]

Wow, that's a totally random and difficult case for a med student.

Is this another Lublin, Poland case?