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Abdominal wall thickening in a middle aged man
  1. M Bhushana,
  2. R H Macdonalda,
  3. M H Irvingb,
  4. C E M Griffithsa
  1. aHope Hospital, Salford, UK: Department of Dermatology, bDepartment of Surgery
  1. Dr M Bhushan, Dermatology Centre, University School of Medicine, Hope Hospital, Eccles Old Road, Salford M6 8HD, UK

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Answers on p 723.

A 44 year old man presented to the surgical team with a three week history of a sensation of increasing tightness of the lower abdominal wall. There had been no obvious precipitating factors, clinical prodrome, or associated systemic symptoms. He had been previously well and took no regular medication of note. Initial inspection of the skin was unremarkable but palpation revealed a firm, non-tender induration of the skin (11 × 4.5 cm) around the umbilicus. The rest of the skin was unaffected. General examination was normal. A peripheral blood eosinophilia of 1.5 × 109/l (normal 0.2–0.4 × 109/l) was noted. All other laboratory investigations including erythrocyte sedimentation rate, blood film, renal and hepatic function, and immunology screen were normal. Computed tomography and magnetic resonance scans of the abdomen were also reported as normal. An open biopsy, down to and including rectus sheath, was performed under general anaesthesia. Histology of the biopsy is shown in fig1.

Figure 1

Histology of the skin biopsy (haematoxylin and eosin (A) magnification × 25 and (B) magnification × 400).

Questions

(1)
What is the diagnosis?
(2)
What is the pathogenesis of this condition?

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