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Picture of the Month—Quiz Case

Melissa Tripoli, BS; Nektarios Lountzis, MD; Ashish Mahajan, MD; Eric Hossler, MD
JAMA Pediatr. 2013;167(1):85. doi:10.1001/2013.jamapediatrics.209a.
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A 9-year-old otherwise healthy girl presented with a lesion on the left upper lip for the past year. It was slowly growing and somewhat tender to deep palpation but was not interfering with feeding or development. No similar lesions were present on the rest of her body. Physical examination revealed a 4-mm, firm, white, nontender, mobile papule at the left upper vermilion border (Figure 1). The rest of the physical examination was unremarkable. An excisional biopsy was performed (Figure 2 and Figure 3).

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Grahic Jump Location

Figure 1. A 4-mm, firm, white, nontender, mobile papule at the left upper vermilion border of an otherwise healthy 9-year-old girl.

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Grahic Jump Location

Figure 2. Scanning view of the biopsy specimen, showing a well-defined dermal proliferation of large polyhedral cells (hematoxylin-eosin, original magnification ×20).

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Grahic Jump Location

Figure 3. Close-up of the cells shows abundant eosinophilic granular cytoplasm and centrally located vesicular nuclei. The cells were arranged in cords and surrounded by a dense collagenous stroma. No significant cellular atypia or degenerative changes were seen (hematoxylin-eosin, original magnification ×200).

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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