Here is a case I am reluctant to use the "consistent with" diagnosis because of the comment in the microscopic (which I have a bold font).
CLINICAL HISTORY:
3 month history of ulceration under breast, seep fluid, no signs of infection - also has pink, thin plaques with fine scale on arms, trunk, positive mild pruritus - TAC helped but did not clear, no new meds, all started after husband died this summer, no blisters. Rash - ? related - R/O atopic derm vs drug reaction vs contact vs other. Erosions - R/O infection vs vasculopathy vs other
GROSS EXAMINATION:
A. right upper arm. The specimen consists of one 3 mm diameter x 2 mm skin punch biopsy. All submitted in one cassette.
B. right breast. The specimen consists of one 4 mm diameter x 5 mm skin punch biopsy. All submitted in one cassette.
MICROSCOPIC EXAMINATION:
A. Sections show homogeneity to superficial dermal collagen associated with ectatic blood vessels and angulated mononuclear inflammatory infiltrates. Occasional enlarged triangular fibroblasts are seen.
B. Dermal reactive and inflammatory changes are similar to the above. Additionally, an ulcer is characterized by a base of fibrin, inflammatory cells and necrotic debris.
Differential diagnostic possibilities include radiation change and lichen sclerosus. Clinical pathologic correlation is recommended.
DIAGNOSIS:
A. Homogenous dermal sclerosis, ectasia and mononuclear inflammation, consistent with lichen sclerosus, skin of right upper arm.
B. Homogenous dermal sclerosis, ectasia and mononuclear inflammation, consistent with lichen sclerosus, ulcerated, skin of right breast.