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Case 179: Lumps on the arms

A 39 year old man presents with poorly controlled hypertension. You note that he has multiple subcutaneous nodules on both his arms. He recalls that his mother had similar lumps.

1. What diagnostic features can you see?

As well as the obvious subcutaneous nodules there are also pigemented cutaneous "cafe au lait" markings.

2. What is the diagnosis?

These are features of neurofibromatosis type I and together with the family history of a similar condition the diagnosis is elatively certain.

3. Why is his blood pressure a problem?

There is an increased incidence of adrenal phaeochromocytoma in the setting of NF1.