Dear All, The Question Sheet for Diagnostic Exercise #249, contributed by Tessie B.M. Möck, Carolina C. Guizelini, Rayane C. Pupin, Ricardo A.A. de Lemos, Danilo C. Gomes, and Claudio S.L. Barros, is attached. Laboratório de Anatomia Patológica, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil. Corresponding author: tessiebeck@hotmail.com Best Regards Claudio The Diagnostic Exercises are an initiative of the Latin Comparative Pathology Group (LCPG), the Latin American subdivision of The Davis-Thompson Foundation. Members and non-members from any country of residence contribute to these exercises. Please consider contributing a case to this initiative. It does not have to be unusual, and all pathology sub-specialties are welcome! Please consult instructions on how to format and submit your DE at https://davisthompsonfoundation.org/diagnostic-exercises-instructions/ Previous cases are available at https://davisthompsonfoundation.org/diagnostic-exercise/