Case Number : Case 43 Posted By: Guest

Phillip McKee - Overseas Consultations (USA) Wrote:

The final diagnosis was intracytoplasmic lumina in porocarcinoma. Well done to all those who contributed.

Submitted on 10/08/2010 00:17
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David Shelton - (USA) Wrote:

Hi All. Squamous syringometaplasia is never atypical - clearly the cells around the infiltrate are atypical - Monster cells I would have said yes if there was no cuticular lumen - so the diagnosis must be porocarcinoma.

Submitted on 09/08/2010 20:05
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

I liked very much the idea of squamous syringometaplasia raised by Dr Yamilie. Since the early morning I am thinking of the arrangment of the cells in the centre of the field around what appears like a monster cell. There is what reminds me of the double border of eccrine sweat gland structures. I think squamous syringometaplasia is the correct answer.

Submitted on 09/08/2010 15:57
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Juan Carlos Garces - Hospital Oncologoco / Hospital Luis Vernaza (Guayaqul Ecuador) Wrote:

Good morning. Porocarcinoma. Such atypia you can see also in Pilomatrxcarcinoma

Submitted on 09/08/2010 14:38
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Wayne Grayson - (Johannesburg, South Africa) Wrote:

I think the image depicts a malignant epithelial neoplasm, with intracytoplasmic lumen formation in the large pleomorphic cell at the centre of the field. My diagnosis, therefore, is eccrine porocarcinoma.

Submitted on 09/08/2010 14:38
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Carlos - Trainee (Spain) Wrote:

Ductal differentiation with atypical cells = porocarcinoma. If this is an intracytoplasmic lumina of a vessel = epithelioid haemangioendothelioma

Submitted on 09/08/2010 14:07
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Yamile Corredoira - Dept of Pathology, Faculty of Medicine, Universidad de Chile (Santiago (Chile)) Wrote:

Although it looks like squamous cell carcinoma, the small cells in cords reminded me of squamous siringometaplasia which often looks malignant but isn't. I think I keep siringometaplasia as first diagnosis.

Submitted on 09/08/2010 13:49
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

I would like to make some reconsiderations after some reading and re-examination of this very difficult case: 1. I will exclude PEComa because the cells should have clear and granular cytoplasm 2. I will also exclude malignant glomus tumor. I revised its pictures and it has a different context 3. I think metastatic adenocarcinoma (which I suggested earlier) should be considered especially if there is ductal differentiation 4.Melanoma wheather primary or metastatic (which I suggested earlier) is still on my DDx list 5.I liked also the possibilities of: Poolrly differentiated SCC or porocarcinoma. Sounds logic with the squamoid nature of the cells 6. Another approach is the perception of this lesion as a combination of spindle cells and presumptive histiocytes (Fibrohistiocytic tumors). With the atypical nature of the cells and their bizzare nature one might consider the malignant forms of fibrohistiocytic tumors such as: atypical fiboxanthoma and pleomorphic undifferentiated sarcoma (the synonym of malignnat fibrous histiocytoma). 6. Another opinion: If the large cell in the centre contain vacoules, could this be undifferentiated angiosarcoma or Epithelioid angiosarcoma? Waiting to know the correct answer. Thank u Dr McKee for putting us through such challenges which provoke lots of reading and thinking.

Submitted on 09/08/2010 12:43
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Rodrigo Restrepo - UPB (Mdlln, Colombia) Wrote:

Maybe poorly-differentiated squamous cell carcinoma

Submitted on 09/08/2010 11:40
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Phillip McKee - Oerseas consultations (USA) Wrote:

Wow, what a diverse range of opinions!!!

Submitted on 09/08/2010 11:39
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Marcela Saeb Lima - MSL Dermatopato (Mexico City) Wrote:

There is a malignant epithelial squamoid neoplams with what it looks like a cytoplasmic ductal differentiation, could be porocarcinoma. Very difficult case Phillip! Good morning everyone

Submitted on 09/08/2010 11:37
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Richard Carr - Warwick (UK) Wrote:

Very difficult but I think we are dealing with a relatively cohesive sheet of basaloid cells and a sqaumoid "Monster" cell. The cytoplasm of a few of the cells, including the "Monster" appears squamoid. The commonest tumour with monster cells is a nodular BCC ("pleomorphic" BCC). We would also consider a porocarcinoma and a squamous cell carcinoma in this case. I think my first thoughts of a malignant ganglioneuroblastoma are off the mark here.

Submitted on 09/08/2010 10:39
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Miah S - (UK) Wrote:

The infiltrate looks malignant and the background cells good easily represent naevoid melanoma, however, the cell in the middle has a intracytoplasmic vacuole which could be early balloon cell change??

Submitted on 09/08/2010 10:21
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Malignant fibrous histiocytoma sounds a good suggestion. I would like to add it to my DDx.

Submitted on 09/08/2010 05:15
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Eman El-Nabarawy - Dermatology Department,Faculty of Medicine, Cairo university. (Egypt) Wrote:

Malignant fibrous histiocytoma.

Submitted on 09/08/2010 04:49
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

I found this case very difficult. I am thinking of PEComa (perivascular epithelioid cell tumor) or malignant glomus tumor. Other suggestions: metastatic carcinoma or metastatic melanoma.

Submitted on 09/08/2010 04:41
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