Case Number : Case 25 Posted By: Guest

Phillip McKee - Overseas consultations (USA) Wrote:

Well. you are all mostly in the right ballpark and quite a few got the diagnosis correct. This was a difficult case without seeing the rest of the tumor. It comes from a primary cutaneous epithelioid hemangioendothelioma. The lumina were positive for vascular markers. See you all tomorrrow

Submitted on 14/07/2010 21:42
________________________________________
Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Well I have to admit that on the first look I did not recognize the intracytoplasmic vaculoes. I gave it a second look, I agree they are seen in the lower right quadrant of the filed. I will put epithelioid hemangioendothelioma as the first possibility. MCRH has large histiocytes with abundant esinophilic cytoplasm but no intracytoplasmic vacuoles.

Submitted on 14/07/2010 18:52
________________________________________
Ana Cristina Ruiz - Universidad CES (Medellín Colombia) Wrote:

I see a tumoral lesion composed of epithelioid cells with pink cytoplasm and vesicular nuclei. Intracytoplasmic lumina with erythrocytes are occasionally formed. I consider this case is a epithelioid vascular tumor more consistent with epithelioid hemangioendothelioma

Submitted on 14/07/2010 18:27
________________________________________
Meyers - (Denmark) Wrote:

The bland nature of the lesion would suggest it is not a angiosarcoma. Hemangioendothelioma/ cutaneous angiomatoid nodule are very likely.

Submitted on 14/07/2010 18:01
________________________________________
Phillip McKee - Overseas consultations (USA) Wrote:

The lesion on low power does not have the morphology of an epithelioid angiomatous nodule

Submitted on 14/07/2010 17:59
________________________________________
Richard Carr - Warwick (UK) Wrote:

Just checked out our own case of cutaneous epithelioid angiomatous nodule and it is identical to Phillips though of course his image is better! We would want to scan back to low power to see the overrall lesion and we should see if there are nice well formed capillary vessels (as in EAN). I still cannot r/o epithelioid haemangioendothelioma (i.e. angiosarcoma) on this field but guessing it is EAN now that everyone agrees probably an epithelioid vascular lesion.

Submitted on 14/07/2010 17:44
________________________________________
JKL - Trainee (UK) Wrote:

Difficult case. Lots of differentials but the vacuoles with red blood cells are suggestive of Cutaneous epitheliod angiomatous nodule

Submitted on 14/07/2010 17:15
________________________________________
Wayne Grayson - (Johannesburg, South Africa) Wrote:

Quite a tricky case! I see somewhat atypical epithelioid cells, some with intracytoplasmic vacuoles. At least one cell shows an apparent erythrocyte contained within one of these vacuoles. I favour an epithelioid vascular tumour, such as an epithelioid angiomatous nodule or an epithelioid haemangioendothelioma. Not quite sure if there are some rhabdoid inclusions; although I do not see any mitoses, I guess an epithelioid angiosarcoma also needs to be considered.

Submitted on 14/07/2010 17:12
________________________________________
Juan Carlos Garces - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

I think Cutaneous angiomatoid epithelioid nodule is a good suggestion

Submitted on 14/07/2010 16:16
________________________________________
Phillip McKee - Overseas consulatations (USA) Wrote:

Good morning all. This case is certainly generating a very wide differential diagnosis. The correct answer is somehere in all of the options mentioned above.

Submitted on 14/07/2010 15:06
________________________________________
Eman El-Nabarawy - Dermatology Department,Faculty of Medicine, Cairo university. (Egypt) Wrote:

Very very difficult case to me.Cutaneous epitheliod angiomatous nodule (epitheliod cells with intracytoplasmic vacules).DD histiocytosis.

Submitted on 14/07/2010 13:19
________________________________________
Richard Carr - Warwick () Wrote:

Like suggesion of multicentric reticulohistiocytosis / reticulohistiocytoma on the basis of slide ground glass appearances. Also think xanthogranuloma but you have not shown us nice touton cells. Whenever we see histiocytes and plasma cells must think of infections like Leish, Histoplasma, MAI etc. I don't think this Sago palm (and I know Philip has an example because he showed it too us 10 years ago in London and I am sure it had multiple little rounded uniform slightly amphophilic blobs). I don't this this one is malakoplakia. I could not help thinking of epithelioid haemangioendothelioma (it was the blood cells but I guess immuno would easily rule that out). Great image and very difficult !! again.

Submitted on 14/07/2010 10:01
________________________________________
Christos - Trainee (UK) Wrote:

Pale cells, some contain vacuoles/ bubbly cytoplasm - could this be a case of leprosy

Submitted on 14/07/2010 08:35
________________________________________
Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

This is very challenging. The only idea that came to me is the presence of large histiocytes with abundant esinophilic cytoplasm. I thought of Multicenteric reticulohistiocytosis but I cant find the characteristic multinucleated cells. May be in other areas of the field. May be other rare histiocytic disorders. Never saw malakoplakia before, but I dont think I see the MGB. It was the first time to hear about sago palm diseas. I read it but I am not sure of it as I did not c it before. I feel anxious to know the correct diagnosis.

Submitted on 14/07/2010 07:41
________________________________________
Rodrigo Restrepo - UPB (Mdlln.Col) Wrote:

Sago palm disease

Submitted on 14/07/2010 03:39
________________________________________
Juan Carlos Garces - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Very difficult case to me. It looks like an histiocytic infiltrate with those eosinophilic bodies. Perhaps Malakoplakia?. Sure there will be many better oppinions.

Submitted on 14/07/2010 01:42
________________________________________