Case Number : Case 31 Posted By: Guest

Phillip McKee - Overseas consultations (USA) Wrote:

The final diagnosis is proliferative fasciitis. Obviously the clinical information would have been helpful. The ganglion-like cells axpress Factor XIIIa. are weakly positive for actin and are desmin and S100-protein negative. Congratulations to all of you who suggested this diagnosis. It was indeed a very difficult case.

Submitted on 22/07/2010 20:42
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Phillip McKee - Overseas consultation (USA) Wrote:

Marcela, you are doing well, keep on moving!!!!!

Submitted on 22/07/2010 19:41
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Marcela Saeb Lima - MSL Dermatopato (Mexico City) Wrote:

I sure went back to read, really a good exercise you have put me through. Now I think I was completely wrong, moving towards proliferative fasciitis.

Submitted on 22/07/2010 16:57
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Lim - () Wrote:

Proliferative myositis.

Submitted on 22/07/2010 16:33
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Mo - (India) Wrote:

Wow! what a case for spot diagnosis - beautiful picture Dr Mckee. Can you add Rhabdomyoma into the differential as cells not worrying enough for sarcoma?

Submitted on 22/07/2010 15:56
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Phillip McKee - Overseas consultations (USA) Wrote:

This one is really difficult but I like the way your minds are working. The correct diagnosis is in someones(s) comment but which one? I'll reveal all at around 1.00 pm Arizona time. Keep thinking. Phillip

Submitted on 22/07/2010 15:46
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Miah S. - (UK) Wrote:

I was completely lost until reading the differentials on the site. The diagnosis is proliferative fasciitis I am sure!

Submitted on 22/07/2010 14:11
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Jonathan S. - (UK) Wrote:

A ganglioneuroma I would include in the DD although the background stroma does not fit.

Submitted on 22/07/2010 14:04
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Yvonne Bury - (UK) Wrote:

I agree with all your differential diagnosis and I also think this is a really tricky case which I would not diagnose without immunohistochemistry. However, I would like a few differentials to the list: AFX and lymphoma as some more commoner DDs to consider. Looking at the large cells they really have prominent eosinophilic cytoplasm and I have decided to throw in a few more exotic differentials like giant cell angioblastoma or a pleomorphic rhabdomyosarcoma. Last suggestion, what about EBV infection?

Submitted on 22/07/2010 13:35
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Richard Carr - Wawrick (UK) Wrote:

Some brilliant descriptions and suggestions already. Brown stains for epithelioid angiosarcoma (and all the other epithelioid tumours!) The cells that are queing up and have slightly squared off connections and the intermediate-like filaments cytoplasm made me think mesothelial (?metastasis in skin) obviously that is a really wild shot. I also thought of the cells in ischaemic fasciitis in addition to those suggestions below. Regards to all. Impossible today!

Submitted on 22/07/2010 11:46
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Eman El-Nabarawy - Dermatology Department,Faculty of Medicine, Cairo university. (Egypt.) Wrote:

The ganglion-like cells in a tissue culture like stroma is suggestive of proliferative fasciitis.Still can't rule out anngiosarcoma cause of the epithelioid cells, extravasated RBCs, intracytoplasmic vacules!?.

Submitted on 22/07/2010 06:43
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

First of all, this is really a difficult case. I studied the section carefully and I can say that I can see Large atypical epithelioid like cells, extravasated RBC's, some vascular lumina. I noticed that some of the vascular lumina contain or are lined by these atypical cells. I also can see some rounded vacuoles some with an RBC inside them. I thought of a poorly differentiated angiosarcoma. Actually I never saw a poorly differentiated angiosarcoma before. I revised it in my textbook and found also that there is a variant of angiosarcoma called epithelioid angiosarcoma. So my ddx here is: Poorly differentiated angiosarcoma or epithelioid variant of angiosarcoma. Markers are essential in this case to confirm the diagnosis and to differntiate it from other simulants of poorly differentiated angiosarcoma such as melanoma or carcinoma.

Submitted on 22/07/2010 05:10
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Could be proliferative myositis but I would like to rule out a metastasis from carcinoma (signet ring cell or breast lobular carcinoma)with clinical history and immuno (desmine, ck )

Submitted on 22/07/2010 03:01
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Rodrigo Restrepo - UPB (Mdlln/Col) Wrote:

Ganglion-like cells in a collagenous stroma.My diagnosis is proliferative fasciitis.

Submitted on 22/07/2010 02:09
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Marcela Saeb Lima - MSL Dermatopato (Mexico City) Wrote:

Epithelioid cells in a desmoplastic stroma. The cells show vesicular nuclei, with prominent nucleoli. The cytoplasm looks somewhat granular, some with intracytoplasmic vacuolar changes. There is red blood cell extravasation. I have differential diagnoses: epithelioid angiosarcoma vs melanoma. Oh! it looks difficult

Submitted on 21/07/2010 23:52
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