Case Number : 92 Posted By: Guest

Iskander Chaudhry - Manchester Royal Infirmary (Manchester, U.K.) Wrote:

Victory is sweet! I must say I was tempted to intervene but I did not want to spoil the fun! One of Richard's long shots is correct - this is a Silicone granuloma - I am sure you are all kicking yourselves - Phillip is back mid next week so you will have me for a couple of more days - have a great weekend and see you Monday for some more treats. I will let Phillip respond to your mucinous metaplasia suggestion on his return.

Submitted on 16/10/2010 22:08
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

I think lipoblastoma is a good idea!!!

Submitted on 16/10/2010 05:52
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Saleem Taibjee - Warwick () Wrote:

I should have also included lipoblastoma in the differential given the vascularity.

Submitted on 15/10/2010 21:14
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Saleem Taibjee - Warwick () Wrote:

I would like to throw another differential into the mix - chondroid lipoma, based on the striking multivacuolated lipoblasts. I still think the first suggestion of the day, PEComa, is a possibility though. Tough case from just this one field.

Submitted on 15/10/2010 21:12
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Maria - (Madrid) Wrote:

I am agree whith all the diferentials of my colleages but I think that another one is foering material.

Submitted on 15/10/2010 18:53
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Richard Carr - Warwick (UK) Wrote:

Well what fun Iskander is having with us today and with no clues. I think these are either lipoblasts (i.e. a Well differentiated liposarcoma) or psuedolipoblasts. I decided against brown fat. I also thought of silcone granuloma and parachordoma/chordoma but the latter is a long shot! I will also mention myoepithelioma as it passed through my mind. Can't wait to find out. Regards R

Submitted on 15/10/2010 17:42
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Marwa Fawzi - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

I see lipoblast-like cells around the blood vessels in the dermis & dissecting the collagen??Is it a breast tissue??metastatic signet ring carcinoma of the breast is a nice idea ??

Submitted on 15/10/2010 15:04
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

Another idea, metastatic signet ring carcinoma of the breast.

Submitted on 15/10/2010 12:54
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richard carr - Warwick (UK) Wrote:

Great thanks Mona, I do recieve that journal and will read it with interest.

Submitted on 15/10/2010 11:53
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Dear Dr Carr, Thank u for ur comment on yesterday's case and ur description about signet ring cell SCC goes with what I know that it does not contain intracytoplasmic mucin. I think yesterday's case is SCC with mucinous metaplasia. What about checking this most recent article Am J Dermatopathology, 2010 Sep 16. [Epub ahead of print] Cutaneous Squamous Cell Carcinoma With Mucinous Metaplasia on the Sole Associated With High-Risk Human Papillomavirus Type 18. Caputo V, Colombi R, Ribotta M, Rongioletti F. I will try also to get the full article to study it in more details.

Submitted on 15/10/2010 10:21
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richard carr - Warwick (UK) Wrote:

Nice image!! - Iskander may be in luck! I have posted a further comment on Case 91. Nearly the weekend but a bit dull & cold today in Warwick. Regards to all.

Submitted on 15/10/2010 09:55
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Dear Dr Iskandar, Dear Dr Richard, It will be of great educational value and as a continuation of yesterday's case if u tell us what is difference between adenosquamous carcinoma, signet ring cell SCC and SCC with mucinous metaplasia. These 3 entities as much as I know are sometimes mistaken with each other. Thank u very much..

Submitted on 15/10/2010 09:51
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

I would like to add another DDx: metastatic clear cell carcinoma (brearst, ovarian, vaginal tract, uterine..). Not renal as it has a distinctive pathological picture.

Submitted on 15/10/2010 08:53
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

Nice idea Mona, however, on searching this entity I foud it to be presented in sheats of clear to granular eosinophilic cells separated by slit-like vascular spaces. Thought of Angiolipoma.

Submitted on 15/10/2010 05:37
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

I can see nests and strands of clear to granular (predominantely clear) cells. I can percieve and I think it is striking that almost all the nests are focally associated with blood vessel walls. Is that a PEComa!!

Submitted on 15/10/2010 00:10
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