Case Number : Case 324 Posted By: Guest

Phillip McKee - Overseas Consultations (Arizona, USA) Wrote:

You should know me better Richard - this is another case of Atypical fibroxanthoma!! Well done to those who suggested it in their differentials.

Submitted on 08/09/2011 04:46
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Hassan Poursasan - Aleris Medilab (Stockholm) Wrote:

AFX, R/O melanoma,spindle cell squamous carcinma and leiomyosarcoma

Submitted on 07/09/2011 02:36
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Amira Tawdy - Cairo University (Egypt) Wrote:

spindle cell carcinoma d.d malignant fibrous histocytoma

Submitted on 06/09/2011 17:08
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

Favoured spindle cell SCC. DD spindle cell melanoma,AFX,angiosarcoma for immunos.

Submitted on 06/09/2011 11:40
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Zouheir Maarouf - North Cumbria University Hospital NHS (Carlisle, UK) Wrote:

I think this is atypical fibroxanthoma but need to exclude the spectrum of diff. diagnosis of leiomyosarcoma (location less likely), melanoma (melanoma markers), spindled carcinoma (no convincing epidermal features, EMA?), angiosarcomas?.

Submitted on 06/09/2011 10:47
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Richard Carr - Warwick (UK) Wrote:

I would favour spindle cell carcinoma given that we have had an AFX already within the last week and then amelanotic melanoma. I would have leiomyosarcoma well down the list as we practically never see histologically high grade dermal leiomyosarcoma in this clinicopathological setting although some nuclei are quite cigar-like! So rarely in fact we don't usually do muscle markers in our routine panel (perhaps we are missing them!!).

Submitted on 06/09/2011 10:20
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Rodrigo Restrepo - UPB/CES (Mdlln/Col) Wrote:

Atypical fiboxanthoma vs Leiomyosarcoma

Submitted on 06/09/2011 08:19
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Francisco Vilchez - Department of Dermatology. Virgen de la Victoria Clinical Universitary Hospital. (Málaga (Spain)) Wrote:

Atypical fiboxanthoma vs leiomyosarcoma

Submitted on 06/09/2011 07:02
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Marcela Saeb Lima - Instituto Nacional de Ciencias Médicas y Nutrición Salvaor Zubirán (Mexico City) Wrote:

I agree with the differential diagnoses: spindle SCC, melanoma, AFX, angiosarcoma, pleomorphic KS. I would definitively do immunohistochemistry with low/high CK, S100, CD31, herpes virus 8.

Submitted on 06/09/2011 06:18
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ANDREW DANCKWERTS - NHLS / WITS UNIVERSITY (JOHANNESBURG, RSA) Wrote:

HIGH GRADE MALIGNANT SPINDLED CELL NEOPLASM. THE DIFFERENTIAL DIAGNOSIS IS AS FOLLOWS: 1. LEIYOMYOSARCOMA (FAVOURED ON MORPHOLOGY); 2. SPINDLED MELANOMA; 3. SPINDLED CARCINOMA; 4. POORLY DIFFERENTIATED ANGIOSARCOMA (IN VIEW OF SITE AND AGE); 5. PLEOMORPHIC KAPOSI SARCOMA; AND 6. AFX (BY EXCLUSION). AN EXTENSIVE IMMUNOHISTOCHEMICAL STAINING PROFILE IS REQUIRED TO DIFFERENTIATE.

Submitted on 06/09/2011 06:04
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Mona Abdel Halim - Dermatology Dept. Cairo University (Egypt) Wrote:

I think from the second image I can percieve some atypical cells on the basal layer with hyperchromatic nuclei and loss of ordered stratification of the epidermis together with dense inflammatory cell infiltrate and overlying parakeratosis, so from the H&E, I am favouring spindle cell SCC. Still my scientific approach will be exactly as Dr Luzar said with the addition also of the possibility of undiff angiosarcoma (will add CD31/ CD34)

Submitted on 06/09/2011 05:12
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Marwa Fawzi - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Atypical fibroxanthoma ,need immunos to exclude other neoplastic spindle cell proliferations.

Submitted on 06/09/2011 05:02
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Bostjan Luzar - Institute of Pathology, Medical Faculty University of Ljubljana (Ljubljana, Slovenia) Wrote:

Spindle cell proliferation on sun-exposed skin in an elderly. Differential diagnosis includes melanoma, spindle cell squamous carcinoma, leiomyosarcoma, so immunohistochemistry is crucial. If S100-, CKs-, desmin-, than spindle cell AFX is my main consideration. If the lesion extensa into the subcutis, I would (with the above immunoprofile) label the lesion as pleomorphic sarcoma, NOS.

Submitted on 06/09/2011 04:41
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