Case Number : Case 436 Posted By: Guest

[b]Richard Carr - Warwick (UK) Wrote:[/b]

I clearly need to type faster!

[size=2]Submitted on 09/02/2012 18:00[/size] [b]Richard Carr - Warwick (UK) Wrote:[/b]

Beg borrow or steal (Phillip would probably advocate your selling body parts) to get a copy of the 4th Edition!! My diagnosis is atypical dermal smooth muscle tumour (pilar in this case). This is not mentioned in Mckee 4th (PHM correct me if I a wrong) but I think many pathologists are accepting purely dermal lesions under the "atpical" designation as there have been no reported metastases to date (from mitotic dermal lesions). They do need to be excised with clear margins. Must emphasise that any "invasion" of subcutis and the name changes to leiomyosarcoma. Symplastic leiomyoma should be "degenerative" atypia and lack mitoses. Sorry just noticed Bostjan has even given a reference - regards to all!!

[size=2]Submitted on 09/02/2012 17:56[/size] [b]Phillip McKee - Overseas Consultations (Cave Creek, Arizona, USA) Wrote:[/b]

Although the lesion is circumscribed rather than infiltrative, there is marked pleomorphism and there were conspicuous mitoses including atypical forms. I diagnosed this lesion as a cutaneous leiomyosarcoma. The degree of pleomorphism and mitotic activity would to my mind be beyond atypical leiomyoma although this is a mute point and others might disagree.

[size=2]Submitted on 09/02/2012 17:52[/size] [b]Zena Slim (SpR Histopath) - Wessex Deanery (QAH Portsmouth) Wrote:[/b]

My differentials : Atypical Dermatofibroma Atypical leiomyoma, Pleomorphic fibroma , and AFX. I would do an immunopanel to distinguish. I would want to do a formal mitotic count and examine the rest of the specimen to exclude a cutaneous leiomyosarcoma..these can be nodular and show irregular margins as in this lesion.

[size=2]Submitted on 09/02/2012 16:49[/size] [b]Izzat Abdul-kadir - ST2 - York Hospital (UK) Wrote:[/b]

Pilar leiomyoma.

[size=2]Submitted on 09/02/2012 15:34[/size] [b]Eman El-Nabarawy - Cairo University (Egypt) Wrote:[/b]

Symplastic leiomyioma.

[size=2]Submitted on 09/02/2012 14:14[/size] [b]A Bansal - BCU HB (North Wales) Wrote:[/b]

More on 'atypical leiomyoma of skin' here: http://dermatology.cdlib.org/1503/case_presentations/leiomyoma/jimena.html Does not seem to be mentioned in Pathology of the Skin (McKee, Calonje, Granter) but I only have the 3rd edition.

[size=2]Submitted on 09/02/2012 13:00[/size] [b]Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:[/b]

Symplastic leiomioma

[size=2]Submitted on 09/02/2012 12:53[/size] [b]Mona Abdel Halim - Dermatology Dept. Cairo Univ. (Egypt) Wrote:[/b]

Cytologically I was thinking of leiomyosarcoma but architecturally it is circumscribed non infiltrative, so I agree with Marcela that this is pleomorphic (atypical) leiomyoma.

[size=2]Submitted on 09/02/2012 12:23[/size] [b]Marcela Saeb Lima - INCMNSZ (Mexico City) Wrote:[/b]

pleomorphic leiomyoma

[size=2]Submitted on 09/02/2012 12:12[/size] [b]ANDREW DANCKWERTS - WITS UNIVERSITY, JOHANNESBURG (JOHANNESBURG, RSA) Wrote:[/b]

In view of the pushing rather than ifiltrative nature of the margins, relative circumscription and the absence of coagulative tumour necrosis, despite the presence of pleomorphism, nuclear atypia and an atypical mitotic figure, the features appear to fall short of the histological diagnosis of leiomyosarcoma. In view of this, I favour this case to be representative of the diagnosis of an ATYPICAL INTRADERMAL SMOOTH MUSCLE NEOPLASM, similar to its counterpart in the female genital tract, namely, Smooth Muscle Tumour of Uncertain Malignant Potential (STUMP). Other differential diagnoses also worth considering are as follows: 1. spindle cell melanoma; 2. spindle cell carcinoma; 3. atypical fibroxanthoma (AFX) - would like to perform immunohistochemistry to differentiate.

[size=2]Submitted on 09/02/2012 11:06[/size] [b]Yüksel Okumuş - Bursa State Hospital (Turkey) Wrote:[/b]

Cutaneous Leiomyosarcoma

[size=2]Submitted on 09/02/2012 10:24[/size] [b]Bostjan Luzar - Institute of Pathology, Medical Faculty University of Ljubljana (Ljubljana, Slovenia) Wrote:[/b]

Atypical intradermal smooth muscle neoplasm (Kraft S, Fletcher CD. Am J Surg Pathol 2011; 35: 599-607)

[size=2]Submitted on 09/02/2012 09:59[/size] [b]A Bansal - BCU HB (North Wales) Wrote:[/b]

I think this is a cutaneous leiomyosarcoma but a bit circumscribed and not that infiltrative at deep aspect. DD: spindle cell melanoma, spindle cell carcinoma. Would do immunohistochemistry panel.

[size=2]Submitted on 09/02/2012 09:48[/size]