Case Number : Case 533 Posted By: Guest

[b]Jaime A Mejia, MD - Medicina Diagnóstica (Cali, Colombia) Wrote:[/b]

Nice case, very convincing arguments. Thanks Dr. McPhee.

[size=2]Submitted on 25/06/2012 21:33[/size]
[b]Phillip H McKee - Overseasonsultations (Cave Creek, AZ, USA) Wrote:[/b]

Well done all of you who diagnosed MPNST. The mast cells are a clue and there is too much nuclear pleomorphism and hyperchromasia for a neurofibroma in addition to the mitosis. The ill-defined eosinophilic fibrillary cyoplasm is also a diagnostic pointer. The tumor came from a patient with neurofibromatosis type 1.

[size=2]Submitted on 25/06/2012 17:56[/size]
[b]Sasi Attili - Ninewells University Hospital, Dundee (United Kingdom) Wrote:[/b]

I thought leimyosarcoma for this one based on the cigar shaped nuclei. Agree the mast cells are confusing the picture a little bit but the cellular morphology is unlike a NF as i don't see wavy nuclei.

[size=2]Submitted on 25/06/2012 16:10[/size]
[b]Jaime A Mejia, MD - Medicina Diagnóstica (Cali, Colombia) Wrote:[/b]

I have found a report of certain negative correlation between mast cell count and malignancy in soft tissue tumors. In the light of that hypothesis: Could it be a neurofibroma? http://www.ncbi.nlm.nih.gov/pubmed/1594501

[size=2]Submitted on 25/06/2012 15:55[/size]
[b]Jaime A Mejia, MD - Medicina Diagnóstica (Cali, Colombia) Wrote:[/b]

Spindle cutaneous tumor with mast cells, mitotic activity and perinuclear vacuoles. Mast cells can be seen in some ST tumors: synovial sarcoma, neurofibromas, solitary fibrous tumor, GIST, MFH, leiomyosarcomas. My best guess in this case is a cutaneous leiomyosarcoma with mast cells, need to r/o neurofibroma. My panel would include: S-100 prot, HMB-45, SMA, h-caldesmon, desmin, CD34.

[size=2]Submitted on 25/06/2012 15:50[/size]
[b]Zena Slim (SpR Histopath) - Wessex Deanery (QAH Portsmouth) Wrote:[/b]

spindle cell lesion..needs an immuno-panel. Based on morphology my leading differentials are MPNST vs cutaneous Leiomyosarcoma

[size=2]Submitted on 25/06/2012 13:26[/size]
[b]Rodrigo Restrepo - UPB/CES (Mdlln/Col) Wrote:[/b]

Malignant peripheral nerve sheath tumor

[size=2]Submitted on 25/06/2012 12:28[/size]
[b]Marcela Saeb Lima - INCMNSZ (Mexico City) Wrote:[/b]

Agree with Yüksel, malignant peripheral nerve sheath tumor, though there is no pleomorphism there is a mitotic figure.

[size=2]Submitted on 25/06/2012 12:20[/size]
[b]Yüksel Okumuş - Bursa State Hospital (Turkey) Wrote:[/b]

My first impression is malignant peripheral nerve sheath tumor.

[size=2]Submitted on 25/06/2012 12:13[/size]
[b]Engin Sezer - (Istanbul) Wrote:[/b]

Desmoplastic melanoma

[size=2]Submitted on 25/06/2012 11:57[/size]
[b]I. Abdul-kadir - ST2 - York Hospital (UK) Wrote:[/b]

?Dermal leiomyosarcoma.

[size=2]Submitted on 25/06/2012 11:23[/size]