In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 907 - 10th December Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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The patient is a 70 year old white woman with a previous biopsy. An excision for margin exam is taken from the right parietal aspect of the scalp.

Case posted by Dr. Mark Hurt


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Guest Amira Tawdy

Posted

Basal cell carcinoma with matricial differentiation which shows some features similar to pilomatricoma

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Hanan Vaknine MD

Posted

Benign adnexal tumor with matrical and trichoepithelioma-like differentiation
DD:
Trichoepithelioma with matrical differentiation
Proliferating epidermal cyst with pilar differentiation
Inverted follicular keratosis with pilar differentiation
I do not thick it is malignant (manely no BCC compenet prsent)

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Dr. King-Chung Lee

Posted

I also favor a benign skin adnexal tumor. How about panfolliculoma.

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There is differentiation towards the infundibulum, inner root sheath and germ: Trichofolliculoma versus panfolliculoma.

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Robledo F. Rocha

Posted

Trichoblastoma-like tumor with infundibular and matrical differentiation. This remembers me a letter by Hu et al.:
[url="http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-0880"]http://www.medicaljo...0/00015555-0880[/url]

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Guest Saleem Taibjee

Posted

Benign, would favour trichoblastoma with some differentiation towards inner root sheath. Papillary mesenchymal aggregates are against BCC.

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Dr. Mona Abdel-Halim

Posted

I have read the comments and revised the images again, yes I missed the units with intimate fibroepithelial relation favoring trichoblastoma but I think there is also retraction of the stroma from the upper epithelial island on the right side (first image). Could it be BCC with juxtaposed trichoblastoma like and panfolliculoma like areas? Or there is no BCC component at all here? We need also to know what was the diagnosis of the original biopsy?

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Guest Jim Davie MD

Posted

Agree with panfolliculoma....this tumor seems to 'have it all' with mixed sebaceous, squamous, basaloid, and classic pilomatricoma features of matrical/trichohyaline/ghost cell differentiation.

If one doesn't believe in splitting out the term 'panfolliculoma' (or has mercy on one's clinicians/patients getting the report!), I would call it a pilomatricoma. The focal connection to the epidermis, patchy mucinous stroma, infundibulocystic squamous features, and areas of follicular differentiation (with papillary mesenchymal bodies) and limited sebaceous differentiation would not be too inconsistent with pilomatricoma.

[i]A recent (free full-text) review article (2010) presenting the wide range of differentiation and incidental histologic features in pilomatricomas seen over the years at one Indian institution, with comparison to other review articles (Dr. Hurt is listed in the article references for extra kudos to the article authors) :[/i]
[i][b] [url="http://www.ijdvl.com/article.asp?issn=0378-6323;year=2010;volume=76;issue=5;spage=543;epage=546;aulast=Simi"]Pilomatricoma: a tumor with hidden depths.[/url][/b]
[size=3][color=#000000][font=arial, helvetica, clean, sans-serif][color=#660066]Simi CM[/color], [color=#660066]Rajalakshmi T[/color], [color=#660066]Correa M[/color].
Link (free full text article): [/font][/color][/size][url="http://www.ijdvl.com/article.asp?issn=0378-6323;year=2010;volume=76;issue=5;spage=543;epage=546;aulast=Simi"]http://www.ijdvl.com...546;aulast=Simi[/url][/i]

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Mark A. Hurt MD

Posted

My diagnosis was panfolliculoma. The previous biopsy was very small, and I could not make a definitive diagnosis, so I asked to see the remainder.

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