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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 919 - 30th 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 93 year old white man with a shave biopsy of a red, translucent papule taken from the proximal right lower leg.

Case posted by Dr. Mark Hurt


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Dr. Richard Carr

Posted

Would go for metastatic (adeno-) carcinoma first but there was indeed a report of cutaneous presentation of a metastatic pure epithelioid angiosarcoma of the heart mentioned in one of the recent Am J. Dermpathol papers (Am. J. Dermpath. Val-Bernal; 2013;35:286-7; orig. ref: Val Bernal et al J. Cutan. Pathol. 2001;28:265-270). Metastases can also target pre-existing angiomas (not sure if that is the cvase above though).

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Robledo F. Rocha

Posted

I favor metastatic adenocarcinoma. I didn't find intracytoplasmatic lumina to consider angiosarcoma. Also, spaces within cellular sheets tend to display round outlines and seem to contain mucoid substance, characteristics of glandular structures, rather than irregular contours and blood-containing, what would make me favor angiosarcoma.

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Robledo F. Rocha

Posted

Dr. Abdul-kadir, what adnexal carcinoma do you suggest?

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Guest Maria George

Posted

My diff incude Merckel cell ca , Seb ca , metstatc melanoma

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Mark A. Hurt MD

Posted

Here are some immunostains. Does this help narrow the diagnosis?

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE919_Image%2005.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE919_Image%2006.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE919_Image%2007.jpg[/img]

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Eman El-Nabarawy

Posted

Metastatic adenocarcinoma of the prostate.

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Guest Ahmed F Lazim

Posted


Metastatic prostatic adenocarcinoma . Is it possible to suggest malignant spiradenoma in addition to metastatic adenocarcinoma at HE morphology ?

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Mark A. Hurt MD

Posted

My diagnosis was:

[b]-- METASTATIC ADENOCARCINOMA[/b]

I favored prostatic carcinoma metastatic to the skin.

Here is the text of my micro: "Immunohistochemically, the lesion is strongly positive for CAM5.2, focally positive in individual cells for CK5/6, weakly positive at the luminal zones for prostate specific antigen, and strongly positive throughout the cytoplasm for PSAP. Negative stains include CK7, CK20, hepatocyte antibody, renal cell carcinoma antibody, CDX2, p63, TTF-1, synaptophysin, and chromogranin."

Regarding the question of spiradenocarcinoma, raised by Ahmed, in my experience, the cells of that kind of neoplasm are usually more basophilic, often resembling a spiradenoma. Unless there is some spiradenoma in a spiradenocarcinoma, however, it can be a very difficult diagnosis.

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Dear Dr Rocha, when I said adnexal, I was thinking of apocrine carcinoma ("ductal" carcinoma) and spiradenocarcinoma.

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