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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 4000! You can review the archived cases and read the suggested diagnoses by users and the final comment by the contributors.
Case are uploaded each week day by 10 am UK time with the correct diagnosis will generally be posted at 8 pm UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 779 - 12th June Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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86 years-old male with a scalp lesion.

Case posted by Dr. Hafeez Diwan.
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Guest
pilomatrix carcinoma

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pathanon
? pilomatrix carcinoma (not seen one before)

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Guest Romualdo

Guest Romualdo

Posted

Pilomatrix carcinoma

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Sasi Attili

Sasi Attili 85

Posted

Looks atypical and agree that there are ghost cells in keeping with a pilomatrical differentiation (though not 100% specific for pilomatrical tumours- Ghost cells may also be seen in various follicular neoplasms and BCC). The lesion looks fairly well circumscribed and I don't see an infiltrating pattern. Proliferating pilomatrixoma and pilomatrix carcinoma would be in my differentials. Feeling a bit incapacitated being unable to see the full silhouette.

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Guest Mario George

Guest Mario George

Posted

Things to be discussed are many and include AFX, hidardenocarcinom, and cutaneous metastasis.

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Guest Dr Engin Sezer

Guest Dr Engin Sezer

Posted

I'd like to add rhabdoid SCC to differentials.

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IgorSC
Agree, pilomatrix carcinoma. I had seen one before on my desk, but I´m not so confortable without the full silhouette.

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Guest Jaime Mejía MD

Guest Jaime Mejía MD

Posted

What we do in our center is r/o epithelioid angiosarcoma by IHC in all epithelioid nodules of bizarre looks or location in elderly people.

Having said that, Is it a far-fetched possibility thinking of an epithelioid angiosarcoma?

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Guest Juan Carlos Garcés, Ecuador

Guest Juan Carlos Garcés, Ecuador

Posted

Agree with pilomatrix carcinoma

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Robledo F. Rocha

Robledo F. Rocha 336

Posted

Most of us agree this is a malignant hair follicle tumor with matrical differentiation. Once I found it a well-circunscribed lesion, I will favor malignant proliferating trichilemmal tumor, probably arising into its benign counterpart, hence the lack of infiltrative growth pattern.

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Guest Jim Davie MD

Guest Jim Davie MD

Posted

Agree with Mark that sebaceous carcinoma should be high in the differential. That was my initial impression based on the photos...some rounded spaces have eosinophilic cuticles that suggest sebaceous duct differentiation, high grade atypia, and messy pleomorphic geographic nature of the ghost cells/necrosis.

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Dr. Richard Carr

Dr. Richard Carr 622

Posted

Image quality aside!! I see ghosted nuclei and pleomorphism. I favour pilomatrical carcinoma.

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Eman El-Nabarawy

Eman El-Nabarawy 69

Posted

Thought of sebaceous carcinoma.

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Iskander H. Chaudhry

Iskander H. Chaudhry 49

Posted

Dear All,

Hafeez is away for 2 weeks and I will be covering for him during this time posting the diagnosis, although he has provided the cases.

Nice to see a good range of differentials here, this was a difficult case.

The diagnosis for this is trichilemmal carcinoma, which is not a well recognized entity!

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Robledo F. Rocha

Robledo F. Rocha 336

Posted

Contrary to that I mentioned above, proliferating trichilemmal tumor does not show predominant matrical differentiation, but predominant differentiation toward the outer root sheath at the isthmus, according to Kazakov et al's Cutaneous Adnexal Tumors.

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Guest adlen

Guest adlen

Posted

proliferating epidermoid cell

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Guest adlen

Guest adlen

Posted

[quote name='Guest' timestamp='1371076876']
proliferating epidermoid cyst
[/quote]

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