Case Number : Case 790 - 27th June Posted By: Guest

Spindle cell melanoma (favoring based on conspicious lymphocytes) vs. spindle cell SCC

SLAM DUNK named for [url="http://en.wikipedia.org/wiki/Slam_dunk"]http://en.wikipedia.org/wiki/Slam_dunk[/url], and not [url="http://en.wikipedia.org/wiki/Slam_Dunk_(manga)"]http://en.wikipedia.org/wiki/Slam_Dunk_(manga)[/url]

is a good mnemonic for D.D of malignant spindle cell neoplasms.


S - SCC
L - Leiomyosarcoma
A - angiosarcoma
M - melanoma
D - DFSP
U - undifferentiated pleomorphic sarcoma (MFH) and AFX
N - Nodular Fasciitis
K - Kaposi's sarcoma

However, in skin SCC , AFX, and desmoplastic melanoma are the commonest .Hence staining for cytokeratin, CD10, and s100 are indicated for the diseases mentioned respectively.But my gut feeling is for SCC because of epidermal hyperplasia and the age 60 not 6 and the location.

Nodular fasciitis. If there is a lytic bone defect under the scalp lesion the variant of nodular fasciitis known as cranial fasciitis will be the correct diagnosis.

I am sorry,I did not recognize that there is no features of malignancy, and given the age and the extravasated RBC, this is a nodular fascitis.

[font="Palatino Linotype, serif"][size="4"]Agree with the diagnosis of nodular fasciitis. I appreciate this tissue culture-like pattern of bland spindle cells in a fibromyxoid background. Scattered lymphocytes and microhemorrhages can also be found. Furthermore, head is the most common site in children.[/size][/font]
[font="Palatino Linotype, serif"][size="4"]I don't think this is cranial fasciitis. It occurs almost exclusively in infants during the first months of life and osseous metaplasia is lacking.[/size][/font]
[font="Palatino Linotype, serif"][size="4"]On the other hand, I'm concerned about the report of recurrence with size increasing, once nodular fasciitis rarely reccurs, even after incomplete resection.[/size][/font]

Agree with nodular fasciitis. I observe a culture-like patern of spildle-cell proliferation, lymphocitic infiltration, eritrocyte extravasation and mitotic figures in a myxoid background. Care must be taken with the other hypothesis like SCC, Melanoma, AFX, Angiosarcoma and Leiomyosarcoma. The patient is too young for these.

On this site, I would call it cranial fasciitis ... Nodular fasciitis on the scalp !!!

Thanks for the acronym! I called this nodular fasciitis.