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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 891 - 18th November 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 an 83 year old white woman with a shave biopsy taken from the left nasal ala

Case posted by Dr. Mark Hurt


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Guest Mazen charaf iddin

Posted

I think , it's Desmoplastic trichoepithelioma

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Guest Amira Tawdy

Posted

Ttrichoepithelioma vs trichoblastoma needs immunos

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Trichoblastoma with some desmoplastic stromal features.

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Sasi Attili

Posted

Trichoblastoma- Desmoplastic Trichoepithelioma type (as the Father would say :))

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Dr. Richard Carr

Posted

(Small nodular) trichoblastoma. These lesions are usually mitotically active, can grow to large size and a small series was reported on the lip in which the authors considered them to be low grade trichoblastic carcinoma because of the infiltration of skeletal muscle and plaque-like asymmetric growth. Unlike desmoplastic trichoepithelioma the dominant pattern is rounded structures (not thin curvilinear) with papillary mesenchymal boides easily identifted throughout (even in the deepest pseudoinfiltrative parts of these lesions). Because they may be large and "infiltrate" deeply (probably over many years) margin control surgery is one way of dealing with them.

Altman DA, Mikhail GR, Johnson TM, Lowe L. Trichoblastic fibroma. A series of 10 cases with report of a new plaque variant. Arch Dermatol. 1995 Feb;131(2):198-201.

Cowen EW, Helm KF, Billingsley EM. An unusually aggressive trichoblastoma.J Am Acad Dermatol. 2000 Feb;42(2 Pt 2):374-7.

Rofagha R, Usmani AS, Vadmal M, Hessel AB, Pellegrini AE. Trichoblastic carcinoma: a report of two cases of a deeply infiltrative trichoblastic neoplasm. Dermatol Surg. 2001 Jul;27(7):663-6.

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Guest Romualdo

Posted

Before the last edition of the WHO blue book I called lesions like that simply trichoepitheliomas (not desmoplastic trichoepitheliomas). Now, I agree with Dr. Richard Carr and would call this lesion a small nodular trichoblastoma.

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Guest Jim Davie MD

Posted

Trichoblastoma.
Highly cellular stroma with absence of definitive papillary mesenchymal bodies, though some earnest attempts seem scattered about. Not mitotically active or cytologically aberrant, with negligible apoptotic activity. For what it's worth, there are very rare pale cells in the basal layer of some nests that look suspiciously like Merkel cells, though a CK20 may well prove me wrong.

Interesting article re CK20 and CK15 staining in trichoblastomas:
Merkel Cell–Poor Trichoblastoma With Basal Cell Carcinoma–Like Foci
[i] Am J Dermatopathol  Volume 29, Number 3, June 2007[/i]

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[color=#1C2837][font=arial, verdana, tahoma, sans-serif][size=4]Trichoblastoma, [/size][/font][/color][color=#1C2837][font=arial, verdana, tahoma, sans-serif][size=4]small nodular.[/size][/font][/color]

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Robledo F. Rocha

Posted

I'm late, but not too late to agree with my colleagues: small nodular trichoblastoma.

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Mark A. Hurt MD

Posted

My diagnosis was trichoblastoma, small lobular (nodular). I think this case is a good contrast with Richard's case from last Friday.

I like the term "lobular" for these lesions, because I always think of a nodule as a clinical term. Some years ago, I wrote an article on a series of these lesions; my name was "immature" trichoepithelioma. They were small lobular (nodular) trichoblastomas. One never quits learning about these lesions.

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Dr. Richard Carr

Posted

Good idea using lobular instead of Akerman's nodular. I totally agree with you and will adopt that from now on - can't think why it never occurred to me before as I was always uncomfortable with it - I suppose one feels straight jacketed by... a healthy respect for... or obligation.... to the past (fathers and mothers)?

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