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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 872 - 22nd October 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 five day old baby with a shave biopsy from the left thigh.

Case posted by Dr. Mark Hurt.


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Guest Saleem Taibjee

Posted

myofibroma - biphasic pattern is supportive. The infant would need a work-up to assess for multiple lesions including imaging.

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Sasi Attili

Posted

[color=#1C2837][font=arial, verdana, tahoma, sans-serif][size=4]infantile myofibromatosis/ myofibroma. Nice case....[/size][/font][/color]

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Robledo F. Rocha

Posted

[size=5][color=#000000][font=Palatino Linotype, serif]Solitary myofibroma displaying beautiful intravascular myofibroblastic clusters and foci of calcification. Increased expression of Ki-67 is expect in a few-days-aged infant.[/font][/color]
[font=Palatino Linotype, serif][color=#000000]As pointed out by Dr. Taibjee, it would be prudent if an in-depth investigation were carried out in order to look for [/color][color=#000000]multiple lesions [/color][color=#000000]involv[/color][color=#000000]ing[/color][color=#000000] superficial soft tissues, [/color][color=#000000]bones,[/color] [color=#000000]and[/color] [color=#000000]visceral organs, once solitary lesions are not common away from head and neck.[/color][/font][/size]

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Mark A. Hurt MD

Posted

Yes, this was a myofibroma, and the only one in this patient, to my knowledge. I really learned a lot from this patient, as I misdiagnosed this initially as leiomyosarcoma. I was overly concerned with the massive necrosis in the lesion, as it is rarely shown or discussed. After reading Stout's early descriptions of the condition, and with the aid of some soft tissue experts, I was set on the right course.

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Robledo F. Rocha

Posted

[quote name='Mark A. Hurt MD' timestamp='1382468747']
I was overly concerned with the massive necrosis in the lesion, as it is rarely shown or discussed.
[/quote]
Very interesting, Dr. Hurt. Although there's no supportive data from the literature, I got a sense that the more frequent the intravascular growth, the more extensive the necrosis. Perhaps this observation may spark interest among researchers.
Thanks for share this nice case.

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Mark A. Hurt MD

Posted

[quote name='Robledo F. Rocha' timestamp='1382494388']

Very interesting, Dr. Hurt. Although there's no supportive data from the literature, I got a sense that the more frequent the intravascular growth, the more extensive the necrosis.
Thanks for share this nice case.
[/quote]

Robledo,

You may well be right, although it is speculative. Perhaps it is an age-related phenomenon, as I get the distinct impression that necrosis may simply be a finding in very young children, as I don't often see necrosis in myofibromas presenting in adults. Yet, they are uncommon enough that my experience simply may not be rich enough to understand the natural history or the spectrum of these lesions. Anyone who has more experience is welcome to chime in!

Mark

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