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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 873 - 23rd 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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74 year-old female with lesion on columella, clinically thought to be a verruca.

Case posted by Dr. Hafeez Diwan


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Guest Engin Sezer

Posted

I'd suggest S100 to highlight desmoplastic melanoma with pleomorphic spindle cells with intranuclear cytoplasmic pseudoinclusions.

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Guest Romualdo

Posted

Agree. The presence of lymphocytes is a clue to desmoplastic melanoma.

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Guest Maria George

Posted

I want to add sclerotic fibroma to the differential.

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I always think about a desmoplastic melanoma when I see fusiform atypical cells with a fibrotic stroma and inflammation, but the clinical impression of verruca, the polypoid configuration and the small number of lymphocytes argues against this diagnosis.

It looks like a polypoid lesion with enlarged and pleomorphic cells, probably a Pleomorphic fibroma.

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Mark A. Hurt MD

Posted

Favor fibrous papule, then pleomorphic fibroma. Doubt melanoma, but I would screen for it.

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Dr. Mona Abdel-Halim

Posted

Agree with Dr Mark, first fibrous papule then pleomorphic fibroma. Did not think melanoma here.

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Guest Mazen charaf iddin

Posted

I agree with Dr Juan and dr Mark, but I'd use the term: Fibroepithelial Polyp with degenerative Changes

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Robledo F. Rocha

Posted

[font=arial,helvetica,sans-serif]I think pleomorphic fibroma is the correct diagnosis. It fits on clinical impression of a verruca.
I don’t consider desmoplastic melanoma as my first choice because it commonly presents on clinical examination as an indurated plaque and on microscopic examination the neoplastic cells have fibroblast-like appearance with mild to moderate cytological atypia rather than those bizarre spindle cells with large pleomorphic and hyperchromatic nuclei that are displayed on pictures above. Anyway, as melanocytic tumors don´t read dermatopathology books, vimentin and S100 will be helpful.
I didn´t find the vascular pattern characteristic of angiofibroma / fibrous papule, except for rare small ectatic vessels in superficial dermis.[/font]

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Guest Jim Davie MD

Posted

Agree with Robledo's line of reasoning for pleomorphic fibroma. Those are large cells!

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Guest Saleem Taibjee

Posted

agree, pleomorphic fibroma.
As an aside, I have seen 2 recent cases of desmoplastic naevus with lymphocytic reaction which would usually be a feature for melanoma. Has anyone else had a simialr experience?

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Sasi Attili

Posted

[quote name='Guest' timestamp='1382556021']
agree, pleomorphic fibroma.
As an aside, I have seen 2 recent cases of desmoplastic naevus with lymphocytic reaction which would usually be a feature for melanoma. Has anyone else had a simialr experience?
[/quote]

Saleem- I have seen a number of cases. As far as I understand, a lymphocytic reaction though should make one search hard for a melanoma, is not specific for it. aka Halo Nevus

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