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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 847 - 16th September 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 53 year old man with shave biopsies taken from the right ear.

Case posted by Dr. Mark Hurt.


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Robledo F. Rocha

Posted

[size=4][font=Palatino Linotype, serif][color=#000000]Bowen disease with Borst-Jadassohn phenomenon.[/color][/font][/size]

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Guest Maria George

Posted

[color=#000000][font=arial, helvetica, clean, sans-serif][size=3]The pattern here is for intraepidermal epithelioma of Borst-Jadassohn phenomenon (BJP). Tumors showing the BJP are mainly clonal seborrheic keratoses and clonal Bowen disease .However intraepidermal sebaceus ca ,inraepidermal porocarcinoma and intraepidermal merckel cell ca may also show BJP.[/size][/font][/color][color=#000000][font=arial, helvetica, clean, sans-serif][size=3]In this case the cells in the nests are vaculated so I may go for intraepidermal sebaceus ca [b].[/b][/size][/font][/color]

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Guest Jim Davie MD

Posted

[size=3][font=arial,helvetica,sans-serif]"Clonal" seborrheic keratosis with Borst-Jadassohn effect.[/font]

[font=arial,helvetica,sans-serif]Agree with Maria's excellent differential. I see the nuclear and cytoplasmic vacuolation to be artefactual, given the similar effect in the background epidermis; this artefact makes it more difficult to assess cytology. There is some apoptosis, but absence of multinucleation, significant nuclear pleomorphism, or mitotic activity that is any different than the surrounding epidermis. The nests are scattered evenly with minimal parakeratosis, in a background of broadly reticulated acanthosis. [/font][/size]

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Mark A. Hurt MD

Posted

Below are immunostains. Do these change any opinions?

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE847_Image%206.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE847_Image%207.jpg[/img]

[img]https://dermpathpro.com/uploads/spot_diagnosis_comment_img/CASE847_Image%208.jpg[/img]

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Dr. Richard Carr

Posted

Before the IHC I was agreeing with Jim i.e. Seborrhoeic keratosis. The only one of these markers I use is Ki67 and I find it usually unhelpful - does look rather high here!

I find p53 (diffuse strong or null in Bowen's/IEC) helpful in some cases and p16 helpful in some more cases (diffuse in clonal bowen's/IEC).

Odd site for a clonal lesion as most in my experience occur on the lower leg for some reason.

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Mark A. Hurt MD

Posted

[font=arial,helvetica,sans-serif]My diagnosis was: clonal seborrheic keratosis.[/font]

[font=arial,helvetica,sans-serif]Böer-Auer A, Jones M, Lyasnichaya OV. Cytokeratin 10-negative nested pattern enables sure distinction of clonal seborrheic keratosis from pagetoid Bowen's disease. J Cutan Pathol. 2012 Feb;39(2):225-33. doi: 10.1111/j.1600-0560.2011.01825.x. Epub 2012 Jan 11. PubMed PMID: 22236073.

Lora V, Chouvet B, Kanitakis J. The "intraepidermal epithelioma" revisited: immunohistochemical study of the borst-jadassohn phenomenon. Am J Dermatopathol. 2011 Jul;33(5):492-7. doi: 10.1097/DAD.0b013e3181fe6f90. PubMed PMID: 21587033.[/font]

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[b]In seborrhoeic keratosis there is poor correlation between the clinical appearance and histopathology[/b] (sometimes the descriptive term [i]benign squamous keratosis[/i] is used). Having said so, clinical description will be very helpful in this regard as the differential diagnosis usually poses no problems. Some used the term intraepidermal epithelioma of Borst and Jadassohn, but most now do not and describe presence of sharply defined nests of morphologically different cells within the epidermis as [b]Borst–Jadassohn phenomenon (not epithelioma)[/b]. Lesions showing the phenomenon include [b]benign and malignant entities[/b]. Examples include clonal seborrhoeic keratosis, Bowen’s disease, intraepidermal poroma, and intraepidermal malignant poroma. There is widespread expression of CK10 in almost all cases of Bowen’s disease.

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