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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 1000 - 23rd April Posted By: Guest

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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The patient is a 30-year-old female with a left ring finger nodule.

Case posted by Dr. Hafeez Diwan.


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I'm thinking giant cell tumour of tendon sheath, with paucity of giant cells. I would ask for melanocytic markers to exclude clear cell sarcoma of soft tissue.

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Guest Romualdo

Posted

The presence of small pockets of spindle to oval cells with moderately abundant clear cytoplasm and slightly but definitely atypical oval nuclei with small prominent nucleoli are highly suggestive of clear cell sarcoma (soft tissue melanoma). Mitotic figures are not seen, as expected. Sparse multinucleated giant cells are also typical features.

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Dr. Mona Abdel-Halim

Posted

My impression is sclerosing epithelioid fibrosarcoma...

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Robledo F. Rocha

Posted

Agree with Mona. It is sclerosing epithelioid fibrosarcoma. Neoplastic epithelioid cells with clear cytoplasm that are arranged in strands along densely hyalinized stroma form a typical picture of this variant of fibrosarcoma.

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Dr. Hafeez Diwan

Posted

I called this giant cell tumor. It appears circumscribed to me. Melanocytic markers were negative. I did not think of a sclerosing epithelioid fibrosarcoma. I will pull the case again and take another look at it.

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Dr. Richard Carr

Posted

I watched this case with great interest yesterday. I was thinking giant cell tumour of tendon sheath rather than digital fibromatosis (Dupuytren's). Might have considered perineurioma, cellular digital fibroma (SAF group). I could not see the typical haemorrhage and osteoclast-type giant cells though and noted a slight epithelioid look to cells in upper right image. Clear cell sarcoma and sclerosing epithelioid sarcomd did not enter my thoughts (until reading the suggestions). I might have have run some immunos (EMA, S100, SMA, CD34, Macrophage) and then signed it out as benign favouring a tendon sheath tumour (assuming IHC unhelpful). As a rule odd variants of common things are still much more common than great rarities though I appreciate the ratio is often reversed on dermpathpro!

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Regarding sclerosing epithelioid fibrosarcoma, as far as I can tell, neither cases arising in the fingers nor giant cells have been reported. And to quote Enzinger and Weiss "In almost all cases the tumor shows foci of spindle-shaped sarcoma similar to conventional fibrosarcoma." If still in doubt, I am told MUC4 is positive in four fifths of cases.

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